obstetrics

Question 1

38 yr old woman, gravida 4, para 3 at 18 weeks comes to the office for a routine anatomy USG. The pt has had no vaginal bleeding, leakage of fluid or contracions. She has no chronic medical conditions and her 3 prior pregnancies resulted in uncomplicated cesarean deliveries. BP is 118/66 mmhg and pulse is 94/min. Fundal height is appropriate for gestational age. Transabdominal USG revelas a fetus measuring 18 weeks gestation, an am iotic fluid index of 8cm. and an anterior placenta that covers the internal cervical os and penetrates the uterine myometrium. This pt is at greatest risk of placental invasion into which structure?

Answer 1

bladder.

Question 2

38 yr old woman, gravida 3, para 2 at 35 weeks gestation comes to the ER due to sudden onset visual changes and headache. The pt reports “spots” in her vision for the past few hours and an occipital headache. The pt’s pregnancy has been complicated by gestational diabtetes Mellitus requiring insulin. BP is 168/114 mmhg and pulse is 90/min.

The pupils are equal and reactive to loght. Extraocular movements are intact. Visual feild testing shows partial loss of vision bilaterally. What is the most likely cause of this pt’s symptoms?

Answer 2

pre-clampsia in pregnancy.

Retinal artery Vasosapsm..

Question 3

2 day old girl is evaluated in the newborn nursery due to tachypnea, snezing and diarrhea. The pt was born visa spontaneous vaginal delivery and had been feeding well until several hours ago when she became tachypneic. She has also been persistently crying and difficutl to console. The patient’s mother did not receive prenatal care during this pregnancy. Respirations are 65/min. All other vital signs are normal for age. On physical exam, thr pt is irritable and has mildly increased tone in all extremities with occasioanl tremors. Nonpharmacological interventions do not significantly improve the pt’s symptoms. What pharmacotherapy would most likely improve this pt’s symptoms?

Answer 3

morphine

Question 4

243 yr old woman, gravida 1, para 0 comes to the office for a routine prenatal care. She is 35 weeks gesttaion and feels well. She reports fetal movement and no contractions, loss of fluid or vaginal bleeding. Pregnancy to date has been uncomplicated and the pt has no underlying medical conditions. She signed up for a clinical trial investigating prolactin. At 34 weeks gestation, she had a serum prolactin level several times higher than what was recorded to pregnancy. What hormone prevents lactation in this pt?

Answer 4

Progesterone

Question 5

16 yr old comes to the ER with vaginal bleeding. Her LMP was 12 weeks ago. She is sexually acitve and does not use contraception. The pt had a miscarriage last year that required a D&C. Urine pregnancy test is positive. Transvaginal USG demonsrates an intrauterine gestational sx without fetal cardiac activity, and D&C is performed. Pathology shows fetal tissue, foccal trophoblastic hyperplasia and some enlarged villi. What is dx?

Answer 5

partial molar pregnancy.

Question 6

28 yr old woman, gravida 2 and para comes to the office with worseing shortness of breath over the past week. She had a recent episode of hemoptysis. The pt has also had ongoing vaginal bleeding after an uncomplicated vaginal delivery of her son 9 weeks ago. She has no bleeding elsewhere and she has not resumed sexual intercourse. On physical exam, the pt’s uterus is enlarged and the adnexa are normal. Lab studies show markedly elevated hCG levels. CT shows multiple bilateral nodules. Whhat would most likely be found on endometrial curettage in this pt?

Answer 6

proliferation of trophoblasts.

pt has hydatidiform molar pregnancy.

Question 7

A newborn baby is in the NICU for mechanical ventilation due to pulmonary hypoplasia. He was born via spontaneous vaginal delivery at 30 weeks gestation to a 41 yr old woman who did not receive prenatal care. The mother had assumed her amenorrhea was due to early menopause, which runs in her family. She took multiple medications for poorly controlled hypertension before realising she was pregnant. Prenantal USG demonstarted severe oligohydraminos for which delivery was induced. Exam of the infant shows an intubated and sedated boy whos weight is at the third percentile. The temporal, occipital and parietal bones are underdeveloped and the right lower limb is shortened and contracted. What is the causative mechanism in this neonante’s condition?

Answer 7

Impaired metabolism of angiotrnsin due to intake of Bp medications.

Question 8

a 26 yr old woman, g1p0, at 36 weeks gestation comes to the office for a routine prenatal visit. She has had no headaches, changes in vision, or right upper quadrant pain. Fetal movememnt is norma;. The pt has no chronic medical conditions and her preganncy has been uncomplicated. Blood pressure today is 150/100mmhg and a repeat measurement is 154/102mmhg. All other vital signs are normal. Urinalysis shows 2+ protein. Thid pt’s condition is most likely due to decreased activity of what?

Answer 8

vascular endothelial growth factor

Question 9

35 yr old woman, g1p0, at 40 weeks gestation undergoes a cesarean delivery. Shortly after delivery of the infant, the pt becomes anxious, SOB, and then unresponsive. BP is 70/40 mmHg. and pulse is 120/min. Oxygen saturation is 83% on room air. There is profuse bleeding from the abdominal laceration and intravenous lines. The lungs are clear too auscultation. Intraarterial blood pressure monitoring is established and pulmonary artery catheterization is performed. Initial measurement are as follows:
Central Venous Pressure - 14 mmhg (n=6-8)
pulmonary capillary wedge pressure - 5mmhg (n=6-12)

what additional pathology maybe found in this patient?

Answer 9

increased pulmonary vascular resistance.

Question 10

37 yr old woman g2p1 at 28 weeks gesttaion comes to the office due to leakage of urine. The pt has had intermittent leakage with cough but no dysuria or hematuria. She reports normal fetal movement and has had uncomplicated pregnancy. Four years ago, the pt had a spontaneous vaginal delivery of 3500g neonate. The pt has no chronic medical conditions or prior surgeries. Vital signs are normal. Prepregnancy BMI was 32kg/m2. She has gained 15.8 kg during this pregnancy. The abdomen is gravid and there is no suprapubic tenderness. Urinalysis is negative for blood, leukocyte esterase and nitrate. Which mechanism is the most likely the cause for this patient’s urinary incontinence.

Answer 10

increased intrabdominal pressure.

Question 11

a newborn girl is being evaluated for cyanosis. She was born at 23 weeks gestation via spontaneous vaginal delivery to a 37 yr old primigravida. The pt’s weight at delivery was 1kg. Shortly after birth, she developed cyanosis that is mostly pronounced in the lower extremities. Supplemental oxygen is significant for generalized and mucosal cyanosis, tachypnea, intercostal retractions and nasal flaring. What is most likelu present in this pt?

Answer 11

right to left intrapulmonary shunt and extrapulmonary shunt.

Question 12

38 yr old woman, g1p0 at 34 weeks gestation comes to the office due to increasing swelling in her hands and legs. The pt first noticed the swelling a few weeks ago but now cannot stand for more than an hour without needing to elevate her legs. She has no orthopnea, dyspnea or chest pain. The pt has no chronic medical conditions and takes no daily medications. Vital signs are normal. Cardiac exam is within normal limits. Lungs are clear to ausculation. Bilateral lower extremities have 2+ pitting oedema to the midshin. Urine dipstick shows no protein. Compared to a healthy nonpregnant woman, what parameter is most likely to be decreased in this pt?

Answer 12

systemic vascular resistance

Question 13

36 yr old woman g2p1 at 38 weeks gestation comes to the hospital in active labour dilated to 10cm. She has received no prenatal care this pregnancy. Her prior pregnancy resulted in an uncomplicated cesarean delivery. On admission, temp is 36.7, BP is 132/84 mmHg, Pulse is 94/min. The pt precipitously delivers an infant weighing 4.1 kg. After delivery of the infant, small placental fragments are removed in pecieces via manual extracion. Profuse vaginal bleeding occurs, and intravenous lines are placed. Uterotonic medications are administered and vigorous uterine massage is performed. The uterine fundus is firm, but the bleeding continues. What is the most likley cause of this patient’s ongoing vaginal bleeding?

Answer 13

placental invasion to the uterine myometrium (placenta acreta)

Question 14

41 yr old woman comes to the office after a positive home urine preganncy test. Her LMP was 12 weeks ago. For the past month, the pt has had increasing nausea, she vomits several times a day and has difficulty keeping any food down. The pt has 3 children, all born at term via cesarean section. On this visit, ultrasound demonstrates echogenic intrauterine tissue without an amniotic sac and multiple bilateral ovarian cysts. Hydropic villi are evacuated fro the uterus during dilation and curettage. What should be closely monitored in this patient after the procedure?

Answer 14

beta hCG levels should be monitored for molar pregnancy.

Question 15

27 yr old nulligravid woman comes to the office for a routine visit. Medical history is significant for epilepsy that is well controlled with valproate and chronic hypertension for which she takes nifedipine. She hopes to conceive in the next few months and plans to start prenatal vitamins soon. The pt takes no other medication and does not use tobacco alcohol or illicit drugs. Blood pressure is 120/80 mmHg. physical examination is normal. If the pt conceives now, her fetus is at increased risk for what anomaly?

Answer 15

myelomeningocele.

Question 15

a newborn is being evaluated in the nursery. The pt was born at term via spontaneous vaginal delivery to a 23 yr old woman. The mother developed dark terminal hair and a deepened voice during pregnancy. The delivery was unremarkable, and the pt’s vital signs are within normal limits. Exam shows ambiguous genitalia and clitoromegaly. Lab studies reveal elevated serum levels of testosterone and androstenedione. Karyotype testing shows 46 XX genotype. Ultrasound of the newborn shows a normal sized uterus. This infant’s presentation is most likely due to deficiency of which enzyme?

Answer 15

aromatase

Question 16

35 yr old primigravida is found to have gallstones at 38 weeks of an uncomplicated pregnancy. ultrasonography performed one year ago failed to demonstrate any abnormalities. What pathogenetic component most likely contributed to this pt’s condition?

Answer 16

estrogen induced cholesterol hypersecretion and progesterone induced gallbladder hypomotility.

Question 17

33 yr old woman, g2p1 is brought to the labour and delivery unit at 32 weeks gestation and precipitously delivers a male infant within 2 minutes of arrival. The infant appears small for gestational age. APGAR scores are 5 and 6 at 1 and 5 minutes respectively. The mother did not receive prenatal care with this pregnancy. On delivery the placenta appears pale and enlarged. In addition, the umbilical cord is inflamed with multiple areas of abscess like foci of necrosis surrounding the umbilical vessels. What is the most likely cause of these findings?

Answer 17

congenital syphilis infection

Question 18

3 week old girl is brought to the ED due to lethargy. The pt was breastfeeding well until this morning when she became increasingly difficult to rouse. She was born at term to a 35 yr old woman who had spontaneous vaginal delivery at home. The pt did not receive any vaccinations or medications after birth due to parental preference. Head circumference is at the 99th percentile. Weight and length are at the 25th percentile. Temp is 37. Physical exam shows a large, bulging anterior fontanelle. The eys are driven downward and the pt does not appear able to look upward. No scalp swelling is present.Intracranial hemorrhage is confirmed on CT scan of the head. What is most likely underlying cause of this pt’s condition?

Answer 18

vitamin deficiency

Question 19

33 yr old woman, g2p1, comes to the office due to a positive home urine pregnancy test. Her LMP was 6 weeks ago, and pelvic ultrasonography confirms an intrauterine pregnancy. The pt has idiopathic pulmonary hypertension complicated by Eisenmenger syndrome. She is aware that pregnancy poses a major mortality risk to herself and the fetus due to the hemodynamic changes of gestation, labour and delivery. The pt consents to pregnancy termination with a mifepristone and misoprostol regimen. What is the mechanism of action for mifepristone in this clinical situation?

Answer 19

progesterone antagonist

Question 20

24 yr old primigravida at 36 weeks gestation comes to the office due to light headedness and nausea at bedtime. Her pregnancy has been uncomplicated, and medical history is unremarkable. The pt takes folic acid daily but has been unable to tolerate oral iron. BP is 115/75 mmHg when sitting, 110/70 mmHg when standing and 80/60 when supine. Physical examination shows a uterus consistent in size with 36 weeks gestation. What is the most likely explanation for this pt’s hypotension while supine?

Answer 20

decreased venous return

Question 21

29 yr old woman, g2p1 at 38 weeks gestation comes to the ED due to heavy vaginal bleeding. The bleeding started an hour ago. It was light initially and associated with only mild abdominal pain, but both the bleeding and the pain have increased and now the pain is constant and severe. The pt has no chronic medical conditions. Her prior pregnancy was a term vaginal delivery complicated by preeclampsia with severe features. BP is 156/98mmHg and pulse is 112/min. The uterus is firm and tender. Pelvic examination reveals heavy bleeding from the cervical os. What is the most likely cause of this pt’s current presentation?

Answer 21

premature separation of the placenta and myometrium

Question 22

21 yr old boy is brought to the office by his mother because of a palpable bulge in the child’s neck. He continues to feed well but appears comfortable only when held with bis body sideways under the breast. He is at the 50th percentile for ehight weight and head circumference. The child favours looking toward the right and cries when his head is turned to the left. There is a firm mass on the left side of his neck that does not move when the child swallows The remainder of the examination is unremarkable. What condition was most likely present prenatally?

Answer 22

intrauterine malposition. congenital torticollis

Question 23

18 yr old woman comes to the office for evaluation of acne. The pt is very upset about the acne scarring which worsened since she started coellege. She has been very stressed by upcoming examinations and feels exhausted due to lack of adequate sleep. The pt has been using topical benzoyl peroxide and tretinoin for the past year. She was also prescribed an oral antibiotic but stopped taking it several months ago due to lack of improvement. The pt is sexually active with her bf and uses an intrauterine device for contraception. Her periods are regular and lasts 5 days. She takes no other medications and does not use tobacco, alocohol. or illicIt drugs. pHYSICAL EXAMINATION SHOES NODULYSTIC ACNE WITH SCARRING ON THE FACE, CHIN AND UPPER BACK BACK. The pt is interested in isotretinoin treatment. What is the best next step in managment of this pt?

Answer 23

urine Beta hcg

Question 24

41 yr old woman, g3p2 at 34 weeks gestation comes to the office for a routine prenatal visit. For the past 2 weeks, the pt has had increasing pain over the pubic symphysis that is unreleived with acetaminophen or warm compress. She has had no dysuria, hematuria, contraction or vaginal bleeding. The pt has hypothyroidism that is well controlled with levothyroxine. Vital signs are normal. Examination shows a tender slightly widened pubic symphysis. Sensation is intact. Whta hormone is the most likely underlying cause oft his pt’s pain?

Answer 24

relaxin

Question 25

37 yr old woman g2p1 at 30 weeks gestation comes to the office to discuss her recent laboratory work. At her last visit at 28 weeks gestation, the pt drank a solution containing 50g of glucose, and her serum glucose was abnormally elevated an hour later. Today she is scheduled to undergo a confirmatory 3-hour glucose test. Her pregnancy has been uncomplicated and the pt has no chronic medical conditions. She is taking daily prenatal vitamin. Vital signs are normal. Physical examination shows a uterine size consistent with gestational age. Fetal heart rate is 140/min. Which hormone is most likely contributing to this patient’s abnormal findings?

Answer 25

human placental lactogen

Question 26

32 yr old woman g2p1 has a spontaneous vaginal delivery. Immediately after delivery of the placenta, the pt has a large amount of vaginal bleeding with passage of fist sized clots, findings consistent with post partum hemorrhage. A dose of tranexamic acid is administered. What is the most likely mechanism of action of this drug?

Answer 26

inhibits plasminogen cleavage and prevents fibrin degradation

Question 27

25 yr old primigravida at 37 weeks gestation is brought to the ED with constant, excruciating abdominal pain and sudden vaginal bleeding for he past 3 hours. The pt is Rh negative and received Rh immunoglobulin at 28 weeks gestation. She has no chronic medical conditions and takes no medications. BP is 160/100 mmHg and pulse is 118/min. Physical examination shows a firm and tender uterus. Speculum examination reveals a moderate amount of bleeding coming from an open cervical os. Foetal heart tracing shows a baseline of 105/min and no variability. what is the most likely cause of this pt’s bleeding?

Answer 27

premature placental separation.

Question 28

29 yr old woman g1p0 at 28 weeks gestation comes to the office to establish prenatal care after recently moving to a new city. She has had no complications in this pregnany and had a normal anatomy ultrasound at 20 weeks gestation. On physical examination, the fundal height measures 28cm. Cardiac auscultation reveals a 2/6 blowing systolic murmur best heard at the left sternal border. The murmur intensifies with inspiration, and there is no ejection click or palpable thrill at the sternal notch. The lungs are clear to ausculation. There is +! pitting oedema to the midshins bilaterally. What is most likely responsible for this patient’s murmur.

Answer 28

high blood flow across the pulmonic valve

Question 29

35 yr old woman, g1p0 comes to the office for an initial prenatal visit. The pt has had no vaginal bleeding or abdominal pain and has not yet felt foetal movement. Menarche occurred at age 13. She sometimes has heavy menstrual bleeding with passage of clots and other times she skips her menses. The pt’s estimated gestational age based on her LMP is 16 weeks. She has type 1 diabetes mellitus that is controlled with insulin. She smokes a pack of cigarettes daily. As part of her prenatal laboratory screening, a second trimester maternal serum quadruple screen is performed and reveals an elevated alpha-fetoprotein level. What is the most likely aetiology of this pt’s abnormal result?

Answer 29

dating error

Question 30

pulmonary hypoplasia in neonates is due to which medication?

Answer 30

ACE inhibitors

Question 31

22 yr old woman comes to the ED with dysuria, vulvar pain, and pruritus. The pt has also felt feverish and fatigues for the last few days. She has a new sexual partner and has been using a hormonal vaginal ring for contraception. Physical examn reveals bilateral inguinal lymphadenopathy and tender vesicular lesion covering the labia majora and perineum. What condition will most likely result as a sequel of this pt’s infection ?

Answer 31

recurrent genital ulcers

Question 32

a day yr old girl is being evaluated in the newborn nursery. The pt was born at 39 weeks gestation to a 38 yr old primigravida who immigrated to the United States during her third trimester. The pt had a strong cry and good tone at delivery but appears small for gestational age. Apgar score were 8 and 9 at 1 and 5 minutes, respectiveley. Physical examination demonstrates white pupils B/L. A continuous harsh murmur is heard over the left infraclavicular area. The abdomen is nondistended, and there is no hepatosplenomegaly. Both ears fail the hearing screening. What maternal interventions would have most likely prevented this infant’s condition?

Answer 32

maternal administration of a live attenuated vaccine before conception.

Question 33

a 12 yr old girl is brought to the office for evaluation of short stature. She was an average-sized infant but over the past few years, her height-growth velocity has plateaued. The pt has not menstruated. Menarche occurred in her mother at age 14, and both her parents are tall. The pt’s height is at <2nd percentile and weight is at the 50th percentile for age and sex. She has no breast buds. She has low hairlines, a short and wide neck, a broad chest and widely spaced nipples. What is the most likely underlying mechanism for this pt’s condition?

Answer 33

meiotic nondisjunction

Question 34

40 yr old woman g5p0 aborta 4 at 12 weeks gestation comes to the ED due to vaginal bleeding, midline pelvic pain and severe nausea and vomiting. She has a history of 4 prior triester losses. Pelvic examination shows a 16 week-sized uterus. Speculum examination reveals dark blood in vahina. A beta-hCG level is >1000000mlU/mL and an ultrasound shows no foetus and a uterine cavity filled with multiple small cysts. The pt undergoes dilation and curettage in the operating room, and a friable mass of tissue consisting of many thin-walled cysts is evacuated from her uterus. Examination of the tissue would most likely show which karyotype?

Answer 34

46XX

Question 35

15 yr old girl is brought to the physician for evaluation of primary amenorrhea. Her mother is concerned because her other daughters had menarche before age 13. Vital signs are normal. The pt i sat the 5th percentile for height and 20th percentile for weight. Examination shows a high arched palate and Tanner stage 1 breasts with inverted and widely spaced nipples. Further evaluation of the ovary would most likely show what ?

Answer 35

atrophic ovaries

Question 36

22 yr old woman presents to clinic for a medical checkup. She has been diagnosed with Turner’s syndrome. CV exam reveals no abnormalities f the heart or aorta. She asks about her chances of having a baby. What method could be used to achieve pregnancy in this pt?

Answer 36

IVF

Question 37

22 yr old woman, who recently relocated comes to the office for a new p visit. She has mild intellectual disability and has completed a high school level of education. The pt has no major health problems but reports persistent swelling of the hands and feet. Menarche occurred at age 13, and she has regular menstrual cycles. Physical exam shows short stature and a webbed neck. Karyotype analysis performed on peripheral leukocytes shows that 40% of the cells have a 45 X genotype and that the remaining 60% contain a 46XX genotype. What is the most likely cause of this pt’s condition?

Answer 37

somatic mosaicism

Question 38

28 yr old woman comes to the office due to vaginal spotting. The pt normally has regular menses with 3-4 days of moderate bleeding. However she has had spotting for the past 2 days and her LMP was 6 weeks ago. Vital signs are normal. Serum quantitative beta hCG level is 800IU/mL and a repeat level performed 2 days later shows an abnormal rise to 900IU/mL. Pelvic Ultrasound reveals no gestational sac in the uterus. If uterine curettage is performed, what microscopic findings would most likely be found in this pt?

Answer 38

dilated, coiled endometrial glands and edematous stroma.

Question 39

46 yr old woman comes to the office due to sexual difficulties for the past year. The pt rarely thinks about sex anymore and frequently declines sex when her husband tries to initiate. She is attracted to her husband and worries that he assumes she is losing interest in him. Although vaginal lubrication is adequate during sex and the pt can reach orgasm, she finds that her mind wanders during the experience. She is unsure what is causing a decrease in her sex drive, although she notes that she received a promotion 3 months ago and has been working longer hours since then. The pt describes her marriage as stable and loving. She has a history of depressive episode and currently takes bupropion. Physical exam and lab studies, including thyroid tests show no abnormalities. What is the most likely diagnosis?

Answer 39

female sexual interest/arousal disorder

Question 40

34 yr old woman g0, comes to the office for evaluation of pregnancy. Menarche was t age 12, and her menstrual cycles are regular, they occur every 30 days with 5 days of menses. The pt and her husband have been trying to conceive for the past 6 months and plan intercourse during her fertile window according to an ovulation predictor kit. She has no medica conditions, takes no meds and has no allergies. BMI is 23 kg/m2. Vital signs and physical examination are normal. If fertilisation and implantation occurred in this cycle, when would the beta-hCG level first be detectable in the serum?

Answer 40

8 days after fertilisation.

Question 41

22 yr old woman at 14 weeks gestation comes to the physician for a prenatal visit. She reports feeling well with the exception of some mild fatigue. Her pregnancy has been uncomplicated upto date. On physical exam, the pt’s abdomen appears larger than would be expected at 14 weeks. An obstetric ultrasound reveals twins, a male and female. What describes the most likely type of twin placentation in this pt?

Answer 41

dichorionic/diamniotic

Question 42

16 yr old girl comes to the office due to malodorous vaginal discharge. The pt arrives with her mother, who stays in the exam room for evaluation. The pt has had increased vaginal discharge for the past 2 days but no abnormal vaginal bleeding or abdominal or pelvic pain. She is sexually active with a new partner and uses a progestin-releasing subdermal implant for contraception. Her LMP was 2 weeks ago. She has no chronic medical conditions and takes no medications. The pt appears anxious. Vital signs are normal/ Abdominal exam shows no tenderness or palpable masses. When the pelvic exam is attempted the pt refuses and says that she is “embarressed and anxious. What is the most appropriate course of action ?

Answer 42

do no perform the exam and ask the pt if she will. perform self collection for testing.

Question 43

a new born baby is evaluated in the nursery after an uncomplicated spontaneous vaginal delivery to a 29 yr old primigravida. The mother declined prenatal testing and ultrasound exam while pregnant. She took prenatal vitamins throughout the pregnancy, which was otherwise uneventful. Exam of the neonate shows a posterior neck mass and B/L nonpitting oedema of the hands and feet. She has low-set ears and a high arched palate. Femoral pulses are diminished. The remainder of the examination is normal. Ultrasonography of the neck reveals a mass composed of cystic spaces separated by connective tissue. What is the most likely underlying mechanism responsible for this pt’s condition?

Answer 43

loss of paternal copy of chromosome.

Question 44

32 yr old woman comes to the office at 28 weeks gestation due to dyspnea. She has been feeling short of breath when she is supine but has no other symptoms. The pt had no prenatal care during pregnancy. She has a hx of epilepsy that is well-controlled with medication. She lives with her husband and does not use tobacco, alcohol or illicit drugs. Her immunisations are upto date and she has no allergies. Physical examination shows a uterine size that is larger than expected for gestational age. Sonographic assessment shows markedly elevated amniotic fluid levels. What foetal anomaly would most likely account for this pt’s polyhydraminios?

Answer 44

anencephaly

Question 45

33 yr old woman g0 comes to the office for preconception counseling. Menarche was at age 12, and her menses recur every 30 days and last 5 days. She has no chronic medical conditions, takes no medications and has no allergies. BMI is 23kg/m2. Vital signs and physical examination are normal. If a normal pregnancy develops, what processes most immediately precedes secretion of beta hCG into the maternal circulation?

Answer 45

synctiotrophoblast invasion

Question 46

34 yr old woman comes to the office with bleeding fro the right nipple. The pt has noticed blood staining her bra on several occasions over the past week but has no fever or breast pin. She has no chronic medical conditions and does not take any medications. Breast examinations shows no palpable masses or skin changes. A thin, blood-tinged discharge can be expressed from the right nipple. There are no enlarged axillary lymph nodes. What is the most likely histopathologic finding in this pt’s right breast?

Answer 46

epithelial cells lining fibrovascular cores

Question 47

if maternal alpha feto protein levels are low, what is it indicative of?

Answer 47

trisomy 18 and 21

Question 48

if maternal alpha feto protein levels are high, what is it indicative of?

Answer 48

nerual tube defects
ventral wall defects
multiple gestation

Question 49

An autopsy is performed on a 17 yr old girl after a fatal aortic dissection. On gross examination, the uterus appears small and underdeveloped. Light Microscopic examination shows the ovaries are primarily composed of connective tissue. What additional abnormalities is most likely to be found in this pt?

Answer 49

turner syndrome

Question 50

34 yr old woman comes to the office due to vulvar and peranal itching and vaginal discharge. She has no other concerns. The pt is sexually active with her fiance and takes combined oestrogen-progestin oral contraceptive pills daily. She has reguar montly menstrual cycles and does not use barrier contraception. The pt took antibiotics 2 weeks ago for a urinary tract infection but has no chronic medical conditions. Pelvic examination shows an erythematous vulva and perineum with excoriations. A thick white discharge is present that adheres to the vaginal walls. The remainder of the physical examination is normal. What is the most likely underlying cause of this pt’s current condition?

Answer 50

decreased number of gram-positive bacteria in the vagina

Question 51

an infant born to a 26 yr old woman is evaluated shortly after delivery. Birth weight and length are at the 10th and 15th percentiles respectively. Vital signs are normal. Physical exam shows a protruding tongue, excessive skin at the nape of the neck, and upslanting palpebral fissures. The startle reflex is symmetric and weak. Cardiac auscultation reveals a ahrsh, 3/5 systolic murmur heard best over the lower sternal border. The pt has normal external female genitalia. Review of maternal medical records shows a past history of 2 spontaneous abortions in the last 3 years. Echo confirms the presence of a ventricular septal defect. What karyotype is most likely to be found in this pt?

Answer 51

46 XX t(14,21).

Question 52

20 yr old woman comes to the office due to increased vaginal discharge and vulvar pruritus. The pt has had vaginal discharge for the past 4 days. She is sexually active with multiple partners and uses oral contraceptves pills. Vital signs are normal. Pelvic exam is performed and wet mount microscopy shows pseudohyphae with buds. what is the most appropriate pharmacotherapy for this pt?

Answer 52

fluconazole

Question 53

32 yr old woman G1P1 comes to the office for vaginal discharge. The pt has no chronic medical conditions and takes no daily medications. Her LMP was 3 weeks ago. The pt has recently become sexually active with a new partner and uses an intrauterine device for contraception.(clue cells are seen on cytology) What best describes the predominant organism causing this pt’s condition?

Answer 53

anaerobic gram-variable rod

Question 54

24 yr old woman comes to the office due to a missed menstrual period. She has had regular menstrual cycles every 28 days and her LMP began 7 weeks. Since then, she had sexual intercourse once 5 weeks ago. The pt has no chronic medical conditions. Urine pregnancy test is positive. what embryologic even is most likely occurring in the embryo at this time?

Answer 54

neural crest migration

Question 55

19 yr old woman comes to the ED with pelvic pain, fever and chills that began last night. The pt’s LMP was 12 weeks ago and she had a surgical pregnancy termination at a clinic 2 days ago. Temperature is 38.3 C, bp is 92/60mmHg and pulse is 102/min. Physical exam reveals an open cervical os and malodorous tissue in the vaginAL CANAL. Bimanual exam shows moderate uterine tenderness and no adnexal masses. what is the most likely cause of this pt’s condition?

Answer 55

Staphyloloccus aureus

Question 56

24 yr old woman comes to the office due to spotting after vaginal intercourse. She also has some yellow vaginal discharge and dysuria but no pelvic pain or cramping. The pt has taken combination oral contraceptives for the past 3 years and has had no menses for the past year. Her mother was diagnosed with cervical cancer at age 47. BMI is 35kg/m2. Vital signs are normal. On exam, the abdomen is soft and nontender. Spec exam reveals purulent discharge from the cervical os, and the cervix is friable. On bimanual exam, There is no cervical motion tenderness and the adnexa are nontender b/l. Urine pregnancy test is negative. Microscopy of the discharge shows abundant neutrophils. If left untreated, this pt’s condition could lead to what complication?

Answer 56

tubular factor infertility.

Question 57

53 yr old woman comes to the office due to an itchy rash she has had on her left breast for the past one month. The pt has applied OTC corticosteroid ointment with no relief of symptoms. The pt’s LMP was 2 years ago. She has a history of hypertension that has improved with weight loss and exercise and she takes no prescription medications. Physical exam shows an eczematous plaque on the left nipple and areola. The remainder of the physical examination is unremarkable. Histologic exam of the skin lesion would most likely show what pathology?

Answer 57

adenocarcinoma

Question 58

24 yr old man comes to the office due to 2 days of burning pain with urination. The pt hs also had increased urinary frequency over the past few days. He has had no fever, chills, nausea, vomiting, flank pain or penile discharge. The pt has sexually active with his longtime bf. Vital signs are within normal limits. Physical examination shows mild suprapubic tenderness. There is no costovertebral angle tenderness. The penis is uncircumcised.Lab shows pH 5, leukocyte esterase positive, nitrites positive. Based on the urinalysis, which organism is most likely cause of this patients disease?

Answer 58

E coli

Question 59

24 yr old woman comes to the office due to copious green vaginal discharge and burning with urination for 3 days. The pt had a yeast infection a year ago, which was treated with OTC medication. She has recently become sexually active with a new partner and occasionally uses condoms. Physical exam shows a yellow-green frothy vaginal discharge and diffuse vaginal erythema but no lesions. The uterus is anteverted with no cervical motion tenderness. WHta is the best test to confirm the diagnosis on this pt?

Answer 59

wet mount saline microscopy

Question 60

16 yr old previously healthy girl comes to the office due to vaginal discharge that began 5 days ago. The discharge is grayish-white and fishy smelling. The pt is sexually active with a male partner and occasionally uses condoms. Temp is 36.7, bp is 106/52mmHg and pulse is 78/min. Exam shows a small amount of grayish discharge in the vaginal vault. The cervix appears normal. What would most likley be seen on wetmount micorscopy?

Answer 60

epithelial cells covered with bacteria.