Obstetrics and Gynecology

Question 1

what is adenopathy

Answer 1

enlargement of lymph nodes due to gynecologic infections, malignancy or inflammation

Question 2

what is fibroadenoma

Answer 2

solid, mobile, well-circumscribed round breast mass. most common breast tumor in women in women <30 years

Question 3

what is fibrocystic brease disease

Answer 3

common benign breast condition consisting of fibrous and cystic changes in breast. breast pain or tenderness that varies with the menstrual cycle; cysts and fibrous fullness

Question 4

what are risk factors for breast carcinoma

Answer 4

NAACP
Nullparity
Age at menarche (<13yo)
Age at Menopause (>55yo)
breast Cancer (self or family)
Pregnancy of 1st child >30 years

Question 5

what are the USPSTF guidelines for breast cancer screening

Answer 5

baseline mammo every 2 years from age 50-74
every 2 years beginning at age 40 if increased risk factors - 10 years prior to 1st degree relative was dx

Question 6

what are the most common types of breast carcinomas

Answer 6

infiltrating ductal carcinoma (MC)
medullary carcinoma
infiltrating lobular carcinoma
tubular carcinoma
mucinous colloid carcinoma
inflammatory breast cancer

Question 7

what are the msot common site of metastases for breast cancers?

Answer 7

Lymph nodes (MC)
lung/pleura
liver
bones
brain

Question 8

what are the most common causes of nipple discharge in non-lactating breasts

Answer 8

duct ectasia
intraductal papilloma
carcinoma

Question 9

the presentation of milky discharge from a non-lactating breast may indicate what?

Answer 9

hyperprolactinemia

Question 10

what is melasma

Answer 10

hyperpigmentation of the face during pregnancy. can also occur in non pregnant women and women taking OCPs

Question 11

what are vascular changes with pregnancy

Answer 11

spider angiomas and varicosities

Question 12

what is striae gravidarum

Answer 12

CT changes, such as stretch marks (i.e. striae distensae, striae gravidarum)

Question 13

what is the recommended first-generation antihistamine of choice for use during prengnacy

Answer 13

Chlorpheniramine

Question 14

what is chadwick sign

Answer 14

bluish/purplish coloration of the vagina

Question 15

what is Goodell sign

Answer 15

bluish/purplish coloration of the cervix

Question 16

A 24-year-old woman, gravida 2 para 1, at 30 weeks gestation, presents to the emergency department with sudden onset of severe, sharp, right lower quadrant abdominal pain that started 6 hours ago. She denies any vaginal bleeding or discharge. Her vital signs are stable, but she appears uncomfortable. On examination, there is marked tenderness in the right lower quadrant with rebound tenderness. Her white blood cell count is elevated. What is the most likely diagnosis?
A Acute Appendicitis
B Placental Abruption
C Round Ligament Pain
D Ectopic Pregnancy
E Urinary Tract Infection

Answer 16

a. acute appenditicits

Question 17

A 55-year-old male presents with a 3-month history of painless, progressively enlarging lymph nodes in the cervical region. He also reports a recent unintentional weight loss of 10 pounds and night sweats. On examination, multiple firm, non-tender lymph nodes are palpable in the cervical and supraclavicular areas. There is no hepatosplenomegaly. What is the most appropriate initial diagnostic step?
A Prescribe a course of broad-spectrum antibiotics
B Perform a complete blood count and erythrocyte sedimentation rate
C Order a computed tomography (CT) scan of the neck and chest
D Excisional biopsy of the largest lymph node
E Initiate empirical antituberculous therapy

Answer 17

d. excisional biopsy of the largest lymph nodes

Question 18

A 28-year-old pregnant woman at 32 weeks gestation presents with a sudden onset of intensely itchy, red, hive-like lesions that started on her abdomen and have now spread to her thighs and buttocks. She denies any history of allergies or similar skin conditions. On examination, the lesions are raised, erythematous, and some have a pale center. There are no vesicles or pustules. What is the most likely diagnosis?
A PUPPP (Pruritic Urticarial Papules and Plaques of Pregnancy)
B Atopic Eruption of Pregnancy
C Intrahepatic Cholestasis of Pregnancy
D Herpes Gestationis (Pemphigoid Gestationis)
E Contact Dermatitis

Answer 18

A. PUPPP (Pruritic Urticarial Papules and Plaques of Pregnancy)

Question 19

A 23-year-old woman consults her physician because of a breast mass; the mass is mobile, firm, and approximately 1 cm in diameter. It is located in the upper outer quadrant of the right breast. No axillary lymph nodes are present. What is the most likely diagnosis in this patient?
A Carcinoma of the breast
B Fibrocystic disease
C fibroadenoma
D Pagets disease

Answer 19

c. fibroadenoma

Question 20

What is the treatment of choice for fibroadenoma?
A modified radical mastectomy
B lumpectomy
C biopsy
D radical mastectomy

Answer 20

c. biopsy

The treatment of choice for a suspected fibroadenoma is either a fine-needle biopsy or an excision biopsy. Although rare, malignant neoplasms have occasionally been found in fibroadenoma. Radical mastectomy and radiation therapy are not treatment modalities for a fibroadenoma.

Question 21

A 45-year-old female presents with unilateral, spontaneous, and bloody nipple discharge. She denies any breast lumps, pain, or changes in the overlying skin. Her family history is negative for breast cancer. On examination, the discharge is elicited from a single duct. There are no palpable masses, and axillary lymph nodes are non-palpable. What is the most appropriate next step in the management of this patient?
A Reassurance and observation
B Initiate antibiotic therapy
C Order a mammogram and ultrasound
D Direct duct excision
E Fine needle aspiration of the nipple discharge

Answer 21

c. order and Mammo and US

Question 22

A 41-year-old woman comes to your office after finding a breast lump during a routine self-examination. She has been examining her breasts regularly for the past 5 years; this is the first lump she has found. On examination, there is a lump located in the right breast. The lump’s anatomic location is in the upper outer quadrant. It is approximately 3 cm in diameter and is not fixed to skin or muscle. It has a hard consistency. There are three axillary nodes present on the right side; each node is approximately 1 cm in diameter. No lymph nodes are present on the left. At this time, what would you do?
A tell the patient that she has fibrocystic breast disease; ask her to return in 1 month, preferably 10 days after the next period, for a recheck
B tell the patient to update her will as her prognosis is grave
C tell the patient to come back for a breast examination in 6 months
D order an ultrasound examination of the area
E none of the above

Answer 22

e. none of the above

Question 23

What is the first diagnostic procedure that should be performed for the 41-year-old woman comes to your office after finding a breast lump during a routine self-examination. She has been examining her breasts regularly for the past 5 years; this is the first lump she has found. On examination, there is a lump located in the right breast. The lump’s anatomic location is in the upper outer quadrant. It is approximately 3 cm in diameter and is not fixed to skin or muscle. It has a hard consistency. There are three axillary nodes present on the right side; each node is approximately 1 cm in diameter. No lymph nodes are present on the left.?

A ultrasonography of the breast
B mammography
C fine-needle biopsy
D magnetic resonance imaging of the breast
E positron emission tomography scan

Answer 23

b. mammography

Question 24

The risk factors for carcinoma of the breast include which of the following?
A a first-degree relative with breast cancer
B nulliparity
C birth of a first child after age 35 years
D early menarche
E all of the above

Answer 24

e. all of the above

Question 25

The U.S. Preventive Services Task Force (USPSTF) recommends which of the following as the preferred mammographic screening protocol for breast cancer in women?
A screen all women older than 40 years every year
B screen all women 40 years or older every 1 or 2 years
C screen all women 50 years or older every 1 or 2 years
D screen all women older than 55 years every 1 or 2 years

Answer 25

c. screen all women 50 years older every 1 or 2 years

Question 26

What is the most common histologic type of breast cancer?
A infiltrating ductal carcinoma
B medullary carcinoma
C invasive lobular carcinoma
D noninvasive intraductal carcinoma
E papillary ductal carcinoma

Answer 26

a. infiltrating ductal carcinoma