Quiz 3

Question 1

A 23 year old G2P1011 has just delivered a healthy term infant without any difficulty. What set of actions is most likely to minimize her risk of hemorrhage?

Answer 1

Uterine massage, gentle cord traction, and oxytocin after delivery

Question 2

What is the most significant risk factor for hemorrhage due to atony?

Answer 2

Excessive uterine distention

Question 3

The initial finding of a soft “boggy” consistency to the uterus in a patient with postpartum bleeding should lead to immediate…

Answer 3

bimanual massage

Question 4

To reduce the risk of postpartum hemorrhage, prophylactic oxytocin should first be administered when during the labor and delivery process?

Answer 4

Third stage

Question 5

What is a predisposing factor for retained placenta?

Answer 5

Uterine leiomyomata

Question 6

Penetration of the placental villi into the uterine muscle is called what?

Answer 6

Placenta increta

Question 7

A 28 year old G2P1 at 32 weeks of gestation presents with generalized itching. On physical examination, her vital signs are normal, she is not jaundiced, and there are excoriation a but no rash. Laboratory evaluation reveals mildly elevated aminotransferases. What is the most likely diagnosis?

Answer 7

Intrahepatic cholestasis of pregnancy

Question 8

A 22 year old G1P0 at 30 weeks of gestation presents with nausea and vomiting and malaise. On physical examination, she is mildly tachycardia and hypertensive. Jaundice is also noted. Laboratory evaluation reveals a moderately elevated serum aminotransferases, elevated serum creatinine, elevated bilirubin, ️Decreased fibrinogen, and proteinuria. What is the most likely diagnosis?

Answer 8

Acute fatty liver of pregnancy

Question 9

In a fetus with higher-than-normal flow velocity by Doppler ultrasound measurement, per cutaneous umbilical blood sampling is performed to assed fetal…

Answer 9

Hematocrit

Question 10

A healthy Caucasian woman, G1P0, presents for routine prenatal care at 12 weeks. Her initial labs showed a hemoglobin of 9 g/dL. The next best step is…

Answer 10

Empiric trial of prenatal vitamin/mineral supplement containing iron sulfate

Question 11

A 45 year old patient complains of frequent loss of urine. The volume is small bit it occurs almost continuously. She denies urgency, has no dysuria, and voids frequently but in small amounts. She does not ever feel “full” but also has the sense that she has completely emptied her bladder. What type of incontinence best describes her condition?

Answer 11

Overflow incontinence

Question 12

A 22 year old patient complains of occasional loss of furine. She reports a sense of intense fullness and “a need to go” just before the urine is lost. She voids infrequently but in large amounts. She does not ever feel that she “gets enough warning” to get to the bathroom. what type of incontinence does she have?

Answer 12

Urge incontinence

Question 13

A patient who loses urine when she coughs or sneezes most likely has a…

Answer 13

urethral prolapse

urethrocele

Question 14

A 22 year old G0 presents for evaluation because she has never had a menstrual period. She has well-developed breasts but scant pubic and axillary hair; the vagina is short and no ovaries and uterus are palpable. Serum estrogen and androgen levels are in the normal male range. What is the most likely diagnosis?

Answer 14

Androgen insensitivity

Question 15

A 32 year old nulligravid woman is seen in your office for her annual visit. On examination, she has hair growth on her nipples and lower abdomen and some temporal thinning of her hair. Blood tests indicated a high-normal level of free and total testosterone. The most likely cause of her hirsutism is…

Answer 15

polycystic ovary disease

Question 16

A 22 year old woman in the endocrine clinic is evaluated for amenorrhea, acne, and excessive hair growth. She states that this is not a new problem but as she has gotten older, the changes have disturbed her more. You do a full hormonal evaluation and diagnose her with adrenal hyperplasia for which you prescribe prednisone. On treatment, she is most likely to see an improvement in what?

Answer 16

Ovulation

Question 17

A 20 year old patient with the diagnosis of congenital adrenal hyperplasia is referred to your clinic for management of her irregular menses. She has been followed by a pediatric endocrinologist for the past 3 years since the diagnosis was made. In review of her labs, you note that she has a normal level of 17a-hydroxyprogesterone and being to suspect the less common 11B-hydroxylase deficiency.The finding that would most support your diagnosis is what?

Answer 17

Severe hirsutism

Question 18

A 26 year old patient with the diagnosis of polycystic ovary syndrome is anxious to conceive. She has a history of irregular menses. The most appropriate first step in re-establishing ovulation for this patient should be what?

Answer 18

Weight reduction

Question 19

Elevating the head of the examining table approximately 30 degrees facilitates…

Answer 19

the observation of the patient’s responses

Question 20

In a woman describing sufficiently frequent sexual encounters, infertility typically is described as failure to conceive after…

Answer 20

12 months

Question 21

In the gynecologic history, it is often possible to distinguish between vaginitis and pelvic inflammatory disease by inquiring about…

Answer 21

the use of topical medications

Question 22

A cholesterol/lipid profile should be performed for women without risk factors at what interval?

Answer 22

Every 5 years after age 45 years

Question 23

The standard 300 mg dose of anti-D immunoglobulin will effectively neutralize how many milliliters of fetal red blood cells?

Answer 23

15 mL

Question 24

In a fetus with higher than normal flow velocity by Doppler ultrasound measurement, percutaneous umbilical blood sampling is performed to assess fetal…

Answer 24

Hematocrit

Question 25

A 22 year old patient complains of continuous loss of urine since her cesarean delivery 1 month ago. This patient’s problem is most likely due to what?

Answer 25

Vesicovaginal fistula

Question 26

A cystocele may best be demonstrated clinically by what?

Answer 26

Use of a Valsalva maneuver

Question 27

A 25 year old patient had an IUD inserted last year but no longer feels the string. What is the most appropriate next step in management?

Answer 27

Ultrasonography

Question 28

A healthy, asymptomatic, nulliparous 36 year old woman requests your advice because she has been unsuccessful at achieving pregnancy over the last 13 months, despite regular menses. Performing an initial physical examination, you detect a firm, non-tender, multinodular uterus whose size corresponds to that at approximately 8 to 10 weeks of pregnancy, which is consistent with leiomyomata uteri. The remainder of the exam is within normal limits. Your next best step is to recommend what?

Answer 28

HSG

Question 29

A 42 year old woman, G2P2, who had a laparoscopic tubal fulguration 7 ears ago has abnormal uterine bleeding. Her menstrual cycle has been 28-30 days with a menstrual flow of 5-6 days. During the last 6 months. the interval has varied from 14-35 days and the menstrual flow has lasted from 1-14 days. The uterus is irregular and firm and consistent in size with an 8-week gestation. Both ovaries are palpably normal in size. Urine pregnancy test is negative. The most appropriate next step in management is what?

Answer 29

Endometrial sampling

Question 30

/a 19 year old primigravid woman is seen because of vaginal bleeding. Her LMP was about 11 weeks ago; the vagina contains a small amount of dark blood and the cervix is long and closed. The uterus is enlarged and not tender. A pelvic ultrasonography demonstrates an intrauterine gestational sac but no fetal pole is identified. The patient is distraught but declines surgical management. What is the most appropriate management of this patient’s condition?

Answer 30

Mifepristone pills and vaginal misoprostol

Question 31

An 8 year old girl is brought to your office by her mother for evaluation of early pubertal changes. Mother had undergone puberty starting at age 13 years and she is concerned that her daughter may be abnormal. Her daughter started to show a growth spurt over this past year and over the past 3 months has begun to exhibit both breast budding and growth of pubic and axillary hair. She has been healthy and other than being slightly overweight, been developmentally normal. What is the most likely source for the girl’s androgenic changes?

Answer 31

Adrenal gland androgens

Question 32

A 15 year old girl is brought by her mother for evaluation of her daughter’s failure to menstruate. The girl reports that she was slightly delayed in hitting her growth spurt but is now the tallest girl in her class. She has always been fit and active and joined the track team at school 3 years ago. She has been otherwise healthy and her most recent school physical was reported to be normal with the exception that the doctor told her that she was underweight. In response to this observation, she has increased her physical training to try to add muscle mass but remains approximately 15% under ideal body weight for her age and height. What is the most appropriate next step in the management of this patient?

Answer 32

Administration of oral contraceptives

Question 33

A 32 year old nulligravid woman is seen in your office for her annual visit. On examination she has hair growth on her nipples and lower abdomen and some temporal thinning of her hair. Blood tests indicated a high-normal level of free and total testosterone. The most likely cause of her hirsutism is what?

Answer 33

polycystic ovarian disease

Question 34

A 22 year old woman in the endocrine clinic is evaluated for amenorrhea, acne, and excessive hair growth. She states that this is not a new problem but as she has gotten older, the changes have disturbed her more. You do a full hormonal evaluation and diagnose her with adrenal hyperplasia for which you prescribe prednisone. On treatment, she is most likely to see an improvement in which of the following?

Answer 34

Ovulation

Question 35

A 20 year old patient with the diagnosis of congenital adrenal hyperplasia is referred to your clinic for management of her irregular menses. She has been followed by a pediatric endocrinologist ffor the past 3 years since the diagnosis was made. In review of her labs, you note that she has a normal level of 17a-hydroxyprogesterone and begin to suspect the less common 11B-hydroxylase deficiency. The finding that would most support your diagnosis is what?

Answer 35

Severe hirsutism

Question 36

A 26 year old patient with the diagnosis of polycystic ovary syndrome is anxious to conceive. She has a history of irregular menses. The most appropriate first step in re-establishing ovulation for this patient should be

Answer 36

Weight reduction

Question 37

A 8 year old woman presents for evaluation of irregular menstrual periods and vaginal spotting. The patient’s last menstrual period was 3 months ago but she has noted mild vaginal spotting on and off for the last 40 days. Her menarche was at age 14 years and her periods were initially regular but over the past 8 to 10 years the became less common with only 5 periods over the last year. Her previous doctor attributed this irregularity to her having gained weight. Her weight has been stable over the last year. She has a BMI o 36. Over the past 2 years she has noted a slight increase in facial and body hair and she had developed troublesome acne over her upper back and face. A review of symptoms is otherwise negative. What is the most appropriate next step in the evaluation of this patient?

Answer 37

Serum FSH, LH, and prolactin

Question 38

The most likely test to be abnormal in a patient with PCOS is

Answer 38

Serum LH