Sorted MCQ A

Question 1

A 55-year-old woman notes constant wetness from her vagina following a total vaginal hysterectomy procedure, which she had undergone 2 months previously. She denies dysuria or urgency to void. The urinanalysis is normal. Which of the following is the best method to diagnose
the etiology of urinary incontinence?
A. Cystometric examination
B. Dye instillation into bladder
C. Postvoid catheterization of the bladder
D. Neurological profile of the sacral nerves

Answer 1

B

Question 2

A 42-year-old woman with long-standing diabetes mellitus complains of small amounts of constant dribbling of urine loss with coughing or lifting.
Give treatment.

Answer 2

Intermittent self-catheterization

Question 3

A 39-year-old woman wets her underpants two to three times each day. She feels as though she needs to void, but cannot make it to the restroom in time.
Give treatment.

Answer 3

Oxybutynin (Ditropan, an anticholinergic medication)

Question 4

A 35-year-old woman has undergone four vaginal deliveries. She notes
urinary loss six to seven times a day concurrently with coughing or sneezing.
She denies dysuria or an urge to void. Her urine culture is negative.
Give treatment.

Answer 4

Burch urethropexy

Question 5

A 23-year-old G1 P0 woman at 38 weeks’ gestation delivered a 7 lb 4 oz baby boy vaginally. Upon delivery of the placenta, there was noted to be an inverted uterus, which was successfully managed including replacement of the uterus. Which of the following placental implantation sites would most likely predispose to an inverted uterus?
A. Fundal
B. Anterior
C. Posterior
D. Lateral
E. Lower segment

Answer 5

A

Question 6

A 24-year-old woman underwent a normal vaginal delivery of a term infant female. After the delivery, the placenta does not deliver even after 30 minutes. Which of the following would be the next step for this patient?
A. Initiate oxytocin.
B. Wait for an additional 30 minutes.
C. Hysterectomy.
D. Attempt a manual extraction of the placenta.
E. Misoprostol estrogen intravaginally.

Answer 6

D

Question 7

A 32-year-old G1 P0 woman at 40 weeks’ gestation undergoes a normal
vaginal delivery. Delivery of the placenta is complicated by an inverted uterus, with subsequent hemorrhage leading to 1500 mL of blood loss. She is managed with a transfusion of erythrocytes. Which of the following is the best explanation of the mechanism of hemorrhage?
A. Inverted uterus stretches the uterus, causing trauma to blood vessels
leading to bleeding.
B. Inverted uterus leads to inability for an adequate myometrial contraction
effect.
C. Inverted uterus causes a local coagulopathic reaction to the uterus
and endometrium.
D. Inverted uterus causes muscular abrasions and lacerations leading
to bleeding.

Answer 7

B

Question 8

A 33-year-old G5 P5 woman, who is being induced for preeclampsia delivers a 9 lb baby. Upon delivery of the placenta, uterine inversion is
noted. The physician attempts to replace the uterus, but the cervix is
tightly contracted, preventing the fundus of the uterus from being repositioned.
Which of the following is the best therapy for this patient?
A. Vaginal hysterectomy.
B. Dührssen incisions of the cervix.
C. Halothane anesthesia.
D. Discontinue the magnesium sulfate.
E. Infuse oxytocin intravenously

Answer 8

C

Question 9

A 51-year-old woman with oligomenorrhea and hot flushes.
Diagnosis.

Answer 9

Ovarian failure

Question 10

A 22-year-old nonpregnant woman with galactorrhea and hyperprolactinemia.
Diagnosis.

Answer 10

Hypothalamic dysfunction

Question 11

A 25-year-old woman slightly obese, slightly hirsute, and with a long history of irregular menses.
Diagnosis.

Answer 11

Estrogen excess

Question 12

An 18-year-old adolescent female with infantile breast development has not started her menses. She has some webbing of the neck region.
Diagnosis.

Answer 12

Ovarian failure

Question 13

A 33-year-old woman who has not started her menses since a vaginal delivery 1 year previously complicated by postpartum hemorrhage.
She was unable to breastfeed her baby.
Diagnosis.

Answer 13

Pituitary dysfunction

Question 14

A 25-year-old woman has a history of 1 year of amenorrhea due to hyperprolactinemia.
She has bilateral galactorrhea due to a prolactin-secreting adenoma. Which of the following tests is also likely to reveal an abnormal finding?
A. DEXA scan of the spine
B. Endometrial biopsy
C. Mammography of the breasts
D. Thyroid-stimulating hormone (TSH) level

Answer 14

A

Question 15

A 31-year old G2 P1 woman at 39 weeks’ gestation complains of painful uterine contractions that are occurring every 3 to 4 minutes. Her cervix has changed from 1-cm dilation to 2-cm dilation over 3 hours. Which
one of the following management plans is most appropriate?
A. Cesarean delivery
B. Intravenous oxytocin
C. Observation
D. Fetal scalp pH monitoring
E. Intranasal gonadotropin therapy

Answer 15

C

Question 16

A 26-year-old G2 P1 woman at 41 weeks’ gestation has been pushing for 3 hours without progress. Throughout this time, her vaginal examination has remained completely dilated, completely effaced, and 0 station, with the head persistently in the occiput posterior (OP) position. Which of the following statements accurately describes the situation?
A. The occiput posterior position is frequently associated with a gynecoid
pelvis.
B. The labor progress is normal if the patient does not have an
epidural catheter for analgesia, but is abnormal if epidural analgesia
is being used.
C. The patient is best described as having an arrest of descent.
D. The bony part of the fetal head is likely to be at the plane of the
pelvic inlet.

Answer 16

C

Question 17

A 24-year-old G2 P1 woman at 39 weeks’ gestation presents with painful uterine contractions. She also complains of dark, vaginal blood mixed with some mucus. Which of the following describes the most likely etiology
of her bleeding?
A. Placenta previa
B. Placenta abruption
C. Bloody show
D. Vasa previa
E. Cervical laceration

Answer 17

C

Question 18

A 31-year old G2 P1 woman at 39 weeks’ gestation complains of painful uterine contractions that are occurring every 3 to 4 minutes. Her cervix has changed from 1-cm dilation to 2-cm dilation over 3 hours. Which
one of the following management plans is most appropriate?
A. Cesarean delivery
B. Intravenous oxytocin
C. Observation
D. Fetal scalp pH monitoring
E. Intranasal gonadotropin therapy

Answer 18

C

Question 19

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 19

D

Question 20

A 24-year-old G2 P1 woman at 39 weeks’ gestation presents with painful uterine contractions. She also complains of dark, vaginal blood mixed with some mucus. Which of the following describes the most likely etiology
of her bleeding?
A. Placenta previa
B. Placenta abruption
C. Bloody show
D. Vasa previa
E. Cervical laceration

Answer 20

C

Question 21

Which of the following is the most significant risk factor for the development
of an ectopic pregnancy?
A. Prior chlamydial cervical infection
B. History of a tubal ligation
C. Prior molar pregnancy
D. Prior miscarriage
E. Combination oral contraceptive pill use

Answer 21

A

Question 22

An 18-year-old adolescent female who is brought to the emergency room
complains of vaginal spotting and lower abdominal pain. Her abdominal
and pelvic examinations are normal. The hCG level is 700 mIU/mL and
transvaginal sonogram shows no intrauterine gestational sac and no
adnexal masses. Which of the following statements is most accurate
regarding this patient’s situation?
A. She has an unruptured ectopic pregnancy.
B. She has a viable intrauterine pregnancy that is too early to assess
on ultrasound.
C. She has a nonviable intrauterine pregnancy.
D. There is insufficient information to draw a conclusion about the
viability of this pregnancy.
E. An MRI scan would be useful in further assessing the possibility of
an ectopic pregnancy.

Answer 22

D

Question 23

A 22-year-old woman, who is pregnant at 5 weeks’ gestation, complains of severe lower abdominal pain. On examination, she is noted to have a blood pressure of 86/44 mm Hg and heart rate of 120 bpm.
Her abdomen is tender. The pelvic examination is difficult to perform
due to guarding. The hCG level is 500 mIU/mL and the transvaginal sonogram reveals no intrauterine gestational sac and no adnexal masses.
There is some free fluid in the cul-de-sac. Which of the following is the
best management for this patient?
A. Repeat hCG level in 48 hours to assess for a rise of 66%.
B. Check the serum progesterone level.
C. Immediate surgery.
D. Intramuscular methotrexate.
E. Repeat sonography in 48 hours.

Answer 23

C

Question 24

A 25-year-old woman at 34 weeks’ gestation is noted to have a placenta
previa, after she presented with vaginal bleeding and has undergone sonography. At 37 weeks, she has a scheduled cesarean. Upon cesarean section, bluish tissue densely adherent between the uterus and maternal？bladder is noted. Which of the following is the most likely diagnosis?
A. Placenta accreta
B. Placenta melanoma
C. Placenta percreta
D. Placental polyp

Answer 24

C

Question 25

A 19-year-old G1 P0 woman at 18 weeks’ gestation, who had a prior cervical conization procedure, states that she had felt no abdominal cramping. She has a cervical dilation of 2 cm and effacement of 70%.
Tx.

Answer 25

Cervical cerclage

Question 26

A 33-year-old woman at 10 weeks’ gestation complains of vaginal bleeding
and passage of a whitish substance along with something “meatlike.”
She continues to have cramping, and her cervix is 2 cm dilated.
Tx

Answer 26

Dilation and curettage of uterus

Question 27

A 20-year-old G2 P1 woman at 12 weeks’ gestation has had no problems with this pregnancy prior to today. She complains of some slight vaginal spotting. No fetal heart tones are heard on Doppler, and a
transvaginal ultrasound reveals no uterine gestational sac and no
adnexal masses. The hCG level is 700 mIU/mL.
Tx

Answer 27

Follow up hCG level in 48 hours

Question 28

28-year-old G3 P2 woman at 22 weeks’ gestation is noted to have vaginal spotting, and fetal heart tones are in the 140 to 145 bpm range.
Tx

Answer 28

Expectant management

Question 29

Which of the following is a risk factor for shoulder dystocia?
A. Maternal gestational diabetes
B. Fetal hydrocephalus
C. Fetal prematurity
D. Precipitous (fast) labor

Answer 29

A

Question 30

The clinician performs a delivery of the posterior fetal arm.
stated maneuver

Answer 30

Decreases the fetal bony diameter from shoulder to axilla

Question 31

The McRoberts maneuver is utilized
stated maneuver

Answer 31

Anterior rotation of the symphysis pubis

Question 32

The nurse is instructed to apply the suprapubic pressure maneuver
stated maneuver

Answer 32

Displaces the fetal shoulder axis from anterior-posterior to oblique

Question 33

A 55-year-old woman, who underwent a vaginal hysterectomy for third-degree vaginal prolapse 1 month ago,complains of constant leakageof fluid per vagina of 7 days duration.
Dx

Answer 33

Vesicovaginal fistula

Question 34

A 44-year-old woman undergoes a right salpingo-ophorectomy laparoscopically.
Bipolar cautery is used to ligate the infundibular pelvic ligament.
The next day, she complains of fever and flank tenderness.
Dx

Answer 34

Ureteral thermal injury

Question 35

A 60-year-old woman presents to her physician’s office with postmenopausal
bleeding. She undergoes endometrial sampling, and is
diagnosed with endometrial cancer. Which of the following is a risk
factor for endometrial cancer?
A. Multiparity
B. Herpes simplex infection
C. Diabetes mellitus
D. Oral contraceptive use
E. Smoking

Answer 35

C

Question 36

A 52-year-old woman, who has hypertension and diabetes, is diagnosed
with endometrial cancer. Her diseases are well controlled. Her
physician has diagnosed the condition as tentatively stage I disease
(confined to the uterus). Which of the following is the most important
therapeutic measure in the treatment of this patient?
A. Radiation therapy
B. Chemotherapy
C. Immunostimulation therapy
D. Progestin therapy
E. Surgical therapy

Answer 36

E

Question 37

A 28-year-old woman at 32 weeks’ gestation is seen in the obstetrical
(OB) triage area for vaginal bleeding described as significant with
clots. She denies cramping or pain. An ultrasound is performed revealing
that the placenta is covering the internal os of the cervix. Which
of the following is a risk factor for this patient’s condition?
A. Prior salpingitis
B. Hypertension
C. Multiple gestations
D. Polyhydramnios

Answer 37

C

Question 38

A 22-year-old G1 P0 woman at 34 weeks’ gestation presents with moderate
vaginal bleeding and no uterine contractions. Her blood pressure
(BP) is 110/60 mm Hg and heart rate (HR) 103 beats per minute (bpm).
The abdomen is nontender. Which of the following sequence of examinations
is most appropriate?
A. Speculum examination, ultrasound examination, digital examination
B. Ultrasound examination, digital examination, speculum examination
C. Digital examination, ultrasound examination, speculum examination
D. Ultrasound examination, speculum examination, digital examination

Answer 38

D

Question 39

An 18-year-old adolescent female is noted to have a marginal placenta previa on an ultrasound examination at 22 weeks’ gestation. She does not have vaginal bleeding or spotting. Which of the following is the most appropriate management?
A. Schedule cesarean delivery at 39 weeks.
B. Schedule an amniocentesis at 36 weeks and deliver by cesarean if
the fetal lungs are mature.
C. Schedule an MRI examination at 35 weeks to assess for possible
percreta involving the bladder.
D. Reassess placental position at 34 to 35 weeks’ gestation by ultrasound.
E. Recommend termination of pregnancy.

Answer 39

D

Question 40

Which of the following is the most significant risk factor for abruptio
placentae?
A. Prior cesarean delivery
B. Breech presentation
C. Trauma
D. Marijuana use
E. Placenta accrete

Answer 40

C