Sorted MCQ B

Question 1

A 35-year-old woman presents with bright red vaginal bleeding at
30 weeks’ gestation. Her urine drug screen is positive. Which of the
following is most likely to be present in her drug screen?
A. Marijuana
B. Alcohol
C. Barbiturates
D. Cocaine
E. Benzodiazepines

Answer 1

D

Question 2

A 32-year-old G1 P0 woman is at 42 weeks’ gestation and being induced
for postterm pregnancy. She has had an uncomplicated pregnatal course.
Her BP is 100/60 mm Hg. The fundal height is 40 cm. Her cervix is
closed, 3 cm long, and firm on consistency. The obstetrician decides on
using a cervical ripening agent with misoprostol in the vagina.
Approximately 2 hours after placing the misoprostol, the patient has
an episode of fetal prolonged deceleration to the 80 bpm for 6 minutes.
Which of the following is the most likely etiology of the prolonged
deceleration?
A. Placental abruption
B. Sepsis
C. Umbilical cord prolapse
D. Uterine hyperstimulation

Answer 2

D

Question 3

A 28-year-old G1 P0 at 35 weeks’ gestation is in the obstetrical (OB)
triage area with spontaneous rupture of membranes. The fetal heart
rate baseline is 150 bpm with normal variability. There are accelerations
seen, and numerous late decelerations noted. In an effort to
improve oxygenation to the fetus, which of the following maneuvers
would most likely help in this circumstance?
A. Supine position
B. Epidural anesthesia
C. Morphine sulfate
D. Stop the oxytocin

Answer 3

D

Question 4

A 25-year-old woman presents with galactorrhea and irregular menses
of 10 months duration. Her pregnancy test is negative. Laboratory
tests reveal normal TSH and serum-free T4 and hyperprolactinemia.
Which of the following is most likely to be a cause of her condition?
A. Posterior pituitary adenoma
B. Abdominal wall trauma
C. Psychotropic medication
D. Hyperthyroidism

Answer 4

C

Question 5

A 47-year-old woman is being evaluated for a possible pituitary tumor.
She complains of headaches and has some visual difficulties. The MRI
shows a mass in the posterior pituitary gland, which the radiologist
notes is unusual. Which of the following is a hormone contained in
the posterior pituitary gland?
A. Follicle-stimulating hormone (FSH)
B. Prolactin
C. Thyroid-stimulating hormone (TSH)
D. Oxytocin

Answer 5

D

Question 6

A 30-year-old G1 P0 woman presents for her routine prenatal care
appointment at 36 weeks’ gestation with pruritic skin rash over her
abdomen. She is diagnosed as having pruritic urticarial papules and
plaques of pregnancy (PUPPP). Which of the following best describes
the pregnancy outcome with her diagnosis?
A. Somewhat increased perinatal morbidity and mortality
B. Increased preterm delivery rate
C. Increased preeclampsia
D. No effect on pregnancy

Answer 6

D

Question 7

An 18-year-old adolescent female undergoes laparoscopy for an acute
abdomen. Erythematous fallopian tubes are noted and a diagnosis of
PID is made. Cultures of the purulent drainage would most likely
reveal which of the following?
A. Multiple organisms
B. Neisseria gonorrhoeae
C. Chlamydia trachomatis
D. Peptostreptococcus species
E. Treponema pallidum

Answer 7

A

Question 8

An 18-year-old adolescent female presents to the emergency department
with a 36-hour history of abdominal pain and nausea. Her temperature
is 100.5°F (38.05°C). Her abdominal examination reveals
tenderness in the right lower quadrant with some mild rebound tenderness.
Pelvic examination shows some cervical motion tenderness
and adnexal tenderness, and also some right-sided abdominal tenderness.
The pregnancy test is negative. In considering the differential
diagnosis of appendicitis versus PID, which of the following is the
most accurate method of making the diagnosis?
A. Following serial abdominal examinations
B. Sonography of the pelvis and abdomen
C. Serum leukocyte count and cell differential
D. Laparoscopy

Answer 8

D

Question 9

32-year-old woman pregnant at 29 weeks’ gestation is noted to have
symptoms concerning for a pulmonary embolism. The evaluation
included chest radiograph, arterial blood gas, EKG, and helical CT
imaging. A diagnosis of pulmonary embolism is made. Which of the
following is most likely to be present in this patient?
A. Dyspnea
B. Chest pain
C. Palpitations
D. Hemoptysis
E. Sudden death

Answer 9

A

Question 10

A 22-year-old woman at 30 weeks’ gestation is noted to have a confirmed
pulmonary embolism based on a segmental filling defect on
helical CT imaging. An EKG is performed. Which of the following is
the most likely finding on the EKG on this patient?
A. Tachycardia
B. Right axis deviation
C. Right bundle branch block
D. S wave in lead III
E. QT interval prolongation

Answer 10

A

Question 11

A 28-year-old woman recently underwent cesarean delivery. Which of
the following is the most appropriate method to prevent the development
of deep venous thrombosis?
A. Unfractionated heparin intravenous infusion
B. Bed rest
C. Early ambulation
D. Depomedroxyprogesterone acetate (Depo-Provera)

Answer 11

C

Question 12

A 29-year-old woman is noted to have three consecutive first trimester
spontaneous abortions. After an evaluation for the recurrent
abortions including karyotype of the parents, hysterosalpingogram,
vaginal sonogram, and testing for antiphospholipid syndrome, the
obstetrician concludes the uterine fibroids are the etiology. Which of
the following types of uterine fibroids would most likely lead to recurrent
abortion?
A. Submucosal
B. Intramural
C. Subserous
D. Parasitic
E. Pedunculated

Answer 12

A

Question 13

A 39-year-old woman is diagnosed as having probable uterine fibroids
based on a pelvic examination revealing an enlarged irregular uterus.
She is currently asymptomatic and expressed surprise that she had
“growths” of the uterus. If she were to develop symptoms, which of the
following would be the most common manifestation?
A. Infertility
B. Menorrhagia
C. Ureteral obstruction
D. Pelvic pain
E. Recurrent abortion

Answer 13

C

Question 14

A 65-year-old woman is noted to have suspected uterine fibroids on
physical examination. Over the course of 1 year, she is noted to have
enlargement of her uterus from approximately 12 weeks’ size to 20 weeks’
size. Which of the following is the best management?
A. Continued careful observation
B. Monitoring with ultrasound examinations
C. Exploratory laparotomy with hysterectomy
D. Gonadotropin-releasing hormone agonist
E. Progestin therapy

Answer 14

C

Question 15

A 29-year-old G1 P0 woman at 28 weeks’ gestation is admitted to the
hospital for preeclampsia. Her blood pressure (BP) is 150/100 mm Hg
and her protein excretion is 500 mg in 24 hours. On hospital day 7,
she is diagnosed with severe preeclampsia and the decision is made to
administer magnesium sulfate and deliver the baby. Which of the following
findings is most likely present in this patient as criteria for
severe preeclampsia?
A. Elevated uric acid levels
B. 5 g of proteinuria excreted in a 24-hour period
C. 4+ pedal edema
D. Platelet count of 115,000/Ul

Answer 15

B

Question 16

A 19-year-old G1 P0 woman at 39 weeks’ gestation is diagnosed with
preeclampsia based on blood pressure of 150/90 mm Hg and 2+ proteinuria
on urine dipstick. The patient is placed on magnesium sulfate,
and develops flushing and fatigue. She asks about the need for the
magnesium sulfate. You explain that it is to prevent the seizures that
may complicate preeclampsia and may even cause death. The patient
asks how seizures associated with preeclampsia can cause mortality.
Which of the following is the most common mechanism?
A. Intracerebral hemorrhage
B. Myocardial infarction
C. Electrolyte abnormalities
D. Aspiration

Answer 16

A

Question 17

A 48-year-old woman who presents with postcoital vaginal bleeding is
noted to have a cervical exophytic mass. A biopsy of the mass confirms
squamous cell carcinoma. If molecular analysis of the cancer is
performed, which of the following HPV subtypes is most likely to be
found in the specimen?
A. 6 and 11
B. 16 and 18
C. 55 and 57
D. 89 and 92

Answer 17

B

Question 18

A 39-year-old woman is diagnosed with advanced cervical cancer that
appears to have spread to her right pelvic side wall. She has right
hydronephrosis as evidenced by the IVP. The biopsy specimen confirms
that it is a poorly differentiated carcinoma. Which of the following
statements regarding this patient’s condition is most accurate?
A. The best therapy for her is surgical excision.
B. Both brachytherapy and teletherapy are important in the treatment
of this patient.
C. Radical hysterectomy is an option in the therapy of this patient.
D. The majority of cervical cancers are of adenomatous cell type.

Answer 18

B

Question 19

A 45-year-old woman is diagnosed with an early cervical cancer, noted
to be confined to the cervix and about 3 cm in diameter. She asks how
she developed this condition. Which of the following is a risk factor
for cervical cancer?
A. Early age of coitus
B. Nulliparity
C. Obesity
D. Late menopause
E. Family history of cervical cancer

Answer 19

A

Question 20

A 33-year-old woman has a Pap smear showing moderately severe cervical
dysplasia (high-grade squamous intraepithelial neoplasia). She
denies a smoking history and does not recall having any sexually transmitted
infections. Which of the following is the best next step?
A. Repeat Pap smear in 3 months.
B. Conization of the cervix.
C. Colposcopy-directed biopsies.
D. Radical hysterectomy.
E. CT scan of the abdomen and pelvis.

Answer 20

C

Question 21

A 40-year-old woman is referred for a Pap smear showing high-grade
squamous intra-epithelial lesions (HSIL). Which of the following
statements is most accurate?
A. If HPV subtyping reveals no high-risk virus present, then routine
cytology is recommended.
B. If colposcopy demonstrates the entire transformation zone, then
no further analysis is needed.
C. If an endocervical curetting shows cervical dysplasia, then an excisional
procedure of the cervix is appropriate.
D. Cervical cancer is highly unlikely due to the Pap smear revealing
only HSIL.

Answer 21

C

Question 22

47-year-old woman G4 P4 has a Pap smear which shows HGSIL.
Colposcopy is performed which is adequate, and reveals CIN III. An
endocervical curettage is negative. The patient also has menorrhagia
caused by uterine fibroids. Thus, the patient undergoes a total abdominal
hysterectomy, including removal of the cervix. The patient asks whether
Pap smears need to be performed now that her cervix has been surgically
removed. Which of the following is the most accurate statement?
A. The patient should continue to have annual Pap smears of the
vaginal cuff.
B. The patient should have Pap smears every 2 to 3 years, which may
be discontinued if negative after 10 years.
C. The patient does not need Pap smears any longer.
D. The patient should have the HPV vaccine.

Answer 22

A

Question 23

A 19-year-old G1 Ab1 woman underwent a uterine curettage after a
miscarriage. She has had no menses since and is not pregnant. The
physician is suspecting intrauterine adhesions. Which of the following
is a feature of intrauterine synechiae (Asherman syndrome)?
A. Usually occurs after uterine curettage
B. Associated with low gonadotropin levels
C. Associated with a monophasic basal body temperature chart
D. Associated with low cortisol levels

Answer 23

A

Question 24

A 24-year-old G1 P1 woman is seen in the office with secondary amenorrhea
after her delivery. She is given a tentative diagnosis of pituitary
necrosis (Sheehan syndrome). Which of the following is consistent
with her presumed diagnosis?
A. Usually associated with hypertensive crisis at or soon after a delivery
B. Is caused by an ischemic necrosis of the posterior pituitary gland
C. Is associated with decreased prolactin levels
D. Is often associated with elevated TSH levels

Answer 24

C

Question 25

A 32-year-old G2 P1 Ab1 woman presents to the gynecologist’s office
with secondary amenorrhea of 8 months’ duration. She had normal
and regular menses before this time. After an evaluation, she is given
a diagnosis of intrauterine adhesions (Asherman syndrome). Which of
the following is the best description of the mechanism of intrauterine
synechiae (Asherman syndrome)?
A. Trophoblastic hyperplasia
B. Pituitary engorgement
C. Myometrial scarring
D. Endometrial hypertrophy
E. Disruption of large segments of the endometrium

Answer 25

E

Question 26

A 25-year-old woman presents with a 6-month history of amenorrhea.
Her pregnancy test is negative. She is evaluated for other causes of secondary
amenorrhea, and is given a diagnosis of polycystic ovarian syndrome
(PCOS). Which of the following is consistent with this disorder?
A. Estrogen deficiency and vaginal atrophy
B. Osteoporosis
C. Endometrial hyperplasia
D. Hypoglycemia
E. A history of regular menses each month prior to 6 months

Answer 26

C

Question 27

A 32-year-old woman G1 P0 at 24 weeks’ gestation is seen by her obstetrician
for painful vesicles on the vulva. PCR is performed and returns
as HSV-2. The obstetrician counsels the patient about the possibility of
needing cesarean when she goes into labor. Which of the following is an
indication for cesarean section due to maternal herpes simplex virus?
A. Vesicular lesions noted on the cervix
B. History of lesions noted on the vagina 1 month previously, now
not visible
C. Lesions noted on the posterior thigh
D. Tingling of the chest wall with lesions consistent with herpes

Answer 27

A

Question 28

A 29-year-old G2 P1 woman is seen in the office for her pregnancy at
16 weeks’ gestation. She complains of some burning of the vulvar area.
Two blisters are noted on the labia majora. PCR is performed on the
lesions, which returns as HSV-1. Which of the following statements is
most accurate in the counseling of this patient?
A. Because this result is HSV-1, the finding is likely a false-positive
result and the patient does not likely have a herpes infection.
B. Because of the finding of HSV-1, the neonate is not at risk for herpes
encephalitis.
C. The patient should be treated the same whether the infection is
HSV-1 or HSV-2.
D. The patient likely has an HIV infection since HSV-1 was isolated
in the vulvar area.

Answer 28

C

Question 29

A 35-year-old healthy G2 P1 woman at 20 weeks’ gestation presents
with primary episode of herpes simplex virus, confirmed by PCR. Oral
acyclovir is given for a 10-day course. Which of the following is the
rationale for the acyclovir therapy?
A. Decrease the likelihood of recurrence and need for cesarean
B. Decrease the likelihood of transplacental transmission to the fetus
C. Decrease the duration of viral shedding and duration of the current
infection
D. Increase the patient’ immunity and IgG levels to HSV

Answer 29

C

Question 30

A 34-year-old woman is seen at her internist’s office complaining of
vulvar pain. On examination, three ulcers are noted on the right labia
majora. The lesions have ragged edges, a necrotic base, and there is
adenopathy noted on the right inguinal region. Which of the following
is the most likely diagnosis?
A. Syphilis
B. Herpes simplex virus
C. Chancroid
D. Squamous cell carcinoma
E. Bartholin gland abscess

Answer 30

C