Wall Quiz #8 Flashcards
1
Q
How is iodide transported across the placenta? A. Endocytosis B. Simple diffusion C. Carrier mediated process D. Iodine does not cross the placenta E. Facilitated diffusion
A
C. Carrier mediated process
2
Q
You are called to the ED as a known 30 week gravid arrives following a gunshot to the abdomen. Vitals stable. Exam shows entry wound in the left upper quadrant above the uterine fundus. Fetal monitor is shown (category I tracing with contractions). Which of the following is the most necessary: A. CT scan of the abdomen B. Amniocentesis C. Laparotomy D. Peritoneal lavage E. Wound fistulography
A
C. Laparotomy
3
Q
A 33yo G4P3 at 29 weeks presents with vaginal bleeding. Her two previous deliveries were cesarean. She has a known anterior placenta previa. She is at greatest risk for:
A. Placenta accreta
B. Placental abruption
C. Preterm cervical dilatation
D. Premature preterm rupture of the membranes
E. Uterine rupture
A
A. Placenta accreta
4
Q
Where is hemoglobin F produced? A. Liver B. Yolk sac C. Bone Marrow D. Yolk sac and liver E. Placenta
A
A. Liver
5
Q
In a normal pregnancy HCG levels increase in a curvilinear pattern and then plateau of 100,000 mIU/mL at how many weeks? A. 5 B. 6 C. 8 D. 9 E. 10
A
E. 10
6
Q
A 19 yo G3P2 at 29 weeks is embarrassed to admit she has been craving and eating ice and clay. What test is likely to be abnormal? A. Toxicology screen B. Liver function tests C. Complete blood count D. EEG E. EKG
A
C. Complete blood count
7
Q
A 57-year-old has leakage of urine when she coughs, sneezes and laughs. Exam shows a right lateral anterior vaginal wall defect. The defect is most likely caused by:
A. Pubococcygeus muscle
B. Detachment of endopelvic fascia from the ischial spine
C. Detachment of endopelvic fascia from the pubocervical ring
D. Detachment of pubocervical fascia from the arcus tendinous fascia pelvis
E. Disruption of the pubourethral ligament
A
D. Detachment of pubocervical fascia from the arcus tendinous fascia pelvis
8
Q
Which of the following is the best management for a post-menopausal patient with an 8 cm unilocular mass of the adnexa?
A. TAHBSO
B. Laparoscopic assessment of mass
C. CT guided drainage
D. CT of the abdomen to evaluate for nodes and CA 125
E. Observation and repeat ultrasound in 12 weeks
A
E. Observation and repeat ultrasound in 12 weeks
9
Q
Which of the following medications are utilized for the treatment of hyperthyroidism in a patient with a molar pregnancy to prevent pulmonary edema during evacuation? A. Beta adnergic receptor blocker B. Ace inhibitor C. Furosemide D. Angiotension receptor blocker E. PTU
A
A. Beta adnergic receptor blocker
10
Q
Erb’s palsy involves which nerve roots? A. C1-C3 B. C3-C5 C. C5-C6 D. C6-T1 E. C6-T2
A
C. C5-C6
11
Q
Which of the following is most likely a cause of postpartum hemorrhage as a result of forceps delivery? A. Uterine atony B. Uterine rupture C. Retained placenta D. Subinvolution of the placental site E. Genital tract laceration
A
E. Genital tract laceration
12
Q
A common cause of transverse lie include which of the following? A. Nulliparity B. Prolonged labor C. Placenta previa D. Oligohydramnios E. Fetal anomaly
A
C. Placenta previa
13
Q
Which of the following is the most common cause of breast cancer? A. Paget’s disease B. Inflammatory Breast cancer C. Ductal carcinoma D. Cystosarcoma Phyllodes E. Lobular carcinoma of the breast
A
C. Ductal carcinoma
14
Q
Which study type answers questions regarding risk factors for disease and prognosis? A. Case Series/ Case Reports B. Meta analysis C. Randomized controlled trials D. Prospective cohort studies E. Case control study
A
D. Prospective cohort studies
15
Q
Functional Residual Capacity in pregnancy declines due to what physiologic change: A. Decrease in RR B. Elevation of the diaphragm C. Increase in Minute ventilation D. Change in PH E. Gain in weight during pregnancy
A
B. Elevation of the diaphragm
16
Q
A woman is concerned that her 6 year old daughter is developing breasts. The least important step in your evaluation is :
A. Serum estradiol level test
B. Bone age
C. A gonadotropic releasing hormone challenge test
D. Pelvic ultrasound
E. Karyotype
A
E. Karyotype
17
Q
A 18-year-old, G1P1 presents to your office with a known history panhypopituitarism. Which of the following is the most important treatment? A. Aldosterone B. ACTH C. Cortisol D. ADH E. Thyroxine
A
C. Cortisol
18
Q
The histologic feature of endometrial hyperplasia that is associated with the greatest risk of progression to invasive cancer is? A. Architectural complexity B. Mitotic figures C. Nuclear atypia D. Squamous differentiation E. Tumor cell necrosis
A
C. Nuclear atypia
19
Q
Metastases to which organ system poses the least risk to a patient with GTN? A. Lung B. Spleen C. Liver D. Brain E. GI tract
A
A. Lung
20
Q
When compared with normal weight women, obese gravidas, with an BMI less than 50, are at an increased risk for the following conditions EXCEPT? A. Fetus with IUGR B. Proteinuria C. Fatty liver disease D. Gestational DM E. Cardiac Dysfunction
A
A. Fetus with IUGR
21
Q
A 29 y/o presents with a history of pelvic pain for several years. She reports a history of domestic violence. Additional screening should be carried out for: A. Bipolar disorder B. Conversion disorder C. Pelvic floor muscle spasm D. Post-traumatic stress disorder E. Depression
A
E. Depression
22
Q
Which of the following antimicrobials can decrease the serum concentration of estrogen and progesterone in a woman taking combined oral contraceptives? A. Ampicillin B. Clindamycin C. Vancomycin D. Rifampin E. Imipenem
A
D. Rifampin
23
Q
A 53-year-old with ovarian cancer is receiving paclitaxel. Within seconds of the infusion she experiences flushing, shortness of breath, and chest pain. The most likely cause of these symptoms is: A. Anxiety B. Fluid overload C. Gastroesophageal reflux D. Hypersensitivity E. Myocardial ischemia
A
D. Hypersensitivity
24
Q
22 y/o G1P0 presents at 8 weeks by U/S. She has a history of a seizure disorder and takes valproic acid. She has not had a seizure in 3 years. The most important plan is to:
A. Discontinue the valproic acid
B. Taper the valproic acid and initiate treatment with lamotrigine (Lamictal)
C. Begin folic acid 4mg per day
D. Perform an amniocentesis at 16 wks
E. Perform Quad screen and U/S in 2nd trimester
A
E. Perform Quad screen and U/S in 2nd trimester
25
```
You are counseling a 22-year-old for starting oral contraceptives. Which of the following do you advise she will have increased risk for?
A. Chlamydia infection
B. Endometrial cancer
C. HSV infection
D. Ovarian cancer
E. Uterine leiomyomas
```
A. Chlamydia infection
26
In the treatment of thyroid storm, all of the following are appropriate management EXCEPT
A. PTU 1000mg load, then 600mg q6hr
B. Iodine 1-2 hrs. after PTU administration
C. Beta blocker (i.e. Labetalol)
D. Potassium Chloride
E. Dexamethasone
D. Potassium Chloride
27
A 17 y/o G0 undergoes an exploratory laparotomy for a 9 cm pelvic mass. A frozen section of the right sided mass shows Schiller-Duval bodies. The next best step is:
A. Close abdomen and observation
B. Bilateral oophorectomy, close and chemotherapy
C. Right Adnexectomy and chemotherapy
D. TAH LSO
E. TAH LSO and chemotherapy
C. Right Adnexectomy and chemotherapy
28
```
During a properly performed mediolateral episiotomy, the muscle that is transected is the:
A. Bulbocavernosis
B. External anal sphincter
C. Ischiocavernosus
D. Pubococcygeus
E. Pyramidalis
```
A. Bulbocavernosis
29
29-year-old is admitted with bilateral ruptured TOA’s. Following a hysterectomy, there is gross contamination of the incision. You irrigate with saline. How will you close the subcutaneous fat and skin?
A. Staples
B. Smead-Jones closure
C. Leave open and pack with antibiotic gauze
D. Subcuticular closure with 4-0 nylon
E. Staples and closed suction drains
C. Leave open and pack with antibiotic gauze
30
```
All the following are extraintestinal manifestations of Crohn’s Disease EXCEPT?
A. Glaucoma
B. Venous Thromboembolism
C. Renal Calculi
D. Osteoporosis
E. B12 Deficiency
```
A. Glaucoma
31
```
On average, epidural analgesia prolongs the second stage of labor by how many minutes?
A. 5 – 10 minutes
B. 15 – 20 minutes
C. 25 – 25 minutes
D. 30 – 40 minutes
E. 1 Hour
```
A. 5 – 10 minutes
32
```
Prophylactic salpingo-oophorectomy reduces the risk of breast cancer in a woman with a BRCA2 mutation by what percentage?
A. 5%
B. 10%
C. 20%
D. 30%
E. >40%
```
E. >40%
33
```
The obturator artery originates from which of the following vessels?
A. Internal iliac artery
B. Umbilical artery
C. External iliac artery
D. Descending Aorta
E. Inferior Gluteal artery
```
A. Internal iliac artery
34
```
A 25-year-old G0P0 presents for contraception. History includes dysmenorrhea and menorrhagia for which she took oral contraceptive pills. She has difficulty with compliance. What would you counsel her on for further treatment:
A. Diaphragm
B. Combination oral contraceptives
C. Levonorgestrel intrauterine device
D. Bilateral tubal ligation
E. Hysterectomy
```
C. Levonorgestrel intrauterine device
35
```
In order to diagnose a primary orgasmic disorder in a patient with a history of anorgasmia, she may also have:
A. Depression
B. Decreased libido
C. Vaginal dryness
D. Interpersonal difficulty
E. Suicidal ideation
```
D. Interpersonal difficulty
36
```
Which portion of an immature teratoma is most important to evaluate the grade of the tumor?
A. Calcifications
B. Cystic fluid
C. Neuroepithelium
D. Squamous epithelium
E. Thyroid elements
```
C. Neuroepithelium
37
```
A 32 y/o G1P0 at 38 weeks gestation presents in active labor. She has a known history of asymptomatic Aortic Stenosis. Which of the following is the first step in her management?
A. Pulmonary artery catheterization
B. Initiate recommended vasodilator
C. Close observation
D. Initiate Beta blocker therapy
E. Initiate diuretic therapy
```
C. Close observation
38
```
What gestational age is delivery indicated for stable chronic hypertension?:
A. 32 weeks
B. 34 weeks
C. 36 weeks
D. 38 weeks
E. 40 weeks
```
D. 38 weeks
39
A 56-year-old obese woman presents with Pap results showing Atypical Glandular Cells (AGC). The most appropriate management is:
A. Repeat pap in 3 months
B. Endometrial and endocervical sampling
C. Colposcopy with directed biopsies and ECC
D. Colposcopy with directed biopsies, ECC and endometrial biopsy
E. Cone biopsy with endometrial curettage
D. Colposcopy with directed biopsies, ECC and endometrial biopsy
40
A 56 y/o woman was exposed to DES in utero. Her recent colposcopy showed signs of punctuation and mosaicism of the anterior vaginal fornix. The most likely abnormal histologic diagnoses is:
A. Micro invasive squamous cell carcinoma
B. Clear cell adenocarcinoma
C. Adenocarcinoma
D. Severe dysplasia
E. Metaplasia
B. Clear cell adenocarcinoma
41
```
Which of the following is not a finding associated with neonatal abstinence syndrome?
A. High pitched cry
B. Poor feeding
C. Seizures
D. Uncoordinated sucking
E. Irritability
```
C. Seizures
42
```
Neonatal encephalopathy develops in 40 percent of newborns with a base deficit of which of the following?
A. 4-8 mmol/L
B. 8-10 mmol/L
C. 10-12 mmol/L
D. 12-16 mmol/L
```
D. 12-16 mmol/L
43
A gravida presents at 14 weeks gestation with Anti Rh- E titer of 1:128. If the paternal test is negative for the E antigen, what is the best management?
A. Termination of pregnancy B. MCA Doppler
C. Repeat titers in 4 weeks
D. Observation
E. Amniocentesis
D. Observation
44
```
Most states require that physicians who take a leave of absence greater than how many months need to participate in a physician re-entry program?
A. 6 months
B. 12 months
C. 24 months
D. 18 months
E. 36 months
```
C. 24 months
45
Which of the following is NOT a metabolic change identified in women taking oral contraceptives?
A. Elevated serum fibrinogen levels
B. Lowered serum free testosterone levels
C. Increased serum levels of triglycerides
D. Decreased total cholesterol
E. Elevated total plasma T4
D. Decreased total cholesterol
46
Which of the following is a short term benefit of Cesarean Delivery on maternal request compared with planned vaginal delivery?
A. Decreased subsequent placenta accreta
B. Decreased subsequent uterine rupture
C. Decreased hospital stay
D. Decreased risk for postpartum hemorrhage
E. Decreased risk for neonatal respiratory morbidity
D. Decreased risk for postpartum hemorrhage
47
```
Findings of this lemon sign and/or “banana sign” on ultrasound are most consistent with which congenital anomaly?
A. Holoprosencephaly
B. Open neural tube defect
C. Tetralogy of fallot
D. Absent corpus callosum
E. DiGeorge Syndrome
```
B. Open neural tube defect
48
```
The most common risk factor for early pregnancy loss is
A. Advanced maternal age
B. Maternal obesity
C. Maternal diabetes
D. Maternal hypertension
E. Maternal thyroid disease
```
A. Advanced maternal age
49
```
Which of the following is not a side effect of CHANTIX® (varenicline)?
A. Nausea
B. Anxiety
C. Insomnia
D. Depression
E. Abnormal dreams
```
B. Anxiety
50
```
Which of the following steps are most likely to prevent separation of the skin and superficial tissues in a patient with 5 cm of subcutaneous adipose tissue noted during CD?
A. Placement of a subcutaneous drain
B. Steri-strips
C. Pressure dressing
D. Subcuticular closing
E. Closure of subcutaneous space
```
E. Closure of subcutaneous space
