TEST BANK for Beckmann and Ling’s Obstetrics and Gynecology 8th Edition Casanova.

TEST BANK

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Beckmann and Ling’s Obstetrics and Gynecology 8th Edition Casanova Test Bank Chapter 1: Women’s Health Examination and Women’s Health Care Management 1: Elevating the head of the examining table approximately 30 degrees facilitates

a: the observation of the patient's responses b: the ability of the patient to comfortably look around to distract her from the examination c: the contraction of the abdominal wall muscle groups, making the examination easier d: comfortable blood pressure measurement e: the physician not being distracted by eye contact with the patient

2: Which of the following uterine positions is most associated with dyspareunia? a: Midposition, retroflexed b:

https://studentmagic.indiemade.com/ Retroverted, anteflexed c: Anteverted, anteflexed d: Retroverted, retroflexed e: Midpostion, anteflexed

3: Inquiry concerning adult and child history of sexual abuse should be included in the sexual history

a: if time permits b: in visits where there are suspicious physical findings but not otherwise c: in visits where sufficient time is allotted d: in all new patient visits e: in visits where a specific indication is noted

4: Peau d'orange change in the breast is associated with

a: edema of the lymphatics b: jaundice

https://studentmagic.indiemade.com/ c: too vigorous breastfeeding d: overly tight undergarments e: galactorrhea

5: Which kind of speculum is often most suitable for examination of the nulliparous patient?

a: Morgan's speculum b: Endoscopic speculum c: Ling speculum d: Graves speculum e: Pederson speculum

6: Which uterine configuration is most difficult to assess for size, shape, configuration, and mobility?

a: Midposition b: Anteverted c:

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There is no difference in difficulty d: Retroverted

7: Which type of speculum is most appropriate for the examination of a parous menstrual woman?

a: Ling speculum b: Graves speculum c: Pederson speculum d: Endoscopic speculum e: Morgan's speculum

8: Menopause is defined as the cessation of menses for greater than

a: 9 months b: 36 months c: 12 months d: 18 months

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e: 24 months

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

a: 3 months b: 9 months c: 12 months d: 18 months e: 6 months

10: During bimanual examination of the adnexa in normal premenopausal women, the ovaries are palpable

a: all the time b: almost never c: about one-half of the time d: about thee-quarters/most of the time

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e: about one-quarter of the time

11: If a patient becomes uncomfortable with a topic during a history-taking session, the best response of the physician is to

a: address the patient's discomfort in a positive and supportive manner b: discontinue discussion of the topic to avoid further patient discomfort c: discontinue discussion to avoid damage to the patient-physician relationship d: continue after making a joke to relieve tension e: ignore the discomfort and proceed with questioning

12: Which of the following statements about the steps in the breast examination is correct?

a: Palpation is done first b: Palpation and inspection are done simultaneously c: Palpation is only done if inspection is abnormal d: Palpation may be done with detailed inspection if a woman is especially modest

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e: Inspection is done first

13: Questions that promote the physician's fullest understanding of the patient's situation are best characterized as

a: compassionate b: chronological c: sympathetic d: emphatic e: evidence based

14: The last menstrual period is dated from the

a: first day of the last normal period b: last day of the last normal period c: first day of the last bleeding episode d: last day of the last bleeding episode

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15: The passage of clots during menstruation

a: is always abnormal b: may be either normal or abnormal c: is always normal d: is extremely rare

16: In the abbreviation of the obstetric history-G[1] P[2] [3] [4] [5]-"1" stands for the number of

a: living children b: pregnancies c: term pregnancies d: preterm pregnancies e: abortions

17: In the abbreviation of the obstetric history-G[1] P[2] [3] [4] [5]-"2" stands for the number of

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a: living children b: pregnancies c: term pregnancies d: preterm pregnancies e: abortions

18: In the abbreviation of the obstetric history-G[1] P[2] [3] [4] [5]-"3" stands for the number of

a: living children b: pregnancies c: term pregnancies d: preterm pregnancies e: abortions

19:

In the abbreviation of the obstetric history-G[1] P[2] [3] [4] [5]-"4" stands for the number of

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a: living children b: pregnancies c: term pregnancies d: preterm pregnancies e: abortions

20: In the abbreviation of the obstetric history-G[1] P[2] [3] [4] [5]-"5" stands for the number of

a: living children b: pregnancies c: term pregnancies d: preterm pregnancies e: abortions

21: Tanner's classification with respect to the breast relates to changes in the breast

a:

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before and after lactation b: associated with malignancy c: associated with maturation d: associated with galactorrhea e: associated with fibrocystic changes

22: The rectovaginal examination should be performed

a: after 52 years of age b: at the initial patient visit c: only for the evaluation of chronic pelvic pain d: only when there are symptoms of pelvic relaxation e: at intervals of 5 years

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

a:

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the duration of the pain b: the symptoms present (fever/chills, itching) c: the timing of pain in relation to menses d: the association of pain with body position e: the use of topical medications

24: The most common reason for failure to visualize the cervix during the speculum examination is

a: failure to use lubricant b: a full bladder c: failure to fully insert the speculum d: use of a speculum that has not been warmed e: use of the wrong speculum

25: Prehypertension is defined as a blood pressure range of

a: 80-90/120-139

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b: 90-100/120-139 c: 80-90/110-129 d: 70-80/110-129 e: 70-80/120-139 ANS: 1-25. [A, D, D, A, E, D, B, C,C,C,A,E,D,A,B,B,C,D,E,A,C,B,E,C,A]

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Chapter 2: The Obstetrician–Gynecologist’s Role in Screening and Preventive Care 1: The sensitivity of a screening test is defined as the proportion of

a: unaffected individuals that test positive b: affected individuals that test positive c: unaffected individuals that test negative d: affected individuals that test negative

2: The specificity of a screening test is defined as the proportion of

a: affected individuals that test negative b: unaffected individuals that test positive c: affected individuals that test positive d: unaffected individuals that test negative

3:

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Counseling an obese patient to lose weight is an example of

a: secondary prevention b: primary prevention c: empathy d: engagement

4: In women, the thyroid-stimulating hormone screening test should be performed at what interval?

a: Every 1-2 years from age 40 years, then yearly after age 50 years b: Every 5 years after age 50 years c: Annually from puberty or from the onset of sexual activity d: Every 5 years from age 19 years, then every 3-5 years after age 65 years

5: The Pap smear for cervical dysplasia should be performed at what interval?

a: Every 2-3 years after age 30 years if three consecutive annual tests are negative b:

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Every 5 years from age 19 years, then every 3-5 years after age 65 years c: Every 1-2 years beginning at age 65 years d: Every 1-2 years from age 40 years, then yearly after age 50 years

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

a: Every other year from age 40 years, then yearly after age 50 years b: Every 5 years after age 45 years c: Every 3-5 years after age 65 years d: Every 5 years from age 19 years, then every 3-4 years after age 65 years

7: A mammography to detect breast cancer should be performed at what interval in women at average risk?

a: Every 1-2 years after age 65 years b: Every 5 years after age 19 years, then every 3-4 years after age 65 years c: Every other year from age 40 years, then yearly after age 50 years d:

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Every 3-5 years after age 45 years

8: A colonoscopy to detect colorectal cancer should be performed at what interval for women at average risk?

a: Every 10 years starting at age 50 years b: Every 1-2 years starting at age 40 years c: Every 10 years starting at age 65 years d: Every 10 years from age 19 years, then every 3-4 years after age 65 years

9: Which of the following is the most appropriate screening mechanism for cervical dysplasia?

a: Pap smear b: Serum HPV titer c: HPV-DNA testing d: Colposcopy of suspicious lesions

10: Which of the following is the most appropriate screening mechanism for colorectal cancer?

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a: Hemogram b: Colonoscopy c: Physical examination of suspicious lesions d: CT scan

11: Which of the following is the most appropriate screening mechanism for thyroid disease?

a: Thyroid-stimulating hormone b: Free thyroxine c: Yearly physician examination d: Thyroid-binding globulin

12: What is the appropriate interval for Pap testing in women who have had a total hysterectomy for reasons other than cervical dysplasia?

a: Every 2 years following the hysterectomy b:

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Every 5 years following the hysterectomy c: No additional Pap testing is needed d: Every year following the hysterectomy

13: In sexually active women age 25 or younger, regular screening for Chlamydia should occur

a: only if the woman is at high risk for infection b: every 3-5 years c: annually d: every 2 years

14: Bone mineral density testing is recommended for women without risk factors for osteoporosis beginning at what age?

a: 40 years b: 65 years c: 50 years d:

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Testing is not recommended for women with no risk factors

15: A 40-year-old woman comes for an initial visit. Her BMI is 30 and she had previously given birth to an infant weighing 9.5lb. Which of the following initial screening tests is indicated for this patient?

a: Fasting blood glucose b: Colonoscopy c: TSH level d: Bone mineral density testing ANS: [b,d,b,b,a,b,c,a,a,b,a,c,c,b,a]

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Chapter 3: Ethics, Liability, and Patient Safety in Obstetrics and Gynecology 1: The principle that the patient should be given what is "due" most closely matches the principle of

a: justice b: nonmaleficence c: beneficence d: autonomy

2: The principle that there should be respect for the patient's right to make choices based on her beliefs and values best matches the principle of

a: beneficence b: nonmaleficence c: justice d:

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autonomy

3: The principle that there is a duty not to inflict harm or injury best matches the principle of

a: nonmaleficence b: autonomy c: justice d: beneficence

4: The principle that there is a duty to promote the well-being of the patient best matches the principle of

a: justice b: autonomy c: beneficence d: nonmaleficence

5: A 32-year-old patient has delivered at 23 weeks of gestation, 3 days after premature rupture of the membranes. She has discussed the circumstances with her obstetrician and requests that no attempts at

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resuscitation should be made. At delivery there are rare gasping, breathing movements. The pediatrician recommends that intubation be done. In this case, the individual with the clearest primary responsibility for this decision is the

a: obstetrician b: pediatrician c: hospital risk manager d: mother e: hospital attorney

6: Respect for patient wishes (autonomy) primarily requires that there be assessment of which of the following?

a: Cost of the proposed treatment b: The legal risk to the physician and hospital c: Patient's ability to consider information d: Physician's concurrence with the patient's wishes e: Standards of care

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7: A 62-year-old woman with newly diagnosed stage III ovarian cancer refuses chemotherapy. She wants to "go home to die." The next step in evaluating this patient is to

a: determine insurance coverage for this action b: call the family for a conference c: accept the patient's wishes and discharge her from the hospital d: call the state medical licensing board and hospital attorney e: assess the patient's comprehension and look for evidence of impaired decision making

8: If a pregnant woman rejects medical recommendations, relying on care given in similar cases would be an example of

a: principle-based ethics b: virtue-based ethics c: feminist ethics d: communication-based ethics e: case-based ethics

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9: The concept of informed consent best relates to the principle of

a: autonomy b: justice c: beneficence d: nonmaleficence

10: Paternalism violates the ethical principle of

a: nonmaleficence b: beneficence c: standard of care d: justice e: autonomy

11: The person with primary responsibility to providing informed consent is

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a: the person or physician's staff assigned the task b: the patient c: the social worker assigned to the patient d: the hospital administrator e: the physician

12: In medical liability cases the complaint comes from the

a: defendant b: judge c: jury d: attorney e: plaintiff

13: Most medical errors are associated with

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a: the use of care guidelines b: the use of medications c: the use of standards of care d: the use of hospital regulations e: the use of improper surgical technique

ANS:[a,d,a,c,d,c,e,e,a,e,e,e,b]

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Chapter 4: Embryology and Anatomy 1: The genital system develops from the embryonic

a: yolk sac b: endoderm c: mesoderm d: ectoderm e: cytotrophoblast

2: The urogenital ridges give rise to elements of the

a: cardiovascular system b: reproductive system c: muscular system d:

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skeletal system e: gastrointestinal system

3: Congenital adrenal hyperplasia ultimately affects the development of the genitalia of female fetuses through the

a: stimulation of cortisol production b: stimulation of cortisone production c: stimulation of androgen production d: inhibition of the SRY gene e: inhibition of the WNT4 gene

4: Primary oocytes first appear at what stage of development

a: In the primordial follicles b: At puberty c: In the primary sex cords d:

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At birth e: In the embryonic yolk sac

5: Primordial germ cells can be identified during the third week of development in the

a: vaginal plate b: urogenital sinus c: cortical cords d: gonadal ridge e: yolk sac

6: In the female, which of the following persists to form the major parts of the reproductive tract?

a: Mesonephric (wolffian) ducts b: Prmary sex cords c: Paramesonephric (Mullerian) ducts d: Gubernaculum

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7: Gartner cysts result from remnants of the

a: tunica albuginea b: primary sex cords c: Mullerian ducts d: mesonephric ducts

8: Transverse ultrasonography can begin to reliably distinguish between the two sexes at about how many weeks of gestation

a: 15 weeks b: 5 weeks c: 10 weeks d: 20 weeks e: 25 weeks

9:

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Which of the following results in the absence of the uterus?

a: Degeneration of the Mullerian ducts b: Degeneration of the mesonephric ducts c: Lack of fusion of the inferior parts of the paramesonephric ducts d: Failure of migration of the primordial germ cells

10: Which of the following results in the formation of a double uterus (uterus didelphys)?

a: Lack of fusion of the inferior parts of the Mullerian ducts b: Failure of migration of the primordial germ cells c: Degeneration of the mesonephric ducts d: Degeneration of the Mullerian ducts

11: The labia minora develop from the

a: urogenital folds b:

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labioscrotal swellings c: urogenital sinus d: genital tubercle

12: The labia majora develp from the

a: labioscrotal swellings b: urogenital sinus c: genital tubercle d: urogenital folds

13: The clitoris develops from the

a: urogenital folds b: genital tubercle c: labioscrotal swellings d: urogenital sinus

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14: In the female, the embryologic homologue of the penis is the

a: frenulum b: labia majora c: labia minora d: clitoris

15: The false pelvis and the true pelvis are separated by the

a: linea terminalis b: acetabulum c: obturator membrane d: pelvic outlet e: sacrospinous ligament

16: The diagonal conjugate is defined as the distance

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a: between the true and false pelvis b: between the lower border of the pubis anteriorly and the lower sacrum at the level of the ischial spines c: between the upper border of the pubis anteriorly and the lower sacrum at the level of the ischial spines d: measured at the greatest width of the superior aperture e: between the ischial spines

17: Which of the following contains the uterine arteries and veins and the ureters?

a: Infundibulopelvic ligament b: Broad ligament c: Uterosacral ligament d: Sacrospinal ligament e: Cardinal ligament

18: The ligament that provides primary support to the uterus is the

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a: uterosacral ligament b: infundibulopelvic ligament c: broad ligament d: sacrospinal ligament e: cardinal ligament

19: The epithelial lining of the fallopian tube is

a: Columnar b: Transitional c: Simple squamous d: Stratified columnar e: Stratified squamous

20: The fallopian tubes enter into which part of the uterus

a:

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Fundus b: Cornu c: SQ junction d: Lower uterine segment e: Mesosalpinx 21: The two main anatomic divisions of the uterus are the corpus and the

a: uterotubal junction b: cornu c: fundus d: isthmus e: cervix ANS: [c,b,c,a,e,c,d,a,a,a,a,a,b,d,a,b,b,a,a,b,e]

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Chapter 5: Maternal–Fetal Physiology 1: Oxygen crosses the placenta by

a: pinocytosis b: facilitated diffusion c: simple diffusion d: active transport e: phgocytosis

2: Glucose crosses the placenta by

a: facilitated diffusion b: simple diffusion c: active transport d: phagocytosis e: pinocytosis

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3: Amino acids cross the placenta by

a: facilitated diffusion b: active transport c: pinocyctosis d: simple diffusion e: phagocytosis

4: Pregnancy has what effect on gastric motility?

a: Gastric motility typically remains the same b: The effect on gastric motility is unpredictable c: Gastric motility typically increases d: Gastric motility typically decreases

5: Pregnancy has what effect on gastric reflux?

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a: The effect on gastric reflux is unpredictable b: Gastric reflux is typically unaffected c: Gastric reflux typically decreases d: Gastric reflux typically increases

6: "Morning sickness" typically begins during which weeks of pregnancy?

a: 1-3 weeks b: 16-22 weeks c: 10-12 weeks d: 14-18 weeks e: 4-8 weeks

7: Changes in gastrointestinal motility during pregnancy are related to increased levels of

a: thyrotropin-releasing factor b:

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human chorionic gonadotropin c: estrogen d: oxytocin e: progesterone

8: Transit time in the stomach and small bowel increases by what percent in the second and third trimesters of pregnancy?

a: 60%-70% b: 1%-15% c: 45%-60% d: 30%-45% e: 15%-30%

9: Epulis is a pregnancy-related vascular swelling of the

a: larynx b:

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pharynx c: nares d: gums e: epiglottis

10: Which of the following pulmonary measurements is decreased in pregnancy?

a: Carbon dioxide pressure b: Tidal volume c: Oxygen pressure d: Oxygen requirement e: Residual volume

11: During pregnancy, total body oxygen consumption

a: decreases by 50% from nonpregnant levels b: increases by 20% from nonpregnant levels

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c: increases by 50% from nonpregnant levels d: decreases by 20% from nonpregnant levels e: increases by 70% from nonpregnant levels

12: By term in a normal pregnancy, maternal blood volume

a: increases by 15% b: increases by 50% c: decreases by 15% d: decreases by 35% e: increases by 35%

13: Iron supplementation in pregnancy is mainly used to

a: maintain fetal hemoglobin concentration b: prevent iron deficiency in the mother c:

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maintain maternal hemoglobin concentration d: prevent iron deficiency in both the mother and the fetus e: prevent iron deficiency in the fetus

14: Which of the following measures of pulmonary function decreases in late pregnancy?

a: Tidal volume b: Residual volume c: Respiratory rate d: Expiratory volume e: Inspiratory capacity

15: The increased nasal stuffiness and perception of increased nasal secretions during prenancy are associated with

a: increased immunoglobulin production b: increased interluminal production of mast cell toxins c:

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increased airway conductance d: decreased airway conductance e: mucosal hyperemia

16: Maternal arterial blood gas analysis during pregnancy would show

a: mild metabolic acidosis b: mild respiratory alkalosis c: mild metabolic alkalosis d: mild respiratory acidosis e: moderate metabolic alkalosis

17: As compared with the nonpregnant state, the risk of thromboembolism during pregnancy

a: is not effected by pregnancy b: is increased during pregnancy and in the puerperium c: is decreased during prengnancy and in the puerperium

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d: is increased during pregnancy and decreased in the puerperium e: is decreased during pregnancy and increased in the puerperium

18: Displacement of the maternal heart during pregnancy is caused by

a: constriction of the anteroposterior diameter of the thorax b: enlargement of the liver c: elevation of the diaphragm d: widening of the mediastinum e: increased lung volume

19: Which of the following best describes the change in position of the maternal heart during pregnancy?

a: Displaced downward and to the right into a more vertical position b: Displaced upward and to the left into a more horizontal position c: Displaced upward and to the right into a more horizontal position d:

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Displaced downward and to the left into a more vertical position e: Displaced further into the thoracic cavity

20: When do changes in maternal cardiac output begin during pregnancy?

a: Early second trimester b: First trimester c: Late first trimester d: Third trimester e: Late second trimester

21: As compared with the nonpregnant state, the overall increase in maternal cardiac output during pregnancy is approximately

a: 30%-50% b: 10%-20% c: 5%-10% d:

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50%-60% e: 60%-80%

22: Which of the following factors contributes to the changed maternal cardiac output during pregnancy?

a: Increased peripheral vascular resistance b: Decreased maternal heart rate c: Increased stroke volume d: Decreased stroke volume e: Increased venous return

23: During pregnancy, maternal ciculating blood volume increases about how much over nonpregnant levels?

a: 30% b: 60% c: 45% d:

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5% e: 15%

24: When does the increase in circulating maternal blood volume reach its peak during pregnancy?

a: 18 weeks b: 32 weeks c: 12 weeks d: 38 weeks e: 24 weeks

25: What percent of cardiac output does the uterus receive at term?

a: 10% b: 30% c: 20% d: 40%

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e: 50%

26: Occlusion of the vena cava by the gravid uterus results in shunting of venous return from the lower extremities primarily through the

a: mesenteric circulation b: portal vein circulation c: paravertebral circulation d: ovarian circulation e: renal circulation ANS: [c,a,b,d,d,e,d,e,d,a,b,e,b,b,e,b,b,c,b,b,a,c,c,b,c,c]

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Chapter 6: Preconception and Antepartum Care A 22-year-old primigravida patient who is approximately 3 months' pregnant expresses concern that she has not felt the baby move yet. She should be informed that "quickening" generally occurs at how many weeks of gestation?

a: 12-14 b: 8-10 c: 22-24 d: 18-20

2: Congestion and a bluish color of the vagina in early pregnancy is called

a: Stoppard sign b: Newman sign c: Hegar sign d: Chadwick sign

3: A softening of the cervix on physical examination in early pregnancy is referred to as

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a: Doderlein sign b: Hegar sign c: Naegele sign d: Chadwick sign

4: Fetal heart tones in a normal, viable pregnancy may routinely be heard by simple, nonelectrically amplified auscultation at or beyond how many weeks of gestational age?

a: 12-14 b: 18-20 c: 21-23 d: 15-17

5: Commonly used electronic Doppler devices will usually detect fetal heart tones initially at approximately how many weeks of gestation?

a: 12

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b: 10 c: 8 d: 14

6: A 21-year-old patient whose last menstrual period started 3 weeks ago calls the doctor's office because she is concerned that she might be pregnant. She should be informed that home urine pregnancy tests typically become positive approximately how many weeks following the first day of the last normal menstrual period?

a: 6 b: 2 c: 4 d: 8

7: A 30-year-old patient with a history of ectopic pregnancy presents with 5 weeks of amenorrhea and a positive home pregnancy test. Intrauterine pregnancy is generally detectable by transvaginal ultrasonography when the beta-human chorionic gonadotropin concentration is greater than

a: 5,000-6,000 mIU/mL b:

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3,000-4,000 mIU/mL c: 1,000-2,000 mIU/mL d: 500-750 mIU/mL

8: "Normal" pregnancy lasts 40 weeks from the first day of the last menstrual period with a margin of error of how many weeks?

a: 1 b: 4 c: 3 d: 2

9: A woman comes for her initial prenatal visit and wants to know her estimated date of delivery (EDD).

Her last menstrual period began January 14. According to Naegele's rule, her EDD will be

a: October 1 b: October 14 c: October 21

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d: October 28

10: In normal singleton pregnancy, from 18 weeks of gestation until 36 weeks of gestation, the fundal height in centimeters is roughly equal to

a: one-half the number of weeks of gestational age b: the number of weeks of gestational age minus 5 c: the number of weeks of gestational age d: twice the number of weeks of gestational age

11: In a woman with a BMI in the normal range, the generally prescribed recommendation for weight gain during pregnancy is

a: 15-20 lb b: 25-35 lb c: 50-55 lb d: 40-45 lb

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12: A 25-year-old primigravida patient at 24 weeks of gestation has gained 8 lb since her last prenatal visit a month ago. What is the most appropriate initial intervention?

a: Insulin b: Dietary counseling c: Hospitalization d: Metformin

13: A 25-year-old G2P1 patient at 20 weeks of gestation is concerned that her child will be breech like her first child was. She can be informed that cephalic presentation occurs in what percentage of deliveries?

a: 15% b: 3.5% c: 95% d: 1%

14: At 36 weeks of gestation, examination in the office reveals that the fetus is in breech presentation.

Breech presentation occurs in what percentage of deliveries?

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a: 3.5% b: 1% c: 95% d: 15%

15: An ultrasound performed at 30 weeks of gestation shows the fetus to be lying transverse. An explanation of the implications of this finding may include the reassurance that shoulder presentation occurs in what percentage of deliveries?

a: 3.5% b: 95% c: 1% d: 15%

16: An abnormal contraction stress test includes which of the following fetal heart rate findings?

a: Decreases in response to maternal respirations b:

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Increases in response to maternal position change c: Decreases in response to a uterine contraction d: Increases in response to fetal movement

17: A biophysical profile in which there is one or more episodes of fetal breathing in 30 minutes, three or more discrete movements in 30 minutes, opening/closing of the fetal hand, a nonreactive nonstress test, and no pockets of amniotic fluid greater than 1 cm would have a total score of

a: 4 b: 8 c: 2 d: 6

18: Exclusive of the fetal heart rate reactivity, which of the following elements of the biophysical profile is generally considered most important?

a: Fetal breathing b: Qualitative amniotic fluid volume c: Fetal tone

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d: Gross body movement

19: Repetitive decelerations following each contraction when three contractions occur in a 10-minute window is generally an indication of

a: fetal well-being b: nonreassuring fetal status c: increased placental blood flow d: reduced amniotic fluid

20: At how many weeks of gestational age does phospholipid production increase, resulting in a positive phosphatidylglycerol test?

a: 33 b: 31 c: 35 d: 29

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21: In counseling a patient about activities during the antepartum period, which of the following activities is generally contraindicated?

a: Regular, non-weight-bearing activity on a three-times-per-week schedule b: Bathtub bathing c: Supine exercises d: Air travel after 28 weeks

22: A 20-year-old pregnant patient requests information about food cravings in pregnancy. She should be informed that pica is often associated with which of the following?

a: Hyperthyroidism b: Anemia c: Substance abuse d: Diabetes

23: At the initial prenatal visit, a 30-year-old primigravida woman asks about traveling for business purposes. Which of the following recommendations is appropriate?

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a: Limit air travel to the first two trimesters b: Avoid travel of any kind after 36 weeks c: Avoid extended periods of inactivity d: Use seat belts up to 20 weeks of gestation

24: The FDA category PRF X carries what important clinical implication?

a: Animal reproduction studies have demonstrated an adverse fetal effect and there are no controlled human studies b: Controlled human studies demonstrate no evidence of risk in pregnancy in any trimester c: Adequate studies have demonstrated positive evidence of fetal risk d: Animal reproduction studies have not demonstrated fetal risk and there are no controlled human studies

25: A 24-year-old pregnant woman asks about the use of medications given prior to pregnancy by her other physicians. Which FDA pregnancy risk factor category is characterized by the presence of human studies in which there is no demonstrable fetal risk during pregnancy?

a: D

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b: C c: B d: A

26: Which of the following effects to the fetus is associated with maternal ingestion of tetracyclines?

a: Hemolytic anemia b: Irreversible arthropathies c: Discoloration of deciduous teeth d: Hyperbilirubinemia

27: Fetal abnormal facies, cleft lip or palate, and microcephaly are associated with maternal ingestion of which of the following drugs during pregnancy?

a: Heparin b: Thiazide diuretics c: Sulfonamides

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d: Phenytoin

28: A 23-year-old pregnant woman who complains of constipation should be informed that physiologic constipation in pregnancy is associated with

a: increased bulk b: decreased water absorption c: decreased blood flow to the gut d: increased transit time

29: Due to the position of the fetus, round ligament pain is often more pronounced

a: in the center b: on the right side c: on the left side d: in the fundus

30:

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For which of the following conditions should all pregnant women be tested?

a: Tay-Sachs b: Sickle cell disease c: Tuberculosis d: HIV ANS:[d,d,b,b,a,c,c,d,c,c,b,b,c,a,c,c,d,b,b,c,c,b,c,c,d,c,d,d,b,d]

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Chapter 7: Genetics and Genetic Disorders in Obstetrics and Gynecology 1: A DNA replication error that results in one amino acid being substituted for another is termed a(n)

a: Missense mutation b: Deletion mutation c: Nonsense mutation d: Insertion mutation

2: During which phase of meiosis is an error most likely?

a: Anaphase I b: Meiosis II c: Metahase I d: Prophase I

3: Which of the following is an example of euploidy? a:

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47, XXY b: 46, XX c: 45, X d: 69, XXX

4: Trisomy 21 is an example of which type of chromosomal anomaly?

a: Ring chromosome b: Aneuploidy c: Euploidy d: Deletion mutation

5: A Robertsonian translocation in the mother increases the risks to her fetus of which of the following conditions?

a: Spina bifida b: Anencephaly c:

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Fragile X syndrome d: Down syndrome

6: Which of the following conditions is inherited through autosomal dominant inheritance?

a: Tay-Sachs disease b: Huntington disease c: Phenylketonuria d: Cystic fibrosis

7: The parents of a child found to have Marfan syndrome are planning to conceive in the future, and inquire about the inheritance pattern of this condition. They should be informed that the inheritance pattern is

a: multifactorial b: autosomal dominant c: X-linked d: autosomal recessive

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8: In autosomal dominant inheritance, the affected parent passes the disease to

a: twice as many male offspring as females b: one-half of the offspring c: twice as many female offspring as males d: one-half of female offspring

9: First trimester screening tests are performed to determine the risk of what abnormality in addition to trisomy 13 and trisomy18?

a: Hemophilia b: Klinefelter syndrome c: Turner syndrome d: Down syndrome

10: A woman who has previously had a child with a neural tube defect should take a daily prenatal vitamin in subsequent pregnancies that contains how much folic acid?

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a: 40 mg b: 0.04 mg c: 0.4 mg d: 4 mg

11: An ultrasound confirms a 7-week intrauterine gestation. If nuchal transparency measurement is to be used to aid in the detection of Down syndrome, the next ultrasound should be performed in how many weeks?

a: 8 b: 2 c: 4 d: 12

12: Trisomy 16 is characterized by which of the following clinical scenarios?

a: Rarely survives to 3 years of age

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b: Multisystem failure within a year of birth c: Cardiac arrest within 3 days of birth d: No live births

13: Which of the following is more common than trisomy 18 (Edwards syndrome)?

a: Turner syndrome b: Trisomy 21 (Down syndrome) c: Trisomy 13 (Patau syndrome) d: Cridu chat syndrome

14: Individuals with which of the following chromosomal abnormalities are most likely to live into adulthood?

a: Trisomy 21 b: Trisomy 16 c: Trisomy 13

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d: Trisomy 18

15: First trimester screening reveals that a woman is at increased risk for carrying a fetus with Down syndrome. She elects to undergo amniocentesis. This is typically performed between what weeks of gestation?

a: 8 and 10 weeks b: 15 and 20 weeks c: 22 and 26 weeks d: 30 and 34 weeks

16: During her initial visit for this pregnancy, a couple inquires about the potential value of chorionic villus sampling. Which of the following conditions cannot be diagnosed by this technique?

a: Down syndrome b: Trisomy 13 c: Trisomy 18 d: Neural tube defects

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17: A 33-year-old patient comes to you for her annual gynecologic exam. In the course of obtaining her history, she tells you that her aunt was diagnosed with breast cancer at age 49 and that her grandfather had lung cancer. She is not of Ashkenazi Jewish origin. You tell her that you recommend which of the following?

a: HPNCC testing b: BRCA 1 and BRCA 2 testing c: Annual clinical breast exams and no further testing at this time d: BRCA 1 testing only

18: The level of alpha-fetoprotein in amniotic fluid is normal in which of the following conditions?

a: Anencephaly b: Spina bifida c: Omphalocele d: Postmaturity

19: The increased availability of what test has resulted in a declining reliance on PUBS?

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a: FISH b: Early amniocentesis c: Fetoscopy d: CVS

20: Which of the following is an accurate description of a germ cell?

a: Two sets of chromosomes b: Gamete c: 2n d: Diploid

21: Which of the following karyotypes is an example of mosaicism?

a: 46, XX/XY b: 47, XXY c:

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47, XXX d: 45, X

22: In autosomal recessive disorders, which parent(s) is/are usually affected?

a: Father always b: Both c: Mother usually d: Neither

23: Color blindness has what kind of inheritance pattern?

a: Autosomal dominant b: X-linked c: Multifactorial d: Autosomal recessive

24:

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In counseling a couple about the role of first trimester screening, the difference between the "triple screen" and the "quadruple screen" should be described as the addition of which marker?

a: hCG b: Estriol c: MSAFP d: Inhibin A

25: In obtaining informed consent regarding chorionic villlus sampling (CVS), the provider should inform the patient that which of the following is the most common complication?

a: Infection b: Bleeding c: Pregnancy loss d: Limb reduction ANS: [a,a,d,b,d,b,b,b,d,d,c,d,b,a,b,d,c,d,a,b,a,d,b,d,b]

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Chapter 8: Intrapartum Care A 22-year-old primigravid patient at 38 weeks gestation calls the office stating that she has had "bloody show." She should be informed that this is related to which of the following?

a: Quickening b: Effacement of the cervix c: Braxton Hicks contractions d: Lightening

2: True labor is associated with contractions that the patient feels in what area?

a: Low abdomen b: Bilateral round ligaments c: Low back d: Uterine fundus

3: A 23-year-old primigravid patient at 36 weeks of gestation asks under what circumstances she should call the office. Which of the following would warrant a phone call?

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a: Loss of the mucus plug b: Back pain c: Contractions every 10 minutes d: Decreased fetal movement

4: When is the optimal time for auscultation of fetal heart tones during labor?

a: At the peak of a contraction b: Immediately following a contraction c: Halfway between contractions d: Immediately prior to a contraction

5: The portion of the fetus that is lowest in the birth canal is defined by what term?

a: Lie b: Position c:

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Attitude d: Presentation

6: Which of the following accurately describes the uterine wall during a true contraction?

a: Not easily indented b: Expuisitely tender to palpation c: Changes shape d: Indents by itself

7: In a vertex presentation, if the anterior fontanel is palpated on the maternal left and the posterior fontanel is felt on the maternal right, what is the position?

a: ROT b: LOT c: OA d: OP

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8: Fetal station is defined by the relationship of the presenting part and by which maternal anatomic landmark?

a: Pubic symphysis b: Ischial spines c: Coccyx d: Sacral promontory

9: Engagement of the fetal head in labor can be misinterpreted under what circumstances?

a: Maternal obesity b: Epidural anesthesia c: Molding d: Ruptured membranes

10: A 30-year-old multiparous patient at 37 weeks of gestation presents to the hospital completely dilated.

Which of the following describes this stage of labor?

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a: First b: Third c: Second d: Fourth

11: The third stage of labor is marked by which of the following events?

a: Delivery of placenta b: Removal of epidural catheter c: Repair of episiotomy d: Inspection for lacerations

12: Which of the cardinal movements of labor best reflects the adequacy of the bony pelvis?

a: Flexion b: Expulsion c:

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Internal rotation d: Engagement

13: When does the greatest rate of descent occur?

a: Latent phase of first stage of labor b: Second stage of labor c: Prior to the onset of labor d: During extension of the fetal head

14: Oral intake in labor is restricted due to what concern?

a: Diarrhea b: Reflux c: Decreased gastrointestinal peristalsis d: Nausea

15:

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A 25-year-old primigravid patient verbalizes a desire to avoid electronic fetal monitoring while in labor.

She should be informed that intermittent auscultation of fetal heart tones is appropriate in which of the following clinical circumstances?

a: Maternal temperature of 101 degrees F b: Third trimester bleeding c: Low-risk term pregnancy d: Intrauterine growth restriction

16: Pain during the first stage of labor is due to which of the following event?

a: Maternal position b: Dilation of cervix c: Effacement of cervix d: Descent of fetal presenting part

17: A 29-year-old primigravid patient at term presents complaining of labor contractions. She is found to be 4 cm dilated with reassuring fetal rate tracings. The most appropriate anesthetic technique to provide pain relief during labor and delivery for this patient is which of the following?

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a: Epidural b: Spinal c: Pudendal d: General

18: Maternal "pushing" efforts prior to the second stage of labor are associated with which of the following outcome?

a: Abruptio placentae b: Swelling of the cervix c: Uterine prolapse d: Fetal compromise

19: What finding at the time of rupture of membranes is most likely to represent an emergent situation?

a: Meconium staining of fluid b: Blood-tinged fluid

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c: Potential for infection d: Prolapsed umbilical cord

20: The presence of molding and/or caput succedaneum prior to the second stage of labor is suggestive of which significant finding?

a: Fetal anomaly b: Inadequate anesthesia c: Birth canal insufficient to allow passage of fetus d: Excessive uterine contractions

21: If an episiotomy is needed, when should it be performed?

a: After the perineum is thinned b: Prior to the fetal head reaching the perineum c: Just after a contraction d: After a perineal laceration has started forming

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22: Excessive traction to the neck during a vaginal delivery can be associated with injury to which of the following structure(s)?

a: Strap muscles b: Trachea c: Thyroid gland d: Brachial plexus

23: Uterine inversion is associated with what aspect of postpartum management?

a: Inspection of the birth canal b: Exploration of the uterine cavity c: Traction on the umbilical cord d: Manual removal of placenta

24: What degree is an obstetric laceration that extends to the rectal sphincter but not the mucosa?

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a: Third b: First c: Fourth d: Second

25: Which technique of labor induction allows for the greatest variability in dosing?

a: Amniotomy b: Membrane stripping c: Oxytocin d: Prostaglandins

26: A 36-year-old pregnant woman with a history of previous classical cesarean delivery requests a trial of labor after cesarean delivery. She should be informed of which of the following?

a: TOLAC is available if the fetus is not breech b: TOLAC is contraindicated

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c: TOLAC is available if epidural anesthesia is not used d: TOLAC can be done if no oxytocin is used ANS:[b,d,d,b,d,a,a,b,c,c,a,d,b,c,c,b,b,a,b,d,c,a,d,c,a,c,b]

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Chapter 9: Abnormal Labor and Intrapartum Fetal Surveillance Which of the following is the best predictor of successful vaginal birth?

a: Clinical pelvimetry b: Radiographic pelvimetry c: Descent of the presenting part during labor d: CT pelvimetry

2: A 30-year-old primigravid patient at term progresses from 4 cm dilation to 7 cm in 5 hours. How would this labor be described?

a: A protraction disorder b: An arrest disorder c: A normal labor d: A prolonged latent phase

3: A 22-year-old multiparous patient has been pushing for 2 hours resulting in no descent of the presenting part. This would be classified as

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a: a normal labor b: a prolonged latent phase c: an arrest disorder d: a protraction disorder

4: Which of the following maternal factors can prevent accurate clinical assessment of uterine contractions?

a: Preeclampsia b: Obesity c: Epidural anesthesia d: Third trimester bleeding

5: For a patient in active labor, which of the following provides a quantitative measurement of the strength of her uterine contractions?

a: "Indentation" of uterus on palpation during contraction

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b: Intrauterine pressure catheter c: Manual palpation of maternal abdomen d: Tocodynamometer

6: For a labor pattern to be considered optimal, contractions must generate peak intrauterine pressures of at least how many mm Hg?

a: 15 b: 25 c: 45 d: 35

7: The incidence of shoulder dystocia and possible need for cesarean delivery increase markedly if the fetus has an estimated weight of at least

a: 3,000 g b: 3,500 g c:

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4,000 g d: 2,500 g

8: Which of the following presentations typically coverts to either a vertex or face presentation?

a: Shoulder b: Brow c: Breech d: Compound

9: Normal fetal heart rate variability is characterized by an amplitude range that is

a: 6-25 bpm b: detectable but at 5 bpm or less c: greater than 25 bpm d: undetectable

10:

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Marked fetal heart rate variability is characterized by an amplitude range that is

a: >25 bpm b: undetectable c: detectable but at 5 bpm or less d: 6-25 bpm

11: Which of the following presentations usually resolves spontaneously as labor continues?

a: Breech b: Vertex c: Compound d: Shoulder

12: A 22-year-old G1P0 patient at term presents with complaints of contractinos for many hours. Her cervix is 100% effaced and dilated to 3cm. In a nulliparous patient, the latent phase of labor is defined as prolonged if it lasts longer than

a:

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10 hours b: 20 hours c: 25 hours d: 15 hours

13: A 37-year-old G4P3 patient reports having contractions "all day." In multiparous patients, the latent phase is defined as prolonged if it lasts more than

a: 10 hours b: 20 hours c: 24 hours d: 14 hours

14: A 30-year-old G2P1 at term is in adequate active labor with the cervical dilation unchanged at 6 cm as documented by several examiners. There has been secondary arrest of dilation when cervical dilation during the active phase of labor stops for at least

a: 2 hours b: 4 hours

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c: 1 hour d: 3 hours

15: Which of the following is the appropriate management of a prolonged latent phase?

a: Cesarean delivery b: Forceps delivery c: Vacuum extraction d: Sedation

16: A 25-year-old G1P0 patient at 32 weeks of gestation has a fetus in the breech position. She inquires about the likelihood of her fetus being in the breech position at the time of term delivery. What percent of singleton term deliveries are breech presentations?

a: 2% b: 7% c: 0.5% d:

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5%

17: Which of the following is a selection criterion that would allow for external cephalic version?

a: No uterine surgical scars b: Fetus less than 35 weeks of gestation c: Presenting part in the pelvis d: Oligohydramnios

18: Outlet forceps-assisted vaginal delivery is appropriately considered with the fetal head at what station?

a: Above the +2 station b: At the +2 station c: Outside the perineum d: At the pelvic floor

19: Low forceps-assisted vaginal delivery occurs with the fetal head at what station?

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a: Outside the perineum b: At the +2 station c: At the pelvic floor d: Above the +2 station

20: A patient has been in the second stage of labor for 2.5 hours. Fetal heart tones are reassuring and there is no clinical evidence of cephalopelvic disproportion. The next step in the management of this patient should be

a: forceps delivery b: immediate cesarean delivery c: oxytocin administration if uterine contractions are inadequate d: vacuum extraction

21: Vibroacoustic stimulation is used to elicit what type of fetal heart rate response?

a: Late deceleration b:

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Acceleration c: Variable deceleration d: Early deceleration

22: Amnioinfusion to relieve umbilical cord compression is useful in cases of

a: fetal heart rate acceleration b: early fetal heart rate deceleration c: late fetal heart rate deceleration d: variable fetal heart rate deceleration

23: If a fetus experiences progressive and sustained hypoxia, the mixed metabolic and respiratory acidosis that may ensue typically results from

a: aerobic gluconeogenesis b: anaerobic glycolysis c: aerobic glycolysis d:

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anaerobic gluconeogenesis

24: In high-risk cases, intermittent fetal heart rate auscultation to monitor fetal well-being should be employed at least how often during the active phase of labor?

a: Every 30 minutes b: Every 10 minutes c: Every 5 minutes d: Every 15 minutes

25: In high-risk cases, intermittent fetal heart rate auscultation to monitor fetal well-being should be employed at least how often in the second stage of labor?

a: Every 5 minutes b: Every 10 minutes c: Every 1 minute d: Every 20 minutes

26:

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Baseline fetal tachycardia is defined as a heart rate greater than how many beats per minute?

a: 120 b: 200 c: 160 d: 180

27: The most common cause of fetal tachycardia is

a: maternal hypothermia b: maternal anemia c: chorioamnionitis d: cord compression

28: Baseline fetal bradycardia is defined as a heart rate of less than how many beats per minute?

a: 110 b:

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80 c: 100 d: 140

29: A fetal heart rate below how many beats per minute is an ominous sign that may presage fetal death?

a: 60 b: 100 c: 80 d: 120

30: Fetal heart rate accelerations are associated with

a: reassuring fetal status b: fetal sleep c: hypoxia d: acidemia ANS: [c,a,c,b,b,b,c,b,a,a,c,b,d,a,d,a,a,d,b,c,b,d,b,d,a,c,c,a,c,a]

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Chapter 10: Immediate Care of the Newborn Following an emergency cesarean section for prolonged bradycardia, you delivered a viable infant. At 1 minute, the heart rate is less than 100 bpm, there is a weak cry, limp muscle tone, a grimace, and blue color throughout.

1: A.

The 1 minute Apgar score is

.

a: 3 b: 5 c: 4 d: 1 e: 2

2: B. An Apgar score of less than immediate resusucitative efforts.

a: 6 b: 5 c: 8

is suggestive of a severely depressed infant who requires

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d: 7 e: 4

3: C. A newborn who is apneic or gasping and has a heart rate of less than bpm usually requires positive pressure ventilation, which may be done with a face mask after clearing the airway.

a: 40 b: 80 c: 100 d: 60 e: 120

4: D. At 5 minutes, after vigorous resuscitation, the baby has a heart rate of more than 100 bpm, good respiratory effort, active muscular activity, a cry, and acrocyanosis. The 5-minute Apgar is

a: 6 b: 8 c:

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10 d: 9 e: 7

5: E.

The 5-minute Apgar score can appropriately be used to

a: identify an infant who needs further evaluation and management b: identify an infant at high risk for neurologic problems c: identify an infant with metabolic acidosis d: identify an infant with birth asphyxia e: identify an infant at risk for low IQ at 6 to 8 years of age

6: F.

During resuscitation of the newborn, metabolic well-being is best assessed by measurement of

a: umbilical cord blood gases b: heart rate c: blood urea nitrogen levels

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d: blood glucose levels e: respiratory rate

7: G. Acidemia is generally accepted as an increase in hydrogen ion concentration in an umbilical arterial sample resulting in a pH of .

a: <7.2 b: <7.0 c: <7.1 d: 7.4 e: 7.3

8: H. Fetal asphyxia is defined as a condition of impaired blood gas exchange leading to progressive hypoxemia and hypercapnia with a significant metabolic acidosis with a base deficit of .

a: 12 mmol/L b: 16 mmol/L c:

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14 mmol/L d: 18 mmol/L e: 10 mmol/L

A young woman presents to your clinic for an incision check. She is a 21-year-old G1P1 who had a primary cesarean section 2 weeks ago at 35 weeks for severe preeclampsia and breech presentation.

Upon entering the room you notice the baby has a distinct jaundiced appearance. She comments that the baby's bilirubin is being followed in the Pedi Clinic.

9: A. Jaundice that persists for weeks requires further investigation, including measurement of both total and direct bilirubin concentrations.

a: 1 b: 3 c: 4 d: 5 e: 2

10: B. Which of the following statements about jaundice in the newborn is correct?

a:

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Jaundice typically poses a serious threat to the infant b: Jaundice that persists for more than 4 days requires immediate treatment c: Jaundice that persists for more than 2 days requires immediate treatment d: Elevation of direct serum bilirubin always requires further investigation e: Term infants are at a higher risk for hyperbilirubinemia than late preterm infants

11: C. Acute bilirubin encephalopathy or kernicterus is associated with total serum bilirubin levels greater than .

a: 30 mg/dL b: 10 mg/dL c: 20 mg/dL d: 40 mg/dL e: 50 mg/dL

You are making morning rounds on a 16-year-old G1P1 who underwent a spontaneous vaginal delivery at 36 weeks. She had a history of an unknown and untreated sexually transmitted infection. She had no prenatal care or prenatal classes. She is concerned about all the events following her delivery last night.

What were they doing to her baby and why? What wes the cream they rubbed in her baby's eyes?

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12: A. Which of the following newborn infants should receive prophylactic antibiotic ointment in both eyes to prevent gonococcal opththalmia neonatorum?

a: Only infants delivered vaginally b: Only preterm infants c: Only macrosomic infants d: Only infants delivered vaginally e: All infants

13: B. The prophylactic application of antibiotic ointment (containing erythromycin [0.5%] or tetracycline [1%]) to both eyes to prevent the development of gonococcal ophthalmia neonatorum may be delayed up to hour(s) to allow for breastfeeding.

a: 1 b: 3 c: 2 d: 5 e: 4

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Why didn't they just leave her and the baby alone? They kept checking the baby all the time.

14: A. After delivery, infant vitals signs should be taken at what interval?

a: Every 30 minutes for the next 2 hours b: Every 2 hours for the first 24 hours c: Every 5 minutes for the next 2 hours d: Every 2 hours until the signs are stable for 8 hours e: Every 30 minutes until the signs are stable for 2 hours

15: B. Following the initial assessment and routine care of a healthy neonate, continued close observation is necessary for the subsequent stabilization-transition period(the first hours after birth) to identify any problems that may arise.

a: 1-3 b: 8-16 c: 6-12 d:

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3-8 e: 10-18

The pediatrics resident came by and told her about having to take blood from the baby's heel to check for some diseases. Is this routine?

16: A. If a heel-stick initial blood sample is collected before 12-24 hours delivery, a second sample should be collected at of age to decrease the probability that phenyketonuria and other disorders with metabolite accumulation are missed as a result of early testing.

a: 1-2 weeks b: 7-8 weeks c: 4-6 days d: 4-5 weeks e: 3--4 weeks

17: B. Premature infants, neonates receiving parenteral feeding, or those treated for illness should have a newborn screening test performed at or near days of age, regardless of feeding status.

a: 3 b:

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1 c: 7 d: 5 e: 9

She was also concerned because her baby, now 12 hours old, had not had a bowel movement.

18: What percent of newborns pass stool within 24 hours?

a: 50% b: 10% c: 30% d: 70% e: 90% ANS: [a,e,c,d,a,a,a,a,e,d,a,e,a,e,c,a,c,e]

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Chapter 11: Postpartum Care Your clinic nurse warns you that your next patient may take some time. Upon entering the room you find a tearful 16-year-old G1P1 who presents for her 6-week postpartum visit.

1: The puerperium, the period following birth during which the reproductive tract returns to its normal, nonpregnant state, lasts approximately

a: 14-16 weeks b: 10-12 weeks c: 6-8 weeks d: 2-4 weeks e: 18-20 weeks

During your interview the patient expresses concern that she and her partner attempted intercourse several weeks ago. It was painful and she is afraid there may be something wrong.

2: The best treatment for dyspareunia in the post partum period is

a: analgesic b: antidepressant c:

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oral estrogen d: lubricant e: topical estrogen

Is it possible that she could get pregnant? She is not breast-feeding.

3: A. The mean time to ovulation in the nonlactating postpartum woman is approximately

a: 75 days b: 45 days c: 60 days d: 15 days e: 30 days

4: B.

a: 10% b: 15%

Approximately

of non-nursing women are fertile at 6-week postpartum.

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c: 20% d: 25% e: 5%

The patient's crying escalates. This was an unplanned pregnancy and she is terrified of being pregnant again. She is grouchy and moody all day and things just get worse at night with the baby getting colicky after the formula, her boyfriend just watching TV, and her mother giving unwanted advice. She has not slept in days.

5: A.

The incidence of postpartum blues is approximately

a: 50%-60% b: 70%-80% c: 90%-99% d: 30%-40% e: 10%-20%

6: B. Approximately what percent of new mothers experience postpartum depression?

a:

.

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20%-25% b: 1%-5% c: 10%-15% d: 30%-45% e: 50%-65%

7: C. The incidence of postpartum psychosis is approximately

a: 0.05%-0.1% b: 0.7%-0.8% c: 0.1%-0.2% d: 0.5%-0.6% e: 0.3%-0.4%

During your review of systems she admits to leaking urine during coughing or sneezing.

8: A. The best treatment fo postpartum stress incontinence is

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a: topical estrogen medication b: empirical antibiotic treatment for cystitis c: anticholinergic medication d: tricyclic antidepressant medication e: reassurance and re-evaluation in 2 months

9: B. The return of normal tone to the pelvic floor muscles postpartum may be enhanced by

a: exogenous estrogen supplementation b: Kegel exercises c: avoiding coitus fo 3 to 6 months d: endogenous estrogen supplementation e: endogenous progesterone supplementation

On continuation of your review of systems she also admits to bleeding with bowel movements and she thinks it is due to the hemorrhoids she developed during her 2 hours of pushing.

10:

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Surgical management of postpartum hemorrhoids may be considered how soon postpartum?

a: 3 months b: 18 months c: 6 months d: 12 months e: Immediately

Your physical exam is within normal limits, including normal thyroid, heart, lungs, and breast exam. On pelvic exam you find that vaginal mucosa is intact but moderately atrophic and her uterus is anteverted, small, and firm with minimal lochia. She is noted to have some nonthrombosed hemorrhoids.

11: A. Uterine involution is a result of a decrease in the

a: size of the intercellular spaces in the uterine myometrium b: increased intravascular volume, especially venous space volume c: number of cells in the uterine myometrium d: number of intercellular spaces in the uterine myometrium e:

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size of cells in the uterine myometrium

12: B. How many weeks does it take for the uterus to return to its pre-pregnancy position in the true pelvis?

a: 2 b: 4 c: 8 d: 10 e: 6

13: C. How many weeks does it take for the uterus to return to its pre-pregnancy size?

a: 2 b: 6 c: 8 d: 10 e: 4

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You receive a call from the Labor and Delivery nurse. The patient you delivered by forceps 3 hours ago is bleeding more than usual. Her pulse is now 110 bpm and she is rapidly soaking pads.

14: A. Immediate postpartum uterine hemostasis is maintained by

a: primary clotting of blood in the uterine artery b: tamponade effect of clots c: scar formation within the uterine cavity d: contraction of the uterine smooth muscle e: decrease in myometrial cell volume

15: B. The elevated pulse rate characteristic of pregnancy

a: decreases approxiamately 1 hour after delivery b: decreases approximately 6 hours after delivery c: persists for approximately 3 weeks postpartum d: decreases at the end of the third stage of labor

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e: persists for about 3 months postpartum

On exam you notice that her bladder is full and she is unable to void spontaneously, so a Foley catheter is inserted and 600 mL of urine drained from the bladder.

16: Transitory urinary retention in the postpartum period following vaginal delivery is primarily related to

a: peripartum cystitis b: periurethral edema c: parasympathomimetic discharge d: sympathomimetic discharge e: progesterone-associated loss of bladder contractility

On exam, there are no cervical or vaginal lacerations and the bleeding responds to fundal massage and an increase in the Pitocin infusion rate. You recommend the patient to proceed with breast-feeding and assure the patient and nurse that you will follow-up in a few hours.

17: A. Postpartum uterine contractile pain is greater in breast-feeding women bcause suckling releases

a: oxytocin b:

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estrogen c: progesterone d: prostaglandins e: inhibin

18: B. When is the endometrium re-established after delivery in most patients?

a: First week b: Fourth week c: Third week d: Second week e: Fifth week

You return later and find the bleeding has stabilized. The urine output is 100 to 200 mL per hour.

19: A. In a normal patient immediately after delivery, what is the weight of fluid lost through diuresis and loss of extravascular fluid?

a:

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3 kg b: 7 kg c: 9 kg d: 1 kg e: 5 kg

20: B. In the intrapartum and postpartum periods, the glomerular filtration rate decreases to normal

a: 1-2 days after delivery b: at the time of delivery c: 3-5 days after delivery d: several weeks after delivery e: at the onset of labor ANS: [c,e,b,b,b,c,c,e,b,c,c,a,b,d,a,b,d,a,b,a,c,e,d]

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Chapter 12: Postpartum Hemorrhage A drop in hematocrit of at least what percent is an indication of postpartum hemorrhage?

a: 5% b: 10% c: 20% d: 15%

2: You are called to evaluate heavy vaginal bleeding in a woman 30 minutes after delivery of her first child.

Bleeding is brisk and ongoing. What is the first sign of significant blood loss that you are likely to observe?

a: Tachycardia b: Shock c: Anuria d: Hypotension

3: A 23-year-old G2P1011 has delivered a healthy term infant without difficulty. Which of the following sets of actions are most likely to minimize her risk of hemorrhage?

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a: Fundal pressure, firm cord traction, and maternal pushing b: Uterine massage, gentle cord traction, and oxytocin after delivery c: Expectant management for placental delivery d: Oxytocin infusion and manual delivery of the placenta

4: A 33-year-old G2P2 just underwent a successful forceps-assisted vaginal delivery of a 4,552-g son, followed by spontaneous placental expulsion. Her pregnancy was complicated by gestational diabetes requiring insulin and by mild polyhydramnios. Labor was spontaneous, with delivery 9 hours after admission, including 2 hours of pushing. In this senario, the most significant risk factor for hemorrhage due to atony is

a: multiparity b: prolonged labor c: excessive uterine distention d: use of forceps

5: The most common cause of postpartum hemorrhage is

a:

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uterine atony b: genital tract trauma c: retained placenta d: coagulation disorder

6: The initial finding of a soft "boggy" consistency to the uterus in a patient with postpartum bleeding should lead to immediate

a: temporary ligation of the uterine artery b: placement of a balloon compression device c: bimanual uterine massage d: administration of packed red blood cells

7: A 19-year-old G1P1 underwent induction of labor at 41 weeks of gestation. She required cervical ripening with a Foley balloon. Oxytocin was started at admission. Delivery occurred 39 hours after admission. Immediately following spontaneous delivery of a 3,119-g male, heavy vaginal bleeding is noted. No prior risk factors are found. The placenta was inspected and found to be intact. Uterine tone is soft despite vigorous bimanual massage and high-dose oxytocin. The next appropriate step in the management of this patient is

a: ultrasound exam for retained products

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b: mobilization of the OB response team c: movement to the OR and prep for exploratory laparotomy d: inspection of the birth canal for trauma

8: Methylergonovine maleate is given intramuscularly because IV administration can directly lead to

a: heart failure b: hypertension c: hypotension d: clotting disorder

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

a: Second stage b: Fourth stage c: Third stage

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d: After completion of the fourth stage

10: In a patient with postpartum bleeding and a firm, contracted uterus, the first step in management should be to

a: order a CAT scan to determine if there are retained placental fragments b: inspect the lower genital tract for laceration c: administer methylergonovine d: increase oxytocin infusion

11: Which of the following is a predisposing factor for retained placenta?

a: Advanced maternal age b: Instrument delivery c: Excessive oxytocin administration during delivery d: Uterine leiomyomata

12: Penetration of placental villi into the uterine muscle is termed

a: placenta accreta b: placenta percreta c: placenta increta d: placenta previa

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13: The first finding in a patient with amniotic fluid embolism typically is

a: cyanosis b: hemorrhage c: respiratory distress d: cardiovascular collapse

14: An opening between the uterine cavity and the abdominal cavity is termed

a: uterine dehiscence b: uterine inversion c: uterine retroversion d: uterine rupture ANS:[b,a,b,c,a,c,b,b,c,b,d,c,c,d]

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Chapter 13: Multifetal Gestation What is the incidence in the general population of twinning?

a: 1 in 50 pregnancies b: 1 in 20 pregnancies c: 1 in 90 pregnancies d: 1 in 250 pregnancies

2: What is the incidence in the general population of monozygotic twinning?

a: 1 in 20 pregnancies b: 1 in 50 pregnancies c: 1 in 90 pregnancies d: 1 in 250 pregnancies

3: In twin-twin transfusion syndrome, the hypervolemia in the recipient twin can lead to

a:

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anemia b: hydramnios c: impaired growth d: oligohydramnios

4: In multifetal gestations, assessment of fetal well-being through daily "kick counts" should be begun at about

a: 20-22 weeks b: 23-25 weeks c: 30-32 weeks d: 27-29 weeks

5: Which of the following statements about dizygotic twinning is correct?

a: Twinning follows the paternal lineage b: Increasing maternal age is an independent risk factor c:

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The incidence is fairly consistent around the world d: The incidence, on average, is approximately 0.005%

6: Twinning within 3 days of fertilization will likely result in what organization of the fetal membranes?

a: Monoamniotic/monochorionic b: Diamniotic/monochorionic c: Diamniotic/dichorionic d: Conjoined twins

7: Twinning between 4-8 days of fertilization will likely result in what organization of the fetal membranes?

a: Diamniotic/dichorionic b: Conjoined twins c: Diamniotic/monochorionic d: Monoamniotic/monochorionic

8:

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Approximately what percent of twin pregnancies detected in the first trimester result in delivery of viable twins?

a: 90% b: 30% c: 50% d: 70%

9: The perinatal morbidity in multifetal gestation is how many times higher than for a comparable singleton pregnancy?

a: Seven to eight times b: One to two times c: Three to four times d: Five to six times

10: In monozygotic twins, oligohydramnios and anemia of one twin and hydramnios with polycythemia of the other twin are the result of

a:

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umbilical cord compression b: congenital anomalies of the fetus c: maternal diabetes d: vascular anastomoses between the fetuses

11: The average time of delivery in a singleton pregnancy is

a: 39 weeks b: 37 weeks c: 40 weeks d: 38 weeks e: 41 weeks

12: The average time of delivery in a twin pregnancy is

a: 32 weeks b: 29 weeks

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c: 35 weeks d: 40 weeks

13: A twin pregnancy in which one twin is characterized by impaired growth, anemia, and hypovolemia and the other twin by hypervolemia, hypertension, polycythemia, and congestive heart filure is defined as

a: single umbilical artery syndrome b: conjoined twin syndrome c: twin-twin isoimmunization syndrome d: twin-twin transfusion syndrome

14: Diagnosis of multiple gestation is usually made by

a: pelvic examination b: fundal height measurement c: Leopold maneuvers d: ultrasound

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15: What is the chief antenatal assessment means used to evaluate the progress of twin pregnancy?

a: Serial nonstress tests b: Serial fundal height measurements c: Serial pelvic examination d: Serial ultrasounography

16: In multiple gestation, periodic ultrasonography is done approximately every 4 weeks beginning at about

a: 16 weeks b: 24 weeks c: 20 weeks d: 28 weeks

17: What percent difference in weight between the larger and the smaller fetus defines discordant growth?

a:

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35%-45% b: 15%-25% c: 25%-35% d: 5%-15%

18: Intrapartum management of twin pregnancies at term is usually determined by

a: size of the twins b: gestational age c: local custom d: presentation of the twins

19: In what percent of twin gestations is each member of the twin pair in the cephalic presentation at the beginning of labor?

a: 25% b: 40% c:

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10% d: 75%

20: Chorionicity can first be determined at approximately how many weeks of gestational age?

a: 15-16 b: 5-6 c: 9-10 d: 7-8

21: Vanishing twin syndrome is seen in approximately what percent of twin pregnancies detected by ultrasound early in the first trimester?

a: 40 b: 20 c: 10 d: 50 e:

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30

22: A 34-year-old woman in her first pregnancy presents for her first prenatal visit at 18 weeks of gestation.

Her medical and surgical history is negative. Her family history is negative except for a history of siblings who were fraternal twins and a grandmother who was a fraternal twin. You perform a sonogram at the bedside, which reveals a twin gestation. You tell her that this type of twin pregnancy is most likely

a: suprazygotic b: unizygotic c: dizygotic d: monozygotic

23: A 32-year-old woman in her first pregnancy presents at 12 weeks gestation for a routine prenatal visit.

She recently had an ultrasound examination, which revealed a twin gestation. You describe that there appears to be an amnion and a chorion surrounding each fetus. This type of chorionicity is also known as

a: monoamniotic/monochorionic b: diamniotic/dichorionic c: diamniotic/monochorionic d: monoamniotic/dichorionic

ANS: [c,d,b,c,b,c,c,c,c,d,c,c,d,c,c,d,d,d,a,b,d,b,c,d,c,b]

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Chapter 14: Fetal Growth Abnormalities: Intrauterine Growth Restriction and Macrosomia 1: Intrauterine growth restriction is defined as a birth weight less than the

percentile

a: 5th b: 3rd c: 20th d: 10th

2: About what proportion of stillborn infants are found to be growth restricted?

a: 50% b: 15% c: 25% d: 5%

3: The normal fetus grows throughout pregnancy, but the rate of growth generally declines after what gestational age?

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a: 33 weeks b: 37 weeks c: 29 weeks d: 41 weeks

4: A fetus with IUGR is at higher risk for

a: hyperglycemia b: alkalosis c: hypothermia d: anemia

5: Early-onset IUGR may be associated with

a: reversible reduction in brain size b: irreversible reduction in organ size

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c: cellular hypertrophy d: uteroplacental insufficiency

6: Late-onset IUGR is commonly associated with

a: uteroplacental insufficiency b: immunologic abnormalities c: cellular hyperplasia d: genetic factors

7: Maternal viral infections associated with IUGR include

a: influenza b: rotavirus c: rubella d: HIV

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8: Between 20 and 36 weeks of gestational age, the fundal height should increase approximately

a: 0.5 cm per week b: 2.0 cm per week c: 3.0 cm per week d: 1.0 cm per week

9: An efficient screening procedure for IUGR is

a: maternal blood pressure measurements b: maternal weight gain measured serially c: clinical estimations of fetal weight d: fundal height measurements

10: The most useful tool to evaluate IUGR is serial

a: nonstress testing

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b: maternal weight measurements c: obstetric ultrasound examinations d: biophysical profile testing

11: Which testing procedure is included in the routine evaluation of IUGR?

a: Amniocentesis b: Doppler velocimetry c: Chorionic villus sampling d: Periumbilical blood sampling

12: Evaluation of fetal-placental circulation is best assessed with Doppler velocimetry of which vessel?

a: Umbilical artery b: Maternal uterine artery c: Umbilical vein d:

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Maternal uterine vein

13: The fetal response to reduced placental perfusion results in decreased blood flow to the

a: kidney b: heart c: brain d: adrenal gland

14: Which of the following treatments has been shown to improve IUGR?

a: Antenatal corticosteroids b: IV hydration c: No therapy has been shown to result in improvement d: Bed rest

15: Hyperviscosity syndrome associated with IUGR is defined as a fetal hematocrit of more than

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a: 65% b: 45% c: 55% d: 35%

16: Hyperviscosity syndrome in IUGR is associated with

a: a decreased fetal hematocrit b: heart failure c: hypothermia d: coagulopathy

17: Growth-restricted newborns have difficulty maintaining euglycemia because the have

a: a low hematocrit b: relative hyperthyroid status c:

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hyperbilirubinemia d: less fat deposition in late pregnancy

18: Macrosomia increases the risk of

a: neonatal morbidity b: neither maternal nor neonatal morbidity c: maternal morbidity d: both maternal and neonatal morbidity

19: The most common maternal medical condition associated with macrosomia is

a: diabetes b: hypertension c: hypothyroidism d: hyperlipidemia

20:

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During the delivery process, the fetus with macrosomia is at increased risk for

a: femur fracture b: facial nerve injury c: depressed skull fracture d: shoulder dystocia

21: A neonate with macrosomia associated with maternal diabetes is at higher risk for

a: hyperthermia b: alkalosis c: anemia d: hypoglycemia

22: Macrosomia is associated with later life

a: failure to thrive b:

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cardiovascular disease c: obesity d: hypothyroidism

23: Current American Colloge of Obstetricians and Gynecologists recommendations include cesarean delivery for a mother without diabetes when the fetus exceeds

a: 4,000 g b: 5000 g c: 4,500 g d: 4,250 g

24: Which of the following is a risk factor for fetal macrosomia?

a: Multiparity b: Increasing maternal age c: Maternal hypertension d: Female fetus ANS:[d,c,b,c,b,a,c,d,d,c,b,a,a,c,a,b,d,d,a,d,d,c,b,a]

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Chapter 15: Preterm Labor A 22-year-old patient asks about the risks of prematurity at her initial prenatal visit. She can be informed that babies born prematurely in the United States account for what percent of all perinatal mortality?

a: 90% b: 75% c: 60% d: 45%

2: An 18-year-old at 35 weeks gestation has been feeling well, although she has occasional "tightening" of her abdomen and had noticed some vaginal spotting this morning. Speculum exam reveals that her cervix is visually dilated to 2 cm. Monitoring for 1 hour reveals one contraction. The fetal heart status is reassuring. The next step in managing this patient shoud be

a: administration of antenatal corticosteroids b: evaluation for the presence of vaginal fetal fibronectin c: admission to the hospital for increased observation d: discharge to home with counseling on signs and symptoms of labor

3:

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Preterm labor is functionally defined as the presence of regular uterine contractions and cervical changes occurring before how many weeks of gestation?

a: 33 b: 30 c: 37 d: 35

4: Which of the following is the strongest risk factor for preterm labor?

a: Septate uterus b: Young maternal age c: Multifetal gestation d: Maternal obesity

5: Which of the following may be a symptom of preterm labor?

a: Constipation

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b: Urinary frequency c: Syncope d: Change in vaginal discharge

6: A 23-year-old patient is administered magnesium sulfate as a tocolytic agent. Which of the following is the mechanism of action of magnesium sulfate?

a: Decreases prostaglandin production b: Prevents calcium entry into muscle cells c: Increases cyclic AMP in cells, which decreases free calcium d: Competes with calcium for entry into cells

7: What is the mechanism of action of ritodrine or terbutaline when administered in the management of preterm labor?

a: Prevent calcium entry into muscle cells b: Increase cyclic AMP in cells, which decreases free calcium c:

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Compete with calcium for entry into cells d: Decrease prostaglandin production

8: When used in the management of preterm labor, indocin blocks the production of which of the following?

a: Calcium b: Oxytocin c: Prostaglandin d: Trombin

9: Which of the following treatments for preterm labor may have an impact on the incidence of cerebral palsy?

a: Nifedipine b: Terbutaline c: Indomethacin d: Magnesium sulfate

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10: A 22-year-old patient is being treated for suspected preterm labor. Which of the following are potential complications of magnesium sulfate?

a: Maternal hypertension, tachycardia, anxiety, chest tightening, and electrocardiogram changes b: Decrease in uteroplacental blood flow with fetal hypoxia and hypercarbia c: Maternal flushing, headache, and respiratory depression at high doses d: Premature constriction of fetal ductus arteriosus

11: Which of the following is a possible complication of beta-adrenergic agents (ritodrine or terbutaline)?

a: Respiratory depression b: Premature constriction of ductus arteriosus c: Decrease in uteroplacental blood flow d: Anxiety

12: Which of the following is a potential risk when managing preterm labor with indomethacin?

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a: Maternal flushing and headache b: Maternal hypertension, tachycardia c: Decrease in uteroplacental blood flow d: Premature constriction of ductus arteriosus

13: A 25-year-old patient is being treated for preterm labor with nifedipine. Which of the following is a possible complication?

a: Electrocardiogram changes b: Decrease in uteroplacental blood flow c: Maternal flushing d: Premature constriction of ductus arteriosus

14: The primary goal of tocolytic therapy is to allow time for which of the following?

a: Administration of corticosteroids b: Surgical correction of uterine anomalies

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c: Onset of labor at term d: Treatment of maternal infection

15: Which of the following tocolytic agents is considered to have the highest degree of safety?

a: Terbutaline b: Nifedipine c: Indomethacin d: Magnesium sulfate

16: In a 30-year-old patient with preterm labor at 32 weeks gestation, corticosteroids are given to do which of the following?

a: Decrease uterine activity b: Enhance fetal lung maturity c: Prevent infection d: Stabilize vascular membranes

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17: Which of the following is an indication for tocolysis?

a: Regular uterine contractions and cervical effacement at 30 weeks of gestational age b: Intrauterine infection c: Multiple fetal anomalies d: Evidence of fetal maturity

18: A 27-year-old at 29 weeks gestation presents for routine prenatal care. She noticed some vaginal spotting this morning. Speculum exam reveals that her cervix is dilated to 4 cm with membranes noted at the cervical os. The patient is contacting every 4 minutes. The fetal heart status is reassuring. What of the following is the appropriate next step in management?

a: Evaluation for gonorrhea b: Placement of an emergent cervical cerclage c: Repeat cervical exam in an hour d: Administer antenatal corticosteroids

19:

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A 24-year-old at 35 weeks of gestation presents to the office with regular uterine contractions and a history of having a "gush" of vaginal fluid 1 hour earlier. Fluid in the vagina turns Nitrazine paper blue.

Her cervix is visually dilated to 3 cm. She is placed on fetal monitoring and is shown to be contracting every 5 minutes. Fetal heart tones are reassuring. The next best step in managing this patient is

a: transfer to labor and delivery b: initiate intravenous magnesium sulfate thearpy c: administer antenatal corticosteroids d: give intramuscular progesterone

20: A 24-year-old multiparous patient at 32 weeks of gestation delivers a vigorous, female child. Her prenatal course was complicated by bleeding in the first trimester that resolved spontaneously and did not recur. She is of African American heritage. Her obstetric history is significant for three previous vaginal deliveries: one full-term child, one delivery at 32 weeks, and twins at 33 weeks. Of the following, which of the following represents this patient's strongest risk factor for the most recent preterm delivery?

a: First-trimester bleeding b: African American race c: History of a prior preterm delivery d: History of a twin gestation

21:

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For a patient with a history of preterm delivery, which of the following has been shown to most significantly decrease her risk of preterm delivery in her NEXT pregnancy?

a: Weekly intramuscular progesterone supplementation b: Serial ultrasound with cervical length assessments c: Bed rest d: Home contraction monitoring

22: A 24-year-old with no prenatal care and unknown last menstrual period presents to the hospital after having had a large "gush" of clear vaginal fluid. Clear fluid from her cervical os turns Nitrazine paper blue. The baby is in breech presentation using abdominal ultrasound. whcih of the following is the most important NEXT step in her care?

a: Administer corticosteroids b: Administer magnesium sulfate c: Administer ampicillin d: Determine gestational age

23: A 34-year-old at 25 weeks of gestation felt "feverish" last evening. She denies contractions, abdominal pain, or vaginal bleeding. Her past medical history is unremarkable. She is afebrile now. Her lungs are

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clear to auscultation. Her abdomen is mildly tender to palpation. There is no rebound or guarding.

Urinalysis is normal. Her WBC is 15,000. The source of the leukocytosis of greatest concern is

a: chorioamnionitis b: gastroenteritis c: pyelonephritis d: thombophlebitis

24: A 34-year-old at 25 weeks of gestation felt "feverish" last evening. She denies contractions, abdominal pain, or vaginal bleeding. Her past medical history is unremarkable. She is afebrile now. Her lungs are clear to auscultation. Her abdomen is mildly tender to palpation. There is no rebound or guarding.

Urinalysis is normal. Her WBC is 15,000. The next appropriate step is which of the following?

a: Doppler ultrasound of extremities b: Amniocentesis c: Ultrasound of abdomen d: CT scan of abdomen

25: A 25-year-old at 30 weeks gestation presents to her obstetrician feeling "unwell." She felt "feverish" and "chills" last evening although she did not take her temperature. She feels "achy, especially in my legs and back." She denies contractions, abdominal pain, or vaginal bleeding. Her temperature is 99.2

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degrees F, her heart rate is 100 bpm, and her respiratory rate is normal. The fetal heart rate is 170/minute. Her lungs are clear to ausculation. Her abdomen is tender to palpation, particularly during an ultrasound that reveals the fetus to be in cephalic presentation. Nitrazine testing of the vagina turns the paper blue. Urinalysis has a few epithelial cells. Complete blood count shows a leukocytosis of 18,000. The next step in her care should be

a: amniocentesis b: lower extremity Doppler evaluation c: abdominal CT scan d: induction of labor ANS. [b,d,c,c,d,d,b,c,d,c,d,d,b,a,d,b,a,d,a,c,a,d,a,b,d]

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Chapter 16: Third-Trimester Bleeding 1: An 18-year-old-woman in her first pregnancy at term, not in labor, has sudden onset of severe continuous lower abdominal pain with a rapid pulse, low blood pressure, fetal bradycardia, and a tender abdomen. Which of the following is the most likely diagnosis?

a: Placenta previa b: Placental abruption c: Amniotic fluid embolus d: Uterine rupture e: Vasa previa

A woman in her first pregnancy at term has profuse vaginal bleeding with no abdominal pain or tenderness. Fetal heart tones are normal. The cervix is 2 to 3 cm dilated with an edge of placenta palpable.

2: A. Which of the following is the most appropriate treatment?

a: Double setup delivery b: Cesarean delivery c:

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Replace blood loss and await vaginal delivery d: Rupture of the fetal membranes to stimulate delivery e: Augmentation of labor with Pitocin

3: B. Which of the following best describes partial placenta previa?

a: The margin of the placenta extends across part but not all of the internal os b: The placenta is located near but not directly adjacent to the internal os c: The edge of the placenta lies adjacent to the internal os d: The entire cervical os is covered by the placenta

4: C. What is the overall frequency of placenta previa?

a: 1 in 250 b: 1 in 150 c: 1 in 50 d: 1 in 200

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e: 1 in 100

5: D. About what percent of women with placenta previa in the third trimester will have at least one episode of bleeding?

a: 75% b: 50% c: 25% d: 10% e: 90%

6: E.

In placenta previa, the first bleeding episode occurs most commonly at what gestational age?

a: 27-28 weeks b: 25-26 weeks c: 23-24 weeks d: 32-33 weeks

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e: 29-30 weeks

7: F. Transvaginal ultrasonography is more acccurate than abdominal ultrasonography in the diagnosis of what type of placenta previa?

a: Fundal b: Anterior c: Posterior d: Partial e: Complete

8: G. Which of the following is a criterion for outpatient care of a patient with known placenta previa?

a: Rh negative b: Partial and not complete previa c: No bleeding episodes beyond the first d: Highly motivated compliant patient

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e: Gestational age greater than 24 weeks

9: H. What is the "gold standard" for diagnosis of a placenta previa?

a: MRI b: Transvaginal ultrasound c: CAT scan d: Transabdominal ultrasound e: Pelvic exam

10: I.

Which of the following is a risk factor for placenta previa?

a: Diabetes b: Nulliparity c: Grand multiparity d: Low pre-pregnancy weigh e:

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Obesity

A 31-year-old woman who believes she is approximately 8 months pregnant presents complaining of bright red vaginal bleeding and severe cramps for the last hour. On questioning, you learn she has had no prenatal care and was in a drug rehabilitation program but left a few weeks ago. On examination, she is normotensive, has a fundal height of 30 cm, and has a tender uterus. She has irregular uterine contractions and a baseline fetal heart rate of 150 bpm with good beat-to-beat variability. Ultrasound shows a 30-week gestation with adequate amniotic fluid and a fundal placenta without evidence of placenta previa or abruptio placentae. Urine drug screen is positive for cocaine. Careful pelvic examination by speculum shows her cervix to be closed with minimal bleeding and no evidence of rupture of membranes.

11: A. Your most likely diagnosis is

a: placenta previa b: abruptio placentae c: vasa previa d: labor e: cervicitis

12: B. Placental abruption is defined as

a: abnormal position of the placenta b:

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premature separation of an abnormally implanted placenta c: abnormal number and location of placental lobes d: premature separation of the normally implanted placenta e: abnormal insertion of the umbilical cord into the placenta

13: C. Placental abruption is associated with

a: prior cesarean delivery b: multiparity c: preeclampsia d: young maternal age e: hyperthyroidism

14: D. The diagnosis of placental abruption is made primarily by

a: ultrasound b: laboratory evaluation

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c: MRI d: clinical presentation and evaluation e: amniocentesis

15: Which of the following is common to both placenta previa and placental abruption?

a: Painful uterine contractions b: Presence of a normal fetal heart rate c: Vaginal bleeding d: Uterus tender to palpation e: Abdominal discomfort

16: Which of the following tests is useful in differentiating maternal blood from fetal blood?

a: Apt b: Lee-White c:

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Harvey d: White e: Coombs

17: In the absence of massive blood loss, coagulation defects are most common in which of the following?

a: Placenta previa b: Vasa previa c: Uterine rupture d: Placental abruption e: Preterm labor

ANS:[b,a,d,a,e,c,d,b,c,b,d,c,d,c,a,d]

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Chapter 17: Premature Rupture of Membranes Premature rupture of membranes is defined as rupture of the chorioamnionic membrane before what event?

a: Complete effacement b: Onset of labor c: Active phase of labor d: Second stage of labor

2: How is amniotic fluid primarily produced by the fetus?

a: Urination b: Pulmonary excretions c: Saliva production d: Secretions from umbilical cord

3: Premature rupture of membranes is associated with about what percent of term pregnancies (37 weeks of gestational age or more)?

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a: 18% b: 8% c: 28% d: 38%

4: Midtrimester preterm premature rupture of membranes (between 16 and 26 weeks of gestational age) may be associated with what event?

a: Genetic amniocentesis b: Excessive physical activity c: Job-related stress d: Coitus

5: What is the difference in frequency of premature rupture of membranes in term pregnancies compared with preterm deliveries?

a: Same in term and preterm b:

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50% decrease in preterm pregnancies c: 100% increase in preterm pregnancies d: 400% increase in preterm deliveries

6: Which of the following is the most serious consequence of preterm premature rupture of membranes?

a: Preterm delivery b: Abruptio placentae c: Cord compression d: Chorioamnionitis

7: What is the relationship between the length of the latency period and gestational age in cases of premature rupture of the membranes?

a: The length of the latency period increases with increasing gestational age b: The length of the latency period is unrelated to gestational age c: The length of the latency period decreases and then increases as gestational age increases d:

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The length of the latency period is inversely related to gestational age

8: A 22-year-old patient at 23 weeks of gestation describes a sudden gush of fluid from the vagina. Which of the following can cause a false-negative Nitrazine test?

a: Basic urine b: Blood contamination c: Cervical mucus d: Rupture of the membranes with no residual fluid

9: A 25-year-old patient at 20 weeks of gestation is concerned about loss of amniotic fluid associated with coitus last night. Which of the following is associated with a false-positive Nitrazine test?

a: Diabetes b: Normal vaginal secretions c: Semen d: Normal urine

10:

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Which of the following presentations is most likely to be confused with premature rupture of membranes at term?

a: Yeast vaginitis b: Bloody show c: Intermittent urinary leakage d: Passage of cervical mucus

11: The Nitrazine test is used to assess for premature rupture of membranes based on what property of amniotic fluid?

a: Higher pH than vaginal secretions b: Lower pH than vaginal secretions c: Higher specific gravity than water d: Lower specific gravity than water

12: Of the following, which is the best indicator of intrauterine infection associated with premature rupture of membranes?

a:

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Decelerations of fetal heart tones b: Onset of uterine contractions c: White cells in amniotic fluid d: Bacteria on Gram stain of amniotic fluid

13: Which of the following should be avoided in a patient with presumed PROM?

a: Amniocentesis b: Sterile speculum examination c: Ultrasonography d: Digital examination

14: Premature rupture of the membranes presents a significant risk of pulmonary hypoplasia and skeletal malformations before what gestational age?

a: 29 weeks b: 22 weeks c:

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25 weeks d: 31 weeks

15: Delivery generally is recommended when PROM occurs after how many weeks of gestation?

a: 30 weeks b: 38 weeks c: 34 weeks d: 36 weeks

16: A 30-year-old patient at 35 weeks of gestational age has premature spontaneous rupture of membranes. The fetus is in a vertex presentation. Which of the following is the most appropriate next step in management?

a: Induction of labor b: Cesarean delivery c: Administration of tocolytic agent d: Administration of corticosteroids

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17: A 32-year-old patient at 30 weeks of gestational age has premature spontaneous rupture of membranes. The fetus is in a breech presentation. Which of the following is the most appropriate next step in management?

a: Induction of labor b: External cephalic version c: Cesarean delivery d: Administration of corticosteroids

18: A 30-year-old primigravid patient at 39 weeks of gestational age reports premature rupture of the membranes yesterday. Which of the following is the most likely to occur?

a: Chorioamnionitis b: Abruptio placenta c: Spontaneous labor d: Postterm pregnancy

19:

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Betamethasone therapy in cases of preterm premature spontaneous rupture of membranes is most useful to prevent what condition?

a: Respiratory distress syndrome b: Necrotizing enterocolitis c: neonatal encephalopathy d: Idiopathic thrombocytopenia purpura ANS.[b,a,b,a,d,a,d,d,c,c,a,d,d,b,c,a,d,c,a]

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Chapter 18: Post-term Pregnancy A woman with a regular 28-day menstrual cycle who has not been using oral contraceptives will have an estimated date of delivery how many weeks from the first day of her last menses?

a: 42 b: 40 c: 38 d: 36

2: A patient is considered postterm if she has not delivered by the end of what week from the first day of the last menstrual period?

a: 41 b: 42 c: 40 d: 42

3: A 22-year-old primigravid patient's estimated date of delivery is November 1. She would be defined as postterm on which of the following dates?

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a: December 2 b: November 12 c: November 25 d: November 18

4: A 30-year-old patient inquires about the likelihood that she will deliver after her due date. She can be informed that postterm pregnancy occurs in what percent of pregnancies?

a: 10% b: 20% c: 5% d: 15%

5: A 25-year-old patient has a history of postterm pregnancy 2 years ago. Approximately what percent of patient's having one postterm pregnancy will have a prolonged pregnancy with their next gestation?

a: 25%

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b: 50% c: 75% d: 0%

6: What is the most common "cause" of postterm pregnancy?

a: Inaccurate estimation of gestational age b: Anencephaly c: Placental sulfatase deficiency d: Extrauterine pregnancy

7: A 27-year-old patient at 41 weeks of gestation in active labor has meconium-stained amniotic fluid at the time of spontaneous rupture of membranes. Which of the following is an appropriate component of a response to her questions about the meconium?

a: Meconium passage only occurs in postterm pregnancy b: The incidence of meconium passage decreases as the pregnancy becomes prolonged c:

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Meconium passage leads to meconium aspiration syndrome in 80%-90% of cases d: Meconium passage occurs in 10%-20% of women in labor

8: Dysmaturity syndrome is most associated with which of the following?

a: Fetal macrosomia b: Hydramnios c: Hypergylcemia d: Umbilical cord compression

9: A male infant delivered vaginally after induction at 42 weeks has a right arm that hangs limply close to his side, with the forearm extended and internally rotated. What is the most likely outcome for this patient?

a: Surgery immediately b: Resolution by 1 year of age c: Surgery when he reaches 6 months of age d: Permanent loss of function

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10: A 40-year-old G2P1 patient says that her family always has large babies. Her previous baby was 3,800 g.

Macrosomia is defined as a fetus weighing at least

a: 5,000-5,500 g b: 3,500-4,000 g c: 4,000-4,500 g d: 4,500-5,000 g

11: Dysmature pregnancies may be associated with neonatal

a: hypoglycemia b: deafness c: hyperglycemia d: necrotizing enterocolitis

12: A 25-year-old G1P0 at 42 weeks in active labor has meconium-stained amniotic fluid discovered at the time of spontaneous rupture of membranes. The next management step should be

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a: monitoring of fetal heart rate and contractions b: amnioinfusion c: ultrasound d: delivery

13: A 30-year-old primigravid patient at 41 weeks and 3 days of gestation has a normal NST and AFI. Estimated fetal weight is 5,600 g. She weighs 320 lbs and has been managed with diet for an abnormal 3-hour glucose test since 28 weeks. The cervix is closed and posterior. Of the following, which is the most appropriate management?

a: Induction of labor at 42 weeks b: Induction of labor today c: Sweeping of membranes d: Cesarean delivery within 24 hours

14: Which amniotic fluid index is consistent with oligohydramnios?

a: 15

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b: 4 c: 10 d: 7

15: Brachial plexus injury is reported in what proportion of term deliveries?

a: 7%-10% b: Less than 1% c: 2%-3% d: 4%-5%

16: A 30-year-old patient expresses a desire to avoid going too far past her due date as happened with her sister. At how many weeks does the decision to consider labor induction to prevent postterm pregnancy become a factor in the management of pregnancy?

a: 38 b: 39 c:

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41 d: 40

17: Elective cesarean delivery may be considered based on fetal weight alone when the estimated fetal weight exceeds how many grams?

a: 3,500-4,000 b: 4,000-4,500 c: 5,000-5,500 d: 4,500-5,000

18: Paralysis of the newborn hand is also termed

a: Duchenne palsy b: Erb palsy c: Klumpke paralysis d: Bell palsy

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19: A 27-year-old G2P1001 at 38 weeks of gestation is asking when she will go into labor. Her cervix is not dilated at this time. Her first pregnancy was delivered at 42 weeks. She has a normal, healthy fetus based on today's antepartum testing. Your counseling may include which of the following?

a: She will deliver within 2 weeks b: She is likely to require cesarean delivery c: She has a 50% change of not experiencing spontaneous labor by 42 weeks d: She should be induced in 1 week

20: A 32-year-old woman is at 41 weeks gestation. Her cervix is found to be unfavorable. She asks her physician about the next step of management and is told that she should

a: have a cesarean delivery within the next 24 hours b: come back to the office in a week for further evaluation c: have a nonstress test and an amniotic fluid index d: have a repeat ultrasound to verify her gestational age

21: A 30-year-old patient at 41 weeks of gestation is found to have an AFI of 3.5cm. The fetus is vertex presentation. Which of the following is the most appropriate management?

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a: Cesarean delivery b: Repeat AFI in 1 week c: Return for routine care in a week d: Induction of labor ANS: [b,d,c,a,b,a,d,d,b,c,a,a,d,b,b,c,d,c,c,c,d]

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Chapter 19: Ectopic Pregnancy and Abortion Abortion is generally defined as termination of pregnancy before what gestational age?

a: 20 weeks b: 15 weeks c: 25 weeks d: 12 weeks

2: A 30-year-old primigravid patient just found out that she is pregnant. Ultrasound documents a normal intrauterine pregnancy of 6 weeks duration. She expresses fear that she will miscarry. She can be informed that 80% of spontaneous abortions occur by what gestational age?

a: 8 weeks b: 10 weeks c: 6 weeks d: 12 weeks

3: What is the incidence of clinically recognized spontaneous abortion?

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a: 30%-40% b: 50%-60% c: 15%-25% d: 5%-10%

4: A 25-year-old patient who just had a spontaneous abortion inquires what the cause was. She can be informed that the most common cause of first-trimester spontaneous abortion is

a: Maternal uterine anomalies b: Abnormal placentation c: Maternal infectious disease d: Fetal chromosomal anomalies

5: What is the most common chromosomal anomaly associated with early spontaneous abortion?

a: Monosomy b:

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Trisomy c: Tetraploidy d: Euploidy

6: A couple that has experienced three consecutive early pregnancy losses inquires about the likelihood that one of them might be the cause. Recurrent early abortion is associated with what chance that one parent is an asymptomatic carrier of a chromosomal abnormality?

a: 10% b: 3% c: 1% d: 20%

7: What is the relationship between the risk of spontaneous abortion being caused by a chromosomerelated abnormality and gestational age?

a: The risk of chromosome abnormality is the same for a couple regardless of gestational age. b: The earlier in pregnancy it occurs, the less likely it is chromosomally abnormal. c: The risk of chromosome abnormality increases until 6 weeks, then it is stable therafter.

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d: The earlier in pregnancy that it occurs, the more likely it is chromosomally abnormal.

8: Which of the following maternal infections has been associated with spontaneous abortion?

a: Neisseria gonorrhoeae b: Escherichia coli c: Chlamydia trachomatis d: Herpes zoster

9: Which of the following best describes the effect of the number of cigarettes smoked per day on the rate of spontaneous abortion?

a: No documented effect b: Linear effect c: Logarithmic effect d: Any amount of smoking has same effect

10:

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Which location of leiomyomata is most associated with spontaneous abortion?

a: Intramural b: Submucosal c: Subserosal d: Pedunculated

11: A 35-year-old patient has a documented nonviable pregnancy at 10 weeks of gestation. What is the most appropriate treatment of the following?

a: Dilation and evacuation b: Administration of Methergine (methylergonovine maleate) c: Hysterotomy d: Suction curettage

12: A 30-year-old patient has bleeding in the first trimester that resolves after 3 days. In general, threatened abortion results in a higher risk for

a:

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intrauterine infection b: preeclampsia c: preterm delivery d: fetal macrosomia

13: A 33-year-old patient has bleeding at 6 weeks of gestation that resolves in 3 days. Ultrasound demonstrates an intact pregnancy. Approximately what percentage of threatened abortions proceed to spontaneous abortion?

a: 50% b: 10% c: 25% d: 75%

14: A 27-year-old patient has had amenorrhea since she underwent dilation and curettage following a spontaneous abortion last year. The presence of Asherman syndrome is confirmed by which of the following?

a: Ultrasound b:

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Physical examination c: Hysteroscopy d: History

15: Treatment of Asherman syndrome includes lysis of the adhesions and treatment with which of the following medications?

a: Clomiphene citrate b: Progesterone c: Oral contraceptives d: Estrogen

16: Postabortal syndrome following elective pregnancy termination results from

a: retained fetal tissue b: uterine atony c: the presence of a combined pregnancy d:

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inadequate surgical technique

17: A 26-year-old woman presents to the emergency room 1 day after a first-trimester abortion complaining of abdominal pain and increasingly severe vaginal bleeding, but no fever or chills. Her cervix is open 1 cm, and clot and white tissue are present. The uterus is 12-week size, soft, and slightly tender. There are no adnexal masses. The most likely diagnosis is

a: appendicitis b: incomplete abortion c: missed abortion d: uterine perforation

18: A 20-year-old woman presents with a complaint of vaginal bleeding for 2 days that started 6 weeks after her last menstrual period. The patient passed some blood clots earlier in the day. The bleeding has been dark in color and associated with moderate lower abdominal cramping. Examination shows a small amount of dark blood in the vagina and the cervical os. The cervix is closed and no tissue is visible.

Bimanual examination reveals a slightly softened, normal-sized uterus and normal adnexa without masses or tenderness. Her quantitative beta-hCG 2 days ago was 846 mIU/mL; a repeat beta-hCG today is 146 miIU/mL. The working dianaosis is

a: threatened abortion b: missed bortion c: complete abortion

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d: incomplete abortion

19: The appropriate management for a patient in the Emergency Department who is felt to have an incomplete abortion is which of the following?

a: Follow-up with her physician within 24 hours b: Suction curettage c: Doxycycline d: Methergine

20: Which of the following is the strongest predisposing factor for ectopic pregnancy?

a: Use of ovulation induction agents b: IUD use c: Elective abortion d: Tubal damage due to inflammation

21:

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At what gestational age do women with tubal ectopic pregnancies typically first experience clinical symptoms?

a: 4 weeks b: Varies with location of the tubal pregnancy c: 8 weeks d: 6 weeks

22: A 24-year-old patient with a positive pregnancy test at home has irregular bleeding and pain. An ectopic pregnancy is on the differential diagnosis list. The etiology for vaginal bleeding in cases of ectopic pregnancy is which of the following?

a: Progesterone excess b: Bleeding from the fallopian tube c: Coagulopathy d: Sloughing of decidua

23: What is the most likely site of implantation in cases of ectopic pregnancy?

a:

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Ovary b: Cervix c: Peritoneal cavity d: Fallopian tube

24: Of tubal ectopic pregnancies, approximately 80% implant in what region?

a: Fimbria b: Isthmus c: Cornu d: Ampulla

25: In the work-up of a possible ectopic pregnancy, a culdocentesis that obtains 3 mL of straw-colored fluid is considered

a: unsatisfactory b: positive c:

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negative d: nondiagnostic

26: Implantation of an ectopic pregnancy in which of the following sites is most likely to reach term?

a: Ovary b: Isthmus c: Cornu d: Fimbria

27: Which of the following best describes a heterotopic pregnancy?

a: A twin ectopic pregnancy b: An ectopic pregnancy outside the fallopian tube c: Two ectopic pregnancies in different sites at the same time d: Coexistent intrauterine and ectopic pregnancies

28:

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In the management of ectopic pregnancy, how is methotrexate most typically administered?

a: Intramuscularly b: Orally c: By direct injection into the ectopic gestational sac d: Intravenously

29: Improvement in which of the following best explains the reduction in the mortality rate associated with ectopic pregnancy?

a: Availability of blood transfusion b: Laparoscopic surgical techniques c: Techniques for detection d: Intensive care technology

30: Hemoperitoneum associated with ruptured ectopic pregnancy may result in irritation of the diagphragm and pain referred to the

a:arm b: flank c: shoulder ANS: [a,d,c,d,b,b,d,c,b,b,d,c,a,c,d,b,b,c,b,d,b,d,d,d,c,a,d,a,c,c]

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Chapter 20: Endocrine Disorders Soon after delivery, infants of women with diabetes are at increased risk for

a: hypoglycemia b: hyperglycemia c: diabetic ketoacidosis d: neonatal infection

2: Polyhydramnios in a diabetic patient increases the risk of

a: postpartum maternal infection b: fetopelvic disproportion c: abruptio placentae d: fetal limb anomalies

3: An obese 27-year-old G2P1 presents for prenatal care. She has a history of GDM in her last pregnancy.

She asks you to explain why she is a diabetic only during pregnancy. You tell her that human placental lactogen results in

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a: decreased levels of free fatty acids b: increased gluconeogenesis c: decreased lipolysis d: decreased glucose uptake

4: A 32-year-old G3P1 presents for her 20-week anatomy scan. She has a history of type II diabetes, poorly controlled, for 10 years. Which of the following anomalies is the most likely anomaly that is attributable to the diabetes?

a: Cardiac abnormalities b: Renal abnormalities c: Gastrointestinal tract abnormalities d: Craniofacial abnormalities

5: A 22-year-old G4P2 presents for routine prenatal care. Which of the following would present the greatest risk of gestational diabetes in this pregnancy?

a: History of giving birth to an infant weighing 3,200 g

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b: Maternal great-great aunt with diabetes c: History of one spontaneous abortion d: History of gestational diabetes in a previous pregnancy

6: A 25-year-old G2P0 has gestational diabetes mellitus, treated with insulin. She is on a mixed regimen of NPH and regular insulin in the morning and evening. Her morning fasting glucose levels have all been 120 to 130 mg/100mL. Which change should be made to her insulin regimen?

a: Increase insulin given in the morning b: Increase insulin given in the morning and the evening c: No change, as this is the goal for fasting glucose levels d: Increase insulin given in the evening

7: A 25-year-old G1P0 with gestational diabetes, diet controlled, sees you for prenatal care at 32 weeks.

She has no evidence of hypertension, and her gestational diabetes is in excellent control. You discuss with her that presuming her diabetes continues to be well controlled and no other complications occur, the recommended delivery plan will include induction of labor at

a: 35-36 weeks b:

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39-40 weeks c: 37-38 weeks d: 41-42 weeks

ANS: [a,c,d,a,d,d,b]

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Chapter 21: Gastrointestinal, Renal, and Surgical Complications A 28-year-old G2P1 presents to labor and delivery at 29 weeks of gestation with fever, malaise, and back pain. Laboratory evaluation shows a white blood cell count of 24,000 and 90% neutrophils, and urinalysis is consistent with infection. The most serious sequela for this patient would be

a: Clostridium difficile enterocolitis b: adult respiratory distress syndrome c: preterm contractions d: hypertension e: pneumonia

2: A 25-year-old G1P0 presents for prenatal care at 9 weeks of gestation. The results of her initial cleancatch urinalysis with culture reveal >100,000 colony-forming units of Enterococcus. she denies dysuria, frequency, or urgency. The most appropriate management for this patient is

a: encourage increased oral hydration b: no treatment c: antibiotics d: urinary alkalization e:

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recommendation for changes in sexual behavior

3: A patient presents at 27 weeks of gestation with malaise and back pain, but no fever. There is evidence of microhematuria on clean-catch urinalysis. The most likely diagnosis is

a: appendicitis b: vaginitis c: pyelonephritis d: urinary calculi e: acute cystitis

4: Urinary tract infection in pregnancy is most likely associated with which of the following organisms?

a: Pseudomonas b: Group B streptococcus c: Lactobacillus d: Neisseria gonorrhoeae e:

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Escherichia coli

5: A 35-year-old G2P1 at 10 weeks of gestation has a history of renal disease due to IgA nephropathy.

Which of the following comorbidities would particularly worsen the prognosis during pregnancy for this mother and fetus?

a: Hypertension b: Anemia c: Depression d: Obesity e: Retinopathy

6: Which of the following is the most common indication for hospital admission of pregnant women during the first half of pregnancy?

a: Vaginal bleeding b: Threatened miscarriage c: Pyelonephritis d: Hyperemesis gravidarum

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e: Preterm labor

7: A 24-year-old G1P0 at 8 weeks of gestation presents with nausea and vomiting. She denies fever, chills, headache, or abdominal pain except for some mild epigastric discomfort. On physical examination, she is mildly tachycardic but there is no evidence of goiter. What is the most likely diagnosis?

a: Pancreatitis b: Cholelithiasis c: Nausea and vomiting of pregnancy d: Cholecystitis e: Hyperthyroidism

8: A 20-year-old G1P0 presents to labor and delivery at 26 weeks complaining of right-sided abdominal pain, nausea, anorexia, and malaise. On physical examination, she has a low-grade fever, 38.1 degrees C. She has lower quadrant abdominal tenderness, right greater than left with guarding on the right. Her cervix is 0 cm dilated and 25% effaced. Tocometry shows irregular contractions every 8 to 10 minutes. A CBC shows a white blood cell count of 15,000 with 85% neutrophils. Your differential diagnosis includes appendicitis. At this point, maternal well-being is reassuring and the fetal heart rate on NST is also reassuring. What is your next step?

a: Tocolysis to prevent preterm delivery b: Fetal ultrasound to further evaluate fetal well-being

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c: Immediate cesarean section with evaluation of the appendix at the time of surgery d: Computed tomography (CT) scan with contrast to evaluate the appendix e: Antibiotics for presumed chorioamnionitis

9: A 35-year-old G6P5 presents to labor and delivery at 27 weeks of gestation with severe right upper quadrant abdominal pain after eating. A right upper quadrant ultrasound shows a stone obstructing the common bile duct. Her serum lipase levels are significantly elevated. Fetal well-being is reassuring on NST. Which of the following is the most appropriate management?

a: Hydration b: Cholecystectomy c: Computed tomography (CT) scan to evaluate the pancreas d: Nasogastric tube e: Immediate cesarean delivery

10: A 32-year-old G3P2 at 33 weeks of gestation slipped and fell on her abdomen while shoveling snow in her driveway. She presents to labor and delivery for evaluation. In the process of your evaluation, it will be important to know the result of which prenatal lab?

a:

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Human immunodeficiency virus (HIV) b: Hepatitis B surface antigen c: Chlamydia testing d: Rubella antibody e: Rhesus factor status

11: 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 excoriations but no rash. Laboratory evaluation reveals mildly elevated aminotransferases. Select the most likely diagnosis:

a: Intrahepatic cholestasis of pregnancy b: Acute fatty liver of pregnancy c: Severe preeclampsia d: Hyperemesis gravidarum e: Hepatitis B infection

12: A 22-year-old G1P0 at 30 weeks of gestation presents with nausea and vomiting and malaise. On physical examination, she is mildly tachycardic and hypertensive. Jaundice is also noted. Laboratory

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evaluation reveals moderately elevated serum aminotransferases, elevated serum creatinine, elevated bilirubin, decreased fibrinogen, and proteinuria. Select the most likely diagnosis:

a: Severe preeclampsia b: Acute fatty liver of pregnancy c: Hyperemesis gravidarum d: Hepatitis B infection e: Intrahepatic cholestasis of pregnancy

13: A 32-year-old G1P0 at 8 weeks of gestation presents with nausea and vomiting and dizziness. On physical examination, she is tachycardic. Laboratory evaluation reveals mildly elevated serum aminotransferases, elevated serum amylase, and decreased thyroid-stimulating hormone levels. Select the most likely diagnosis:

a: Acute fatty liver of pregnancy b: Hepatitis B infection c: Severe preeclampsia d: Intrahepatic cholestasis of pregnancy e: Hyperemesis gravidarum

ANS:[ d,c,d,e,a,d,c,d,b,e,a,b,e]

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Chapter 22: Cardiovascular and Respiratory Disorders 1: Bronchial asthma is encountered in approximately what percent of pregnant patients?

a: 2-8 b: 4-8 c: 2-6 d: 4-12 e: 2-4

2: Severe asthma (very poorly controlled asthma) is associated with less than

a: 30 b: 50 c: 60 d: 20 e: 40

% FEV1 or peak flow.

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3: Which of the following cardiac diseases are best advised not to become pregnant?

a: Primary pulmonary hypertension b: All of these c: Uncorrected tetralogy of Fallot d: Eisenmenger syndrome

4: In normal patients, cardiac output in pregnancy increases approximately

a: 20% b: 80% c: 100% d: 40% e: 60%

5: Which of the following most closely matches the symptoms associated with New York Heart Association Class I?

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a: No symptoms of cardiac decompensation at rest, marked limitation of physical activity b: No symptoms of cardiac decompensation at rest, minor limitation of physical activity c: Symptoms of cardiac decompensation at rest, increased discomfort with physical activity d: No cardiac decompensation or limitation of physical activity

6: Which of the following most closely matches the symptoms associated with New York Heart Association Class II?

a: Symptoms of cardiac decompensation at rest, increased discomfort with physical activity b: No cardiac decompensation or limitation of physical activity c: No symptoms of cardiac decompensation at rest, minor limitation of physical activity d: No symptoms of cardiac decompensation at rest, marked limitation of physical activity

7: Which of the following most closely matches the symptoms associated with New York Heart Association Class III?

a: No cardiac decompensation or limitation of physical activity

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b: No symptoms of cardiac decompensation at rest, minor limitation of physical activity c: Symptoms of cardiac decompensation at rest, increased discomfort with physical activity d: No symptoms of cardiac decompensation at rest, marked limitation of physical activity

8: Which of the following most closely matches the symptoms associated with New York Heart Association Class IV?

a: No symptoms of cardiac decompensation at rest, marked limitation of physical activity b: No symptoms of cardiac decompensation at rest, minor limitation of physical activity c: No cardiac decompensation or limitation of physical activity d: Symptoms of cardiac decompensation at rest, increased discomfort with physical activity

9: The fetuses of patients withfunctionally significant cardiac disease are at increased risk for

a: congenital heart defects b: low-birth weight c: neural tube defects

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d: sepsis

10: Obstetric patients with severe cardiac disease are most likely to die during the

a: second trimester b: third trimester c: postpartum period d: intrapartum period

11: Which of the following is characteristic of patients at increased risk for peripartum cardiomyopathy?

a: History of preeclampsia b: Under 25 years of age c: First pregnancy d: Asian heritage

12: What percent of the offspring of pregnant patients with Marfan's syndrome will inherit the disease?

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a: <3% b: 100% c: 50% d: 25%

13: About

% of patients with rheumatic heart disease have mitral stenosis.

a: 59 b: 90 c: 10 d: 30 e: 70

14: A patient is preeclamptic with blood pressures to 150/110 mm Hg before delivery by induction without difficulty. Postpartum she had a brisk diuresis and her blood pressure fell to 130/75 mm Hg at discharge.

Her antihypertensive medication use during pregnancy was discontinued at her 1 week postpartum visit.

At her annual examination 6 months later her blood pressure was noted to be 145/95 mm Hg. Repeated the following day it was the same. Her most appropriate diagnosis is

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a: gestational hypertension b: severe preeclampsia c: eclampsia d: mild preeclampsia e: chronic hypertension

15: The mechanism of action of thiazide antihypertensive medications is

a: beta-adrenergic blocker b: direct peripheral vasodilation c: false neurotransmission, CNS effect d: calcium channel blocker e: decreased plasma volume and cardiac output

16: The mechanism of action of methyldopa antihypertensive medications is

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a: false neurotransmission, CNS effect b: beta-adrenergic blocker c: decreased plasma volume and cardiac output d: direct peripheral vasodilation e: calcium channel blocker

17: The mechanism of action of Nifedipine antihypertensive medications is

a: decreased plasma voulme and cardiac output b: direct peripheral vasodilation c: beta-adrenergic blocker d: calcium channel blocker e: false neurotransmission, CNS effect

18: The mechanism of action of hydralazine antihypertensive medications is

a:

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decreased plasma volume and cardiac output b: direct peripheral vasodilation c: calcium channel blocker d: beta-adrenergic blocker e: false neurotransmission, CNS effect

19: The mechanism of action of propranolol antihypertensive medications is

a: decreased plasma voulme and cardiac output b: calcium channel blocker c: direct peripheral vasodilation d: false neurotransmission, CNS effect e: beta-adrenergic blocker

20: What serum concentration in mg/dL of magnesium sulfate is associated with decreased patellar reflexes?

a:

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5-10 b: 10-12 c: 8-12 d: 4-6 e: 15-17

21: Hypertensive disease in pregnancy is associated with approximately United States.

% of maternal deaths in the

a: 30 b: 50 c: 20 d: 40 e: 10

22: Approximately

a:

% of eclamptic seizures occur before overt proteinuria.

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4 b: 10 c: 8 d: 6 e: 12

23: Risk factors for preeclampsia include

a: all of these b: multifetal gestation and pregestational diabetes c: multifetal gestation d: antiphospholipid syndrome e: pregestational diabetes

24: Severe preeclampsia is associated with

a: intrauterine growth restriction

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b: visual disturbances c: thrombocytopenia d: all of these e: thrombocytopenia and intrauterine growth restriction

A 24-year-old G1P0 began prenatal care at 7 weeks of gestational age (dates,size, and ultrasound at 16 weeks). Her initial weight was 110 lbs and BP 120/65 mm Hg with no proteinuria. Pertinent data from her antepartum record: GA 31, Wt 129, BP 140/90, Urinary Protein Neg

25: A. Clinical diagnosis at 31 weeks is

a: Severe preeclampsia b: Mild preeclampsia c: Eclampsia d: Normal pregnancy e: Gestational hypertension ANS: [b,c,c,d,d,c,d,d,b,c,a,c,b,e,e,a,d,b,e,c,c,b,a,d,b,b,e,a,c,d]

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Chapter 23: Hematologic and Immunologic Complications When the father is heterozygous Rh D-positive and the mother is Rh D-negative, what is the probability that the fetus will be Rh D-positive?

a: 25% b: 75% c: 50% d: 100%

2: The major class of antibody responsible for Rh isoimmunization is

a: IgG b: IgE c: IgM d: IgA

3: In the case of an Rh D-positive fetus and an Rh D-negative mother, complications will typically first appear in which pregnancy?

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a: Third b: Fourth c: First d: Second

4: Which of the following is the precipitating cause of hydrops fetalis?

a: Severe fluid retention caused by renal failure in the fetus b: Decreased fetal aldosterone secretion c: Intravascular volume overload in a fetus with low-output cardiac failure d: Cardiac response to severe fetal anemia

5: An Rh D-positive fetus in an Rh D-negative mother is identified to have pericardial effusion, pleural effusion, and ascites. This specific condition is

a: coagulation defect b:

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hydrops fetalis c: kernicterus d: anamnestic response

6: Which of the following antigens is associated with mild to severe fetal hemolytic disease?

a: I b: Fyb c: Lewis d: C

7: In cases of fetal Rh isoimmunization, increased fetal hepatic red cell production results in

a: increased oncotic pressure in the fetal vasculature b: unchanged oncotic pressure in the fetal vasculature c: decreased oncotic pressure in the fetal vasculature d: increased and then decreased oncotic pressure in the fetal vasculature

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8: Initial antibody development will occur in approximately what percent of index pregnancies involving an Rh D-negative mother and an Rh D-positive fetus?

a: 15% b: 50% c: 5% d: 25%

9: The major time at which fetal erythrocytes enter the maternal circulation is during

a: spontaneous abortion b: premature rupture of membranes c: labor and delivery d: normal placental circulation

10: The administration of a 300-mg dose of anti-D immunoglobulin to Rh D-negative patients at 28 weeks of gestation is found to reduce the risk of sensitization to approximately what level?

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a: 1.0% b: 0.2% c: 5.0% d: 10.0%

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

a: 5 b: 15 c: 20 d: 10

12: Direct fetal transfusion into the umbilical cord under ultrasound guidance carries with it a risk of fetal complications of up to

a: 3%

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b: 10% c: 5% d: 1%

13: Which of the following statements about the Kleihauer-Betke test is correct?

a: It is indicated only when the amount of fetomaternal hemorrhage is minute b: It identifies antibodies against specific red blood cell antigens c: A negative result is an indication to administer Rh immune globulin d: It is used to detect fetal erythrocytes in the maternal circulation

14: Which of the following statements about ABO hemolytic disease is correct?

a: It results in kernicterus and severe fetal hyperbilirubinemia b: It usually occurs in the second trimester c: It is frequently associated with hydrops fetalis d:

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The relatively low disease severity is likely related to the relatively smaller number of A and B antigenic sites on fetal red blood cells

15: What is the appropriate next management step for a woman who, at 30 weeks of gestation, is determined to be Rh weak D positive?

a: Test the father for presence of antigen b: Perform umbilical cord sampling c: Perform amniocentesis d: No further management is required

16: Severe fetal anemia is indicated by a hematocrit less than

a: 30 b: 25 c: 35 d: 40

17:

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A 28-year-old woman presents for prenatal care at 7 weeks of gestation in her first pregnancy. Her antibody screen is positive for anti-Kell. What is the first step in management of this patient?

a: Order a cordocentesis b: Order an amniocentesis c: Take no action until the status of the father is obtained d: Order a level II obstetric ultrasound

18: A 32-year-old woman had a screen that was positive for an anti-D antibody identified at 8 weeks of gestation. The titer was 1:8. The father is homozygous for the D antigen. She is now 20 weeks prenant.

What is the next step in her management?

a: Amniocentesis for fetal genotype b: Ultrasound for middle cerebral artery Doppler studies c: Immediate administration of anti_D immunoglobulin d: Repeat antibody titer

19: A womant presents for prenatal care at 24 weeks of gestation by her last period. She had a prior child with the same partner who was born with severe anemia and required exchange transfusion. She has an antibody screen positive for anti-D and anti-C. What is the next step in her management?

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a: Perform percutaneous umbilical blood sampling b: Perform ultrasound for middle cerebral artery Doppler studies c: Perform paternal Rh C and D antigen typing and genotyping d: Obtain antibody titer

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

a: hematocrit b: antibody level c: blood type d: bilirubin level [ANS:c,a,d,d,b,d,c,a,c,b,b,a,d,d,d,a,c,d,b,a]

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Chapter 24: Infectious Diseases Approximately what percent of pregnant women have asymptomatic cervical colonization by betahemolytic streptococci?

a: 50% b: 70% c: 30% d: 10% e: 90%

2: Approximately what percent of infants exposed to beta-hemolytic streptococcus in the lower genital tract will become colonized?

a: 50% b: 70% c: 10% d: 30% e:

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90%

3: Hutchinson's teeth, mulberry molars, saddle nose, and saber shins are characteristic of congenital

a: rubella b: bacterial vaginosis c: syphilis d: toxoplasmosis

4: Treponema pallidum reaches the fetus by

a: lymphatics b: direct contact through the chorion c: the amniotic fluid d: transplacental circulation

5: Which of the following is associated with congenital syphillis?

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a: All of these b: Pseudoparalysis c: Cutaneous lesions d: Hepatosplenomegaly e: Osteochondritis of the long bones

6: What increase in the serologic titer for syphilis indicates either inadequate treatment or reinfection and is an indication for further therapy?

a: Twofold b: Eightfold c: Fourfold d: Tenfold e: Sixfold

7:

Which of the following is successful in preventing neonatal gonococcal ophthalmia in the newborn of a woman with Neisseria gonorrhoeae infection?

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a: Penicillin b: Amoxicillin c: Ampicillin d: Tetracycline e: Gentamicin

8: Delivery of an infant through a birth canal with primary herpes infection is associated with a neonatal infection rate of

a: 30% b: 20% c: 50% d: 40% e: 10%

9:

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The risk of congenital rubella syndrome is greatest if the woman contracts the infection during which trimester?

a: First trimester b: Third trimester c: Second trimester

10: Congenital rubella syndrome following vaccination during an undiagnosed pregnancy occurs in

a: no known cases (has not been reported) b: about 0.1% of cases c: about 0.01% of cases d: about 0.5% of cases e: about 1% of cases

11: Which of the following is NOT a neonatal abnormality associated with congenital rubella infection?

a: Musculoskeletal anomalies, including phocomelia

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b: Cataracts and/or retinopathy c: Hepatosplenomegaly d: Deafness or impaired hearing e: Patent ductus arteriosus

12: The most classic eye finding in fetal congenital rubella is

a: microphthalmia b: glaucoma c: myopia d: retinopathy e: cataracts

13: Approximately what percent of Americans infected with the HIV virus are women?

a: 30% b:

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40% c: 20% d: 50% e: 60%

14: What percent of pediatric human immunodeficiency virus (HIV) infection is due to breastfeeding with an infected mother?

a: 50% b: 30% c: 20% d: 40% e: 60%

15: The sensitivity and specificity of the combined use of enzyme-linked immunosorbent assay (ELISA) and Western blot tests for human immunodeficiency virus (HIV) infection is

a: 59%

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b: 99% c: 89% d: 79% e: 69%

16: Universal screening for Group B Streptococcus (GBS) is recommended between which weeks of gestational age?

a: 35-37 b: 33-35 c: 37-39 d: 34-36 e: 36-39

17: Of the six identified forms of viral hepatitis which have been identified, how many may be effectively prevented through vaccination?

a:

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3 b: 2 c: 5 d: 4 e: 1

18: Cesarean section is indicated when there are lesions consistent with HSV infection and

a: the suspected infection is recurrent b: the suspected infection is primary c: at estimated fetal weight less than 6 lb d: all of these e: at gestational age less than 37 weeks

19: Because the rubella vaccine itself is of the live, attenuated type, contraception is recommended until month(s) after vaccination.

a:

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3 b: 6 c: 12 d: 1 e: 2

20: Which type of hepatitis is most uncommon in the United States?

a: A b: B c: E d: D e: C

21: Which type of hepatitis is waterborne?

a: A

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b: C c: D d: E e: B

22: Which of the following statements about hepatitis is true?

a: The risk of vertical transmission with Hepatitis C is increased with co-infection with HIV b: In approximately 50% of cases, HAV infection proceeds to chronic status c: Infants of mothers who are HBsAg positive should receive vaccine and HBIG within 24 hours of birth d: Sixty percent of adults infected with hepatitis B will become chronic infection e: HAV Ig is effective for preexposure but no postexposure prophylaxis

23: Breast feeding is not contraindicated in hepatitis

a: C b:

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A and C c: B d: A e: A,B, and C

24: The latency period from untreated HIV to AIDS is estimated at about

a: 7 b: 1 c: 11 d: 3 e: 15

25: Treatment for HPV lesions during pregnancy includes all but

a: 5- fluorouracil

b: podophylin and trichloroacetic acid

years.

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c: podophylin and 5-fluorouracil d: podophylin e: trichloroacetic acid ANS: [cacda cdcaa aeaab abddc daecc]

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Chapter 25: Neurologic and Psychiatric Disorders 1: A patient presents for her new ob visit at 9 weeks of gestation. She states that she has experienced more headaches than usual in the past 4 weeks. The best management is

a: MRI scan b: acetaminophen c: CT scan d: referral to a neurologist

2: Which of the following is true regarding migraine headaches?

a: They generally are first noted at puberty b: They occur as commonly in men as in women c: Initial treatment includes codeine with or without acetaminophen d: The majority of patients with migraine headaches note improvement during pregnancy

3: In the initial assessment of a pregnant patient with a history of epilepsy, which of the following is true?

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a: Amniocentesis for chromosomal anomalies should be offered b: Counseling regarding the effect of medications on pregnancy is essential c: Cesearean delivery at term is recommended d: Supplemental folate should be started at 20 weeks of gestation e: It is important to stop all anti-epileptic medications

4: Carpal tunnel syndrome in pregnancy is usually treated with

a: low-dose codeine b: wrist splint c: surgical release of restricting fascia d: diuretics e: a short course of steroids

5: The most common mood disorder seen in pregnancy is

a:

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anxiety b: schizophrenia c: bipolar disorder d: depression

6: Postpartum blues and postpartum depression are distinguished by

a: need for counseling b: severity and duration of symptoms c: need for hospitalization d: need for medication

7: Which of the following statements is true regarding bipolar disorders?

a: Onset generally occurs at puberty b:There is a strong genetic component c: Bipolar disorders are more common in women than in men d: Usual medications are considered safe in pregnancy ANS: [b,d,b,b,d,b,b]

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Chapter 26: Contraception A 20-year-old white female G0 comes to see you about contraception. She is in college and plans to go to grad school, so she wants something that is 100% effective in preventing pregnancy. You explain to her that the method failure rate and the typical use rate can be very different depending on the method chosen.

1: A. The "method failure rate" reflects the rate of failure when the method is

a: compared with the use of no contraception at all b: used correctly 100% of the time c: used by a random sample of women d: used in laboratory animals e: used in the laboratory setting

2: B. The most common method of contraception among younger women in the United States is

a: long-acting hormone (rod or injection) b: oral contraceptive c: rhythm d:

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intrauterine device (IUD) e: spermicidal foam

3: C. The pregnancy rate (% pregnant in 1 year) for a couple using no method of contraception typically is

a: 25 b: 65 c: 15 d: 45 e: 85

4: D. In the first year of use, the typical use pregnancy rate for a woman using a diagphragm and spermicide

a: 16 b: 20 c: 28 d:

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8 e: 24

5: E. In the first year of use, the typical use pregnancy rate for a woman using a copper intrauterine contraceptive is

a: 8 b: 1.5 c: 0.8 d: 10 e: 3

6: F.

Which of the following is the least effective birth control option?

a: Combination oral contraceptives b: Cervical cap c: Monthly transvaginal ring d:

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Weekly transdermal patch e: Three-month injectable

7: G. The failure of oral contraceptives usually is related to

a: interference by other medications that the patient is taking b: an inherent problem in the estrogen-to-progesterone ratio c: altered gastrointestinal absorption of the oral contraceptive caused by hormonal influences d: ingestion of the oral contraceptive agent with alcohol e: missed doses of the oral contraceptive

8: H. Which of the following contraceptive techniques relies the least on patient compliance?

a: Contraceptive ring b: Combination pill c: Progestin pill d: Contraceptive patch

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e: Contraceptive implant

A 24-year-old Latin American female G2P2 sees you for her annual. She is about to wean her baby in a few months and is on the progesterone-only pill. She really likes this particular pill because she has had no periods while breastfeeding. She wonders if she can continue to use it.

9: A. You counsel her that one of the main reasons to consider switching to combination birth control pills is

a: better lipid profile b: better control of her moods c: better cycle control d: better weight loss e: better control of her acne

10: B. Which of the following statements about the progestin-only minipill is correct?

a: It cannot be started postpartum until at least 2 months after delivery b: It is taken once per week c:

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It is most useful for women under 30 years d: It is most useful for lactating women

A 34-year-old female G4P4 sees you for her annual exam. You notice that she uses natural family planning for contraception. She states she desires no more pregnancies. You discuss other options including long-acting reversible contraception and permanent sterilization. She declines for religious reasons.

11: A. Your next step should be to

a: refuse to continue to see her as a patient b: laughingly tell her she is crazy and will probably see her pregnant again next year c: give her information on fertility awareness and encourage her to contact you with any questions d: advise her to talk to her partner and come back to discuss the options e: remind her that she is essentially using luck for contraception

12: B. This woman's periods are regular, coming every 28 days. This patient's "fertile" period would be days

a: 10-17 b: 7-14

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c: 7-17 d: 10-20

13: C. Which of the following methods is most appropriate for this woman requesting a "natural" method of family planning?

a: Cervical cap b: Cervical mucus method c: Vaginal ring d: Female condom

A 20-year-old college student G0 sees you for her annual. Her gyn history is remarkable for menarche at 13 years and regular cycles, but her periods last 7 to 9 days and are very painful. Her college roommate had similar periods and got good results with birth control pills. During the history you note that she smokes 1 pack per day. She has migraines that are preceded by flashing lights. Her mother had breast cancer diagnosed at age 49 years and both her parents are hypertensive.

14: A. You are hesitant to prescribe birth control pills because of

a: her migrines preceded by flashing lights b:

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her painful periods that may be consistent with endometriosis c: her smoking one pack per day d: her history of breast cancer in her mother e: her family history of hypertension

15: B. What is the primary mechanism of action of oral contraceptives?

a: Inhibit ovulation b: Impose a barrier between the sperm and the egg c: Create an environment in the uterus that is toxic to the sperm d: Destroy the embryo shortly after fertilization e: Alter the ability of the fertilized egg to implant and grow

16: C. Which is a contraindication to the birth control pill?

a: Smoking in a woman older than 35 years b: A family history of stomach cancer

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c: Dysmenorrhea d: A history of ovarian cysts

17: D. Other than investigating the cause, what action should be taken when a woman using an oral contraceptive experiences a headache?

a: Increase oral contraceptive to twice daily b: Switch to the phasic pill c: Continue oral contraceptive d: Discontinue all contraception e: Discontinue oral contraceptive

A 16-year-old sees you in the Derm Clinic. She is hesitant because she heard antibiotics made "your birth control not work." You reassure her that most common antibiotics do not lessen the effectiveness of birth control pills.

18: A. When taken concurrently, which of the following will reduce the effecacy of oral contraceptives?

a: Tetracycline b:

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Aspirin c: Phenytoin d: Metronidazole e: Methyldopa

19: B. Which of the following best describes "phasic" formulation of oral contraceptives?

a: They contain only progestin in varying doses b: They contain varying doses of hormones throughout the cycle pack c: They are mostly used postpartum d: They contain a higher dose of hormones per month than monophasic contraceptive pills e: They have a different mechanism of action than monophasic pills

20: In which of the following casses should biphasic oral contraceptives be discontintued?

A: Galactorrhea b:Right upper quadrant pain c:Amenorrhea d:Anemia e:Hepatic mass with tenderness ANS: [b,b,e,c,c,b,e,e,c,d,c,a,b,a,a,a,c,c,b,e]

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Chapter 27: Sterilization A couple in their thirties with three healthy children comes to your office to discuss contraception. After a review of long-term contraceptives and sterilization, the couple chooses sterilization. They ask several questions:

1: A. As compared with female sterilization, which of the following is a characteristic of vasectomy?

a: Greater operative complication rate b: Greater cost c: Greater reversibility d: Greater incidence of postoperative depression e: Greater effect on libido

2: B. Roughly what proportion of married couples in the United States use sterilization for contraception?

a: 1 in 3 b: 1 in 2 c: 1 in 8 d:

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1 in 5 e: 1 in 10

3: C. In most cases, successful reversal of female sterilization done by tubal ligation is possible in approximately what percent of cases?

a: 25%-50% b: 5%-10% c: 60%-80% d: Greater than 95% e: 15%-20%

4: D. Vasectomy accounts for approximately what percent of all sterilization procedures?

a: 40%-45% b: 20%-25% c: 50%-55% d:

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30%-35% e: 10%-15%

5: E. Antibodies against the sperm are found in about what proportion of men who have undergone vasectomy?

a: 50% b: 70% c: 10% d: 90% e: 30%

6: F.

a: 4% b: 8% c: 10% d:

what is the 10-year failure rate in tubal ligation done by bipolar coagulation?

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2% e: Less than 1%

7: G. Bilateral tubal ligation has the additional benefit of reducing the likelihood of

a: dysfunctional uterine bleeding b: ovarian cancer c: fallopian tube cancer d: endometrial cancer e: pelvic inflammatory disease

8: H. Which sterilization technique has the longest delay until sterilization is achieved?

a: Hysteroscopic micro-insert b: Hulka clip c: Pomeroy d: Vasectomy

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e: Electrocautery

A 28-year-old G3P3 presents to the emergency room early in the morning in severe pain after a tubal ligation performed yesterday. She claims she was told the procedure went well but the pain developed shortly after getting home yesterday afternoon. She took her pain medicine as prescribed but has not been able to control her pain.

9: A. What is the most likely method of sterilization used?

a: Pomeroy procedure b: Unipolar electrocautery c: Hulka clip d: Bipolar electrocautery e: Falope ring

10: B. Which of the following female sterilization methods is most likely to result in future ectopic pregnancy?

a: Electrocautery b: Pomeroy tubal ligation

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c: Hysteroscopic micro-insert d: Falope ring e: Hulka clip

11: C. Which of the following female sterilization methods is most likely to be successfully reversed?

a: Falope ring b: Electrocautery c: Pomeroy tubal ligation d: Hulka clip e: Hysteroscopic micro-insert

12: D. Which of the following female sterilization methods is most likely to result in operative complications?

a: Electrocautery b: Pomeroy tubal ligation

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c: Hysteroscopic micro-insert d: Falope ring e: Hulka clip

13: E.

Which of the following best describes Pomeroy tubal ligation?

a: Tube divided; proximal stump buried in round ligament; distal stump buried in leaves of broad ligament b: Fimbriated end of tube excised and ligated c: Tube divided; proximal stump buried in uterine wall; distal stump buried in leaves of broad ligament d: Midportion of tube elevated; loop ligated with absorbable ligature and segment excised e: Tube divided; proximal and distal stumps individually ligated

14: F.

The term "interval sterilization" refers to procedures that

a: are performed after the immediate postpartum period b: destroy a portion or "interval" of the fallopian tube c:

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are performed during the immediate postpartum period d: remove a segment or "interval" of the fallopian tube e: are meant to be reversible and therefore only function for an "interval" of time

A 30-year-old G3P3 last menstrual period 6 weeks ago status post tubal ligation presents to the ER with abdominal pain, cramping, and bleeding.

15: Your initial differential diagnosis must include

a: ectopic pregnancy b: ruptured ovarian cyst c: molar pregnancy d: normal menses e: normal intrauterine pregnancy

A 34-year-old G2P2 tells you she wants her copper IUD removed because her periods have become heavier and crampy so her husband is getting a vasectomy.

16: A. You advise her to

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a: wait until 10 weeks after the vasectomy b: wait until 12 weeks after the vasectomy c: wait until 8 weeks after the vasectomy d: wait until 6 weeks after the vasectomy e: wait until 4 weeks after the vasectomy

17: B. As compared with female sterilization, which of the following is a characteristic of vasectomy?

a: Greater postoperative complication rate b: Greater reversibility c: Greater incidence of postoperative depression d: Greater incidence of sexual dysfunction e: Greater cost

18: C. The most likely cause of pregnancy after vasectomy is

a:

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recanalization b: ligation of the tunica albicans c: sperm stored in urethrocele d: sexual activity too soon after surgery

19: D. Postoperative complications of vasectomy such as bleeding, hematoma formation, and local skin infection occur in about what percent of cases?

a: 12%-15% b: 3%-4% c: 15%-20% d: Less than 1% e: 5%-10%

A 28-year-old G2P2 surgical resident on birth control pills consults you about permanent sterilization.

She desires no more children and a recent pregnancy scare made her realize she wants something permanent. Her husband will not get a vasectomy. She cannot take any time off and wants to be as discrete as possible.

20: The permanent sterilization procedure with the briefest recovery is

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a: vaginal tubal ligation b: Pomeroy procedure c: hysteroscopic implant insertion d: tubal ligation with Falope rings e: tubal ligation with minilapaprotomy

A 20-year-old woman comes in for prenatal counseling. She already has given birth to one child. She requests sterilization after the birth of her second child. She is knowledgeable about options and asks for a tubal ligation.

21: A. Which of the following is a significant risk factor for future regret about her decision?

a: Her parity b: Her worry about the high rate of method failure c: Her age d: Her marital status e: Her choice of method

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22: B. Despite careful counseling, what percent of patients will request sterilization reversal?

a: 5% b: 12% c: 1% d: 7% e: 10%

23: C. A 25-year-old patient has undergone reversal of a tubal ligation and then exhibits signs and symptoms of pregnancy. She should initially be presumed to have

a: an abnormal intrauterine pregnancy b: a molar pregnancy c: a normal intrauterine pregnancy d: an ectopic pregnancy e: heterotopic pregnancy ANS: [caada dbaea dadaa abdec ccd]

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Chapter 28: Vulvovaginitis A 16-year-old virginal is brought in by her mother because of possible vaginal infections. Which of the following descriptions is most consistent with normal (physiologic) discharge?

a: White, clear, and flocculent b: White, curds, cottage cheese-like c: Gray-green, thin, and adherent d: Gray-green, frothy

2: A 24-year-old patient requests treatment for what she believes is a bacterial infection of the vagina.

Which of the following is characteristic of vaginal discharge in cases of bacterial vaginosis?

a: Fishy odor b: pH<4.5 c: Whitish color d: Curdy consistency

3: A 40-year-old patient has recently been treated for a urinary tract infection with antibiotics. She now complains of a possible yeast infection. Discharge in cases of vaginal candidiasis is characterized by

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a: presence of hyphae and buds b: thin, homogeneous consistency c: white cells d: foul odor

4: A 30-year-old patient is seen for a vaginal discharge that started after she had relations with a new partner. Which of the following characterizes vaginal trichomoniasis?

a: pH of discharge less than 4.5 b: Vaginal dryness c: White discharge d: Motile protozoa on microscopic examination

5: A 55-year-old patient has recently developed vaginal irritation. Her last menstrual period was 9 months ago. Which of the following is characteristic of atrophic vaginitis?

a: Increased circulating estrogen levels

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b: Thickened vaginal epithelium c: Vaginal dryness d: pH of vagina less than 4.5

6: Most of the liquid portion of physiologic vaginal secretions in a woman of reproductive age comes from

a: vaginal transudate b: the cervix c: the Skene glands d: the Bartholin glands

7: In a 33-year-old woman with regular periods, the creamy white portion of normal vaginal secretions comes from

a: exfoliated squamous epithelial cells b: vaginal white blood cells c: cervical mucus

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d: the Bartholin glands

8: A 19-year-old patient who was concerned about vaginal discharge was found to have normal vaginal secretions. Which of the following is the most appropriate management?

a: Return as needed. b: Return after a single pill of fluconazole. c: Return after a 3-day course of metronidazole. d: Return after the next period.

9: The normal pH of vaginal secretions in a reproductive-age woman is

a: 3.5-4.5 b: 6.5-7.5 c: 5.0-6.0 d: 8.0-9.0

10:

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What is the difference in the normal pH of the vagina before and after menopause?

a: Same in pre- and postmenopausal patient b: Varies depending on the phase of the premenopausal cycle c: Higher in premenopausal patient d: Higher in postmenopausal patient

11: A 38-year-old patient requests treatment for a yeast infection but declines an examination because she is on her period. The most common symptom associated with vulvovaginal candidiasis is

a: pain b: fever c: fishy smelling discharge d: pruritus

12: A 38-year-old patient requests evaluation of a fishy-smelling discharge. Which of the following is a criterion for the diagnosis of bacterial vaginosis?

a:

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Presence of clue cells b: Negative "whiff" test c: Cottage cheese-like discharge d: pH less than 4.5

13: A 45-year-old woman complains of a copious vaginal discharge. Which of the following is a common cause of increased vaginal discharge?

a: Trichomoniasis b: Herpes c: Human papillomavirus d: Atrophic vaginitis

14: A 25-year-old patient complains of vaginal discharge that is white and curdy in appearance. What is the appropriate method to establish the diagnosis?

a: Constellation of symptoms b: Odor of the discharge

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c: The amount of discharge d: Microscopic examination of the discharge

15: What is the normal ratio of anaerobic to aerobic bacteria in the vagina?

a: 1 to 5 b: 5 to 1 c: 1 to 1 d: 10 to 1

16: A 21-year-old patient complains of a vaginal discharge but is also concerned about pelvic inflammatory disease (PID). Which type of vaginitis is associated with PID?

a: Trichomonas vulvovaginitis b: Atrophic vaginitis c: Desquamative inflammatory vaginitis d: Vaginal candidiasis

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17: Which of the following best describes a "clue cell"?

a: Clumped white blood cells b: Vaginal epithelial cells with adherent bacteria c: Keratinized vaginal epithelial cells with adherent white blood cells d: Immature vaginal epithelial cells

18: A 30-year-old patient is found to have Trichomonas. She asks about multiple other symptoms that she is concerned about. She can be informed that Trichomonas vaginalis is a flagellate protozoan that can live in the

a: oropharynx b: vagina c: bladder d: anus

19: In which of the following is treatment of sexual partners recommended?

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a: Trichomonas vaginitis b: Atrophic vaginitis c: Bacterial vaginosis d: Vulvovaginal candidiasis

20: A 29-year-old patient is undergoing evaluation for a symptomatic discharge. Which of the following characterizes the microscopic appearance of Trichomonas?

a: Ground-glass cytoplasm b: Pseudohyphae c: Flagellate protozoan d: Bacillus

21: What characteristic lesions may be found in the upper vagina or on the cervix of patients with Trichomonas vaginalis?

a: Ulcers

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b: White plaques c: Clear blisters d: Petechiae

22: A 26-year-old patient is told by her boyfriend that he has Trichomonas. She has developed a copious discharge recently. The standard treatment for Trichomonas vaginal infection is

a: oral clindamycin b: oral fluconazole c: oral metronidazole d: topical synthetic imidazoles

23: A 30-year-old patient is receiving a prescription for metronidazole for the treatment of Trichomonas.

What additional advice should she receive?

a: Avoid nonsteroidal anti-inflammatory agents b: Avoid alcohol c:

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Avoid caffeine d: Take vitamin supplementation

24: A 22-year-old patient inquires as the origin of the yeast infection for which she is being treated. She can be informed that the most common source of monilial infections of the vagina is

a: sexual contact with an infected partner b: bath water retained in the vagina following bathing c: contaminated clothing d: airborne colonization

25: Roughly 90% of vaginal "yeast" infections are caused by

a: Candida tropicalis b: Torulopsis glabrata c: Candida glabrata d: Candida albicans ANS: [aaadc baaad daadb abbac dcbdd]

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Chapter 29: Sexually Transmitted Infections A 25-year-old woman is found to have gonorrhea. What percent of patients with a sexually transmitted disease (STD) have more than one STD?

a: 20%-50% b: <3% c: 5%-10% d: 70%-90%

2: A 30-year-old patient with herpes inquires about prevention of outbreaks. Daily suppressive therapy for genital herpes prevents what percent of recurrences?

a: 40% b: 60% c: 20% d: 80%

3: In a 23-year-old patient with her first episode of genital herpes, initial therapy should include

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a: benzathine penicillin G b: podofilox c: oral acyclovir d: imiquimod

4: What is/are the first lesion(s) seen in cases of primary genital herpes?

a: Rash b: Vesicles c: Ulcers d: Plaques

5: Treatment for gonorrhea should include

a: quinolone antibiotics b: acyclovir

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c: benzathine penicillin G d: ceftriaxone

6: Aseptic meningitis with headache and fever occurs in some patients about 1 week after infection with

a: HSV b: Neisseria gonorrhoeae c: HPV d: Treponema pallidum

7: Compared with primary genital lesions, recurrent herpes lesions

a: are more dispersed b: have more systemic symptoms c: are milder in severity d: last longer

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8: Which of the following sexually transmitted diseases must be reported to all state health departments?

a: Granuloma inguinale b: HPV c: Chlamydia d: Genital herpes

9: An 18-year-old patient presents with a 5-day history of very painful vulvar ulcers that began as small "blisters." She is now complaining of a low-grade fever, headache, and meningismus. Large, painful vulvar and perineal ulcers and inguinal adenopathy are found on examination. The most likely diagnosis is

a: lymphogranuloma venereum b: disseminated gonoccocal infection c: secondary syphilis d: primary herpes vulvitis

10: A 23-year-old patient presents at term in early labor with an active herpes infection of the labia.

Membranes are intact. Contractions are regular at 3-minute intervals. Her last term labor was 3 years

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ago and lasted 12 hours, ending in a vaginal delivery of a normal 7-lb infant. Which of the following is the best management for this patient?

a: Anticipate normal labor and delivery, plan acyclovir prophylaxis for the infant b: Anticipate rapid labor and delivery but avoid episiotomy c: Tocolysis and intravenous acyclovir d: Immediate cesarean delivery

11: Chlamydia infections are frequently associated with coinfections by

a: Treponema pallidum b: Neisseria gonorrhoeae c: herpes simplex d: human papillomavirus

12: A common sequela of infection by Chlamydia trachomatis is

a: pelvic inflammatory disease

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b: vulvar ulcers c: cyclic, migratory arthralgia d: vaginal discharge

13: Neisseria gonorrhoeae is a

a: gram-negative intracellular diplococcus b: gram-negative extracellular diplococcus c: gram-positive intracellular diplococcus d: gram-positive extracellular diplococcus

14: Following initial infection by Neisseria gonorrhoeae, how soon do symptoms first appear?

a: 3-5 days b: 3-5 weeks c: 1-2 days d:

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1-2 weeks

15: A 22-year-old nulligravid patient is being treated for Neisseria gonorrhoeae salpingitis and asks about her chances of infertility. Based on this single infection, the probability of infertility is approximately

a: less than 1% b: 5% c: 10% d: 15%

16: A 24-year-old G0 patient has been successfully treated for her third episode of Neisseria gonorrhoeae salpingitis. Based on the history of these infections, the risk of involuntary infertility for her is approximately

a: 25% b: less than 10% c: 50% d: 75%

17:

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Lower genital tract infections caused by Neisseria gonorrhoeae are characterized by

a: firm, painless vulvar ulcers b: fever, malaise, and bilateral labial swelling c: inguinal adenopathy d: purulent vaginal or urethral discharge

18: Which of the following is the most frequent expression of gonorrheal infection in men?

a: Pharyngitis b: Conjunctivitis c: Proctitis d: Urethritis

19: Of the following, which criterion is required in order to make a diagnosis of acute salpingitis?

a: Flu-like symptoms b:

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Pus obtained via culdocentesis c: Adnexal tenderness d: Mass on ultrasound

20: A 23-year-old patient is diagnosed with acute pelvic inflammatory disease (PID). Of the following, which factor would be the strongest indication for hospitalization?

a: Coexisting pregnancy b: Nulliparity c: Intermittent vaginal bleeding d: Patient less than 20 years of age

21: In the absence of signs/symptoms which meet highly specific diagnostic rigor, the initiation of treatment for presumed pelvic inflammatory disease is based on

a: cervical Gram stain b: white blood cell count c: clinical suspicion

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d: anaerobic culture

22: The development of cervical cancer is associated with

a: herpes simplex type II b: human papillomavirus c: Chlamydia trachomatis d: herpes zoster

23: HPV subtypes 16 and 18 account for what percent of cervical cancer cases?

a: 50% b: 25% c: 95% d: 66%

24:

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A 23-year-old patient is being seen for presumed genital warts. Condyloma acuminata lesions may be confused with which of the following?

a: Granuloma inguinale b: Early herpes simplex type II infections c: Late lymphogranuloma venereum d: Secondary syphilis

25: Human papillomavirus infection is associated with

a: condyloma acuminata b: basal cell carcinoma c: condyloma lata d: melanoma

26: A 40-year-old patient having a routine Pap smear asks about detection of the human papillomavirus and its relationship to cervical cancer. The human papillomavirus is found in approximately what percent of sexually active women?

a:

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20% b: 80% c: 40% d: 10%

27: Which of the following makes a patient more resistant to therapy for condylomata acuminata?

a: Age greater than 50 b: Overweight c: Diabetes d: Nulliparous

28: Vaginal delivery of a patient with extensive condyloma acuminata of the vulva may result in

a: infant laryngeal papillomas b: maternal hemorrhage c: neonatal ophthalmia

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d: infant encephalopathy

29: When can transplacental spread of Treponema pallidum occur?

a: During the first trimester only b: During the third trimester only c: After rupture of membranes d: At any time during pregnancy

30: Which of the following is characteristic of primary syphilis?

a: Chancre appears 3-5 days after infection b: Serologic testing usually is positive c: Accompanying low-grade fever and anorexia are common d: Chancre is often asymptomatic

31: Which is the most contagious stage of syphilis?

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a: Secondary b: Tertiary c: Primary d: Latent

32: Which of the following is characteristic of secondary syphilis?

a: Skin rash on the palms and soles b: Coalesced sores c: Regional adenopathy d: Raised fleshy growths

33: Which of the following is a nontreponemal test for syphilis?

a: FTA-ABS b: VDRL

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c: MHA-TP d: TP-PA

34: Which of the following is characteristic of secondary syphilis?

a: Low-grade fever, headache, malaise, sore throat, anorexia, and generalized lymphadenopathy b: Serologic testing for syphilis is generally negative c: Asymptomatic chancre that is often missed d: Noninfectious mucous patches

35: How should the diagnosis of human immunodeficiency virus infection be confirmed?

a: Presence of clinical symptoms b: CD4 white blood cell counts c: Western blot testing d: Serum immunoassay ANS: [adcbd accdd baaad dddca cbdda bcadd aabac]

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Chapter 30: Pelvic Support Defects, Urinary Incontinence, and Urinary Tract Infection 1: Enterocele is defined as herniation of what organ through the vagina?

a: Uterus b: Bladder c: Small bowel d: Urethra

2: A 45-year-old patient complains of frequent loss of urine when she coughs, laughs, or strains. The volume lost is small. She does not report any dysuria. Which type of incontinence does she have?

a: Urge b: Overflow c: Stress d: Psychogenic

3: A 45-year-old patient complains of frequent loss of urine. The volume lost is small, but it occurs almost continuously. She denies urgency, has no dysuria, and voids frequently but in small amounts. She does

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not ever feel "full" but also never has the sense that she has completely emptied her bladder. What type of incontinence best describes her condition?

a: Behavioral b: Overflow c: Urge d: Stress

4: A 22-year-old patient complains of occasional loss of urine. 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?

a: Overflow b: Psychogenic c: Urge d: Stress

5: 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

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a: vesicovaginal fistula b: stress incontinence c: overflow incontinence d: behavioral incontinence

6: A cystocele may best be demonstrated clinically by

a: use of a Sims speculum to retract the anterior vaginal wall b: gentle traction on the cervix c: observing posterior rotation of the anterior vaginal wall in response to change in position d: use of a Valsalva maneuver

7: A patient who loses urine when she coughs or sneezes most likely has a(n)

a: urethral prolapse (urethrocele) b: enterocele

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c: rectocele d: cystocele

8: A "Q-tip test" is used to evaluate

a: residual urine b: urethral mobility c: posterior vaginal wall support d: uterine prolapse

9: When performing a "Q-tip test," incontinence is generally associated with upward rotation of

a: 45 degrees b: 10 degrees c: 20 degrees d: 30 degrees

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10: What term is applied when the cervix descends below the vulva?

a: Rectocele b: Enterocele c: Procidentia d: Cystocele

11: Pelvic muscle training programs are most useful for what type of incontinence?

a: Psychogenic b: Overflow c: Urge d: Stress

12: What is the purpose of Kegel exercises?

a: Improve bladder capacity and control

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b: Increase bladder awareness c: Strengthen pelvic floor muscles d: Tighten uterine ligaments

13: A 45-year-old patient is undergoing nonsurgical management of genitourinary problems related to her recent pregnancy. Kegel exercises may be useful in a patient with

a: dyspareunia b: mild stress incontinence c: symptomatic rectocele d: second-degree prolapse of the uterus

14: What is the primary purpose of a ring pessary?

a: Decrease bladder capacity b: Obstruct the urethra c: Channel intra-abdominal pressure toward the introitus

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d: Provide mechanical support

15: Which of the following surgical procedures obliterates the vaginal canal?

a: Sacral colpopexy b: Colpocleisis c: Posterior colporrhaphy d: Burch procedure

16: What percent of women will suffer a urinary tract infection at some point in their lives?

a: 90% b: 10% c: 60% d: 30%

17: Asymptomatic bacteriuria is found in what percent of postmenopausal women?

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a: 10% b: <5% c: 30% d: 20%

18: A 30-year-old patient is evaluated for a possible urinary tract infection. The culture of a urine sample is reported to show greater than 100,000 colonies of "mixed flora." This is most likely indicative of

a: trigonitis b: upper urinary tract infection c: a contaminated specimen d: infection of the proximal urethra

19: In a symptomatic patient, which of the following is indicative of lower urinary tract infection?

a: >100,000 colonies of mixed flora b:

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1,000 colonies of Bacteroides species c: 10,000 colonies of Staphylococcus aureus d: 10,000 colonies of Escherichia coli

20: Cystocele is best defined as

a: descent or prolapse of the rectum b: descent or prolapse of the urethra c: descent or prolapse of the bladder d: herniation of the top of the vagina

21: Which of the following is the best description of a rectocele?

a: herniation of the top of the vagina b: descent or prolapse of the rectum c: descent or prolapse of the urethra d: descent or prolapse of the bladder

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22: Procidentia describes uterine descent beyond the

a: vulva b: ischial spines c: level of the uterine artery d: plane of the pelvic inlet

23: What is the stage of prolapse when the leading part of the prolapse is more than 1 cm beyond the hymen but less than or equal to the total vaginal length?

a: I b: III c: II d: IV

24: What is the condition in which the bladder forces the anterior vaginal wall down and out?

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a: Cystocele b: Enterocele c: Rectocele d: Procidentia

25: Which of the following is the best way to identify a urethral diverticulum?

a: Multichannel urodynamic testing b: The Q-tip test c: Cystourethroscopy d: Single-channel urodynamic testing ANS:[ ccbca dabdc dcbdb bcdcd babac ]

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Chapter 31: Endometriosis 1: A patient is referred to you from her family doctor and asks how the diagnosis of endometriosis is best confirmed.

a: family history b: typical history-physical examination c: CA-125 d: ultrasound e: tissue biopsy

2: A 24-year-old woman is undergoing laparoscopy for otherwise unexplained infertility. What are the chances that endometriosis will be found in this woman?

a: Greater than 90% b: 50%-70% c: 20%-40% d: 80%-90% e:

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Less than 15%

3: A 24-year-old woman is undergoing laparoscopy for otherwise unexplained infertility. Which of the following is the most likely site for endometriosis to be found?

a: Vagina b: Posterior cul-de-sac c: Inguinal ligaments d: Ovaries e: Fallopian tube

4: A 26-year-old infertile patient expresses concern that she has endometriosis. Which modality would provide the most accurate diagnosis?

a: MRI b: Ultrasound c: Positron emission tomography (PET) d: CT scan

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e: Laparoscopy

5: A patient who is taking a GnRH agonist for control of symptoms associated with endometrisosis complains of severe hot flashes and night sweats. The most appropriate next step would be to

a: administer an antidepressant medication b: take no action c: administer progestin along with the GnRH agonist d: discontinue the GnRH agonist e: administer danazol along with the GnRH agonist

6: A 22-year-old patient presents to you with infertility and menorrhagia. She inquires about endometriosis. You share with her that which of the following is a "classic" symptom of endometriosis?

a: Dyschezia b: Diarrhea c: Progressive dysmenorrhea d:

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Sudden abdominal pain

7: A 24-year-old woman is undergoing laparoscopy for otherwise unexplained infertility. She is found to have complete obliteration of the cul-de-sac. According to the American Fertility Society classification of endometriosis, a patient with complete obliteration of the cul-de-sac by adhesions has

a: moderate disease b: severe disease c: mild disease d: terminal disease e: minimal disease

8: A 25-year-old patient is found to have minimal and asymptomatic endometriosis at the time of laparoscopy for infertility. What is the most appropriate treatment for this patient's endometriosis?

a: Expectant management b: Administration of oral contraceptives c: Administration of a GnRH agonist d: Laser ablation

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e: In vitro fertilization for pregnancy

9: In a 35-year-old patient who has undergone total abdominal hysterectomy and bilateral salpingooophorectomy for endometriosis, estrogen replacement therapy should be

a: started immediately b: started only after five symptom-free years c: started between 3 and 6 months after surgery d: started after follow-up laparoscopy 1 year later e: avoided indefinitely

10: In counseling a 38-year-old patient regarding surgery for symptomatic endometriosis, she should be told that if both ovaries are not removed, her chance of requiring another operation in 5 years is

a: 90% b: 70% c: 50% d:

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10% e: 30%

11: A 16-year-old who had an imperforate hymen diagnosed at age 13 years presents for management of significant lower abdominal cyclic and non-cyclic pain. Laparoscopy documents moderate pelvic endometriosis. First-line therapy for this patient is nonsteroidal anti-inflammatory drugs (NSAIDS) and

a: Long-acting progestin thearpy b: continuous oral contraceptives c: GnRH agonist thearpy d: hormone replacement therapy e: danocrine sodium therapy

12: A 23-year-old woman comes to the office because of increasing pelvic heaviness, cyclic lower abdominal pain, and an inability to conceive. Her menstrual symptoms begin 1 day before her menstrual flow and they last for 3 days. Her menstrual cycle is regular, but is heavy with clots. She says she has been trying to get pregnant for the past 3 years even though they have a 6-year-old from her husband's previous marriage. The test or procedure most likely to establish a diagnosis in this patient is

a: serum CA-125 level b: laparoscopy

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c: basal body temperature chart d: empiric GnRH agonist therapy e: hysterosalpingography

13: Physical examination is normal except for painful nodules noted posterior to the cervix on physical examination. The most likely mechanism by which this occurs is

a: embryonic rests b: a viral DNA vector c: retrograde menstruation d: rich pelvic lymphatic drainage e: multipotent coelomic cells

14: The most likely mechanism for this patient's infertility is

a: increased macrophage activity b: prostaglandin-induced tubal motility abnormality

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c: elevated levels of FSH d: pelvic scarring e: persistent anovulation

15: A 26-year-old accountant presents for evaluation of deep pain with intercourse. The patient reports that her symptoms have been becoming more troublesome over the past 6 to 12 months. The discomfort now accompanies almost every attempt at intercourse and has become independent of sexual position.

A review of her past history reveals that her menarche was at age 12 years with periods generally, regular, occurring approximately every 28-30 days. Her periods are generally "average" in flow but she has noted progressively more menstrual discomfort, which now comes up to 2 to 3 days before the onset of her flow. She has had lifetime partners and no known sexually transmitted infections. She has never been pregnant though she and her husband began trying 6 months ago but have given up the idea because of her discomfort with intercourse. The most likely cause of this patient's dyspareunia is

a: ovarian cyst b: endometriosis c: pelvic inflammaotry disease d: vulvitis e: fixed uterine retroversion

16:

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A 24-year-old patient with dysmenorrhea and infertility is found to have pelvic endometriosis as well as implants in the pleural cavity and kidneys. These findings would support the theory of endometriosis development based upon

a: multipotent coelomic cells b: a vira DNA vector c: vascular and lymphatic dissemination d: lymphatic dissemination e: retrograde menstruation ANS: [ecbec cbaad bbcdbc]

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Chapter 32: Dysmenorrhea and Chronic Pelvic Pain 1: A 19-year-old nulligravid woman presents for evaluation of painful menses. Her periods began at age 12 years and became both regular and painful within about a year after they started. Abdominal and pelvic examinations do not reveal a cause for this patient's symptoms. What is the most likely cause of this patient's dysmenorrhea?

a: Somatization b: Endometriosis c: Excess prostaglandin production d: Adenomyosis e: Anovulation

2: The agent most likely to be responsible for this patient's symptoms is

a: Prostaglandin F2-alpha b: Progesterone c: Oxytocin d: Estrogen e:

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Prostaglandin E2

3: The patient illustrates her pain with an opening and closing fist. You can tell her that the uterine contractions associated with primary dysmenorrhea result in baseline intrauterine pressures in excess of

a: 30 mm Hg b: 80 mm Hg c: 110 mm Hg d: 50 mm Hg e: 140 mm Hg

4: For this patient or a smilar patient, which of the following would distinguish secondary from primary dysmenorrhea?

a: Presence of an abnormal pelvic examination b: Pain that begins on the first day of menstrual flow c: Crampy, episodic pain d: Irregular menses

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e: Patient began to experience pain at or before age 20 years

5: A 28-year-old woman presents for the evaluation of chronic lower abdominal pain, which has been present and unresolved for the past 2 years. She would like to know how common her problem is.

Chronic pelvic pain of greater than 12 months duration is estimated to be present in what percent of women aged 18 to 50 years?

a: 5%-10% b: 25%-30% c: 15%-20% d: 45%-50% e: 35%-40%

6: If this patient were to undergo a laparoscopy, the likelihood that an identifiable cause will be found is approximately

a: 20%-30% b: 40%-50% c: 80%-90%

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d: 10%-15% e: 60%-70%

7: A patient is referred for evaluation of possible primary dysmenorrhea. Which of the following would cause suspicion of secondary dysmenorrhea?

a: Presence of blood clots in menstrual flow b: Dyspareunia c: Nausea and vomiting during periods d: Irregular periods e: Improvement of symptoms with nonsteroidal anti-inflammatory (NSAID) therapy

8: A 23-year-old patient complains of increasing pelvic heaviness and cyclic lower abdominal pain. Periods are heavy with clots. On examination, the uterus is tender and symmetrically enlarged with a "boggy" feel. Which of the following is the most likely diagnosis for this patient?

a: Uterine myomas b: Primary dysmenorrhea c:

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Endometriosis d: Missed abortion e: Adenomyosis

9: A 23-year-old patient complains of increasing pelvic heaviness and cyclic lower abdominal pain. She has been attempting to conceive for the past 3 years. Pelvic examination reveals painful nodules posterior to the cervix. Which of the following is the most likely diagnosis for this patient?

a: Endometriosis b: Adenomyosis c: Cervical cancer d: Primary dysmenorrhea e: Uterine myomas

10: An 18-year-old woman complains of cyclic, sharp, crampy, lower abdominal pain. Pelvic examination is normal. Which of the following is the most likely diagnosis for this patient?

a: Adenomyosis b: Uterine myomas

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c: Endometriosis d: Primary dysmenorrhea e: Human papilloma virus (HPV) infection

11: An 18-year-old virginal woman complains of cyclic, sharp, crampy, lower abdominal pain that begins on the first day of her menstrual flow and lasts 2 to 3 days. Periods are regular and heavy with clots. Pelvic examination is normal. The most appropriate initial therapy for this patient would be

a: an acetaminophen/codeine combination b: an injectable progestin contraceptive agent c: a nonsteroidal anti-inflammatory agent d: a long-acting GnRH agonist e: low-dose, monophasic oral contraceptive pills

12: During laparoscopy on a 21-year-old for pelvic pain, you note thickening of the adnexa. This is most consistent with

a: leiomyoma uteri b:

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pelvic inflammatory disease c: endometritis d: adenomyosis uteri

13: A 25-year-old patient presents for evaluation of pelvic pain. Which of the following durations of pain establishes the diagnosis of "chronic pelvic pain?"

a: at least 6 months b: three or more of a woman's first six menstrual cycles c: more than 21 days in a given month d: three consecutive menstrual periods

14: A 37-year-old woman experiences intermittent diarrhea and abdominopelvic pain. The symptoms are relieved with defecation and seem to be exacerbated in periods of stress. The most likely diagnosis is

a: endometriosis b: uterine leiomyomata c: adenomyosis

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d: interstitial cystitis e: irritable bowel syndrome

15: A 30-year-old patient is referred to you with a chief complaint of recurrent urinary tract infections. Her symptoms include pelvic pain, dyspareunia, and urinary urgency and frequency. A review of her records reveals a normal urinalysis and urine culture associated with many of her past "episodes." The best test to establish her diagnosis would be

a: magnetic resonance imaging (MRI) b: cystoscopy c: wet prep d: cervical cultures e: pelvic ultrasound

16: A 26-year-old woman presents with 2 years of severe dysmenorrhea, associated with diarrhea during her menses. On bimanual exam you note uterine immobility and tender nodularity posterior to the uterus. What is the most likely cause of this patient's dysmenorrhea?

a: Endometriosis b:

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Interstitial cystitis c: Irritable bowel syndrome d: Pelvic inflammatory disease e: Fibroids

17: A 40-year-old woman with a history of pelvic pain has a hysterectomy. The pathology report notes islands of endometrial tissue in the myometrium of the uterus. The most likely cause of her pain is

a: hematometra b: adenomyosis c: endometrial cancer d: endometriosis e: endometrial hyperplasia

18: A 33-year-old woman reports crampy abdominal pain and diarrhea that is relieved with defecation. Her symptoms have been present for several years, and they worsen during times of stress. She denies any fevers, and there is no eidence of blood in her stool. Which of the following medications may help treat her symptoms?

a:

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Hyoscyamine b: Hydrocodone c: Ibuprofen d: Lactulose e: Acetaminophen

19: An 18-year-old woman complains of severe cramps and nausea at the time of her menses. Her pelvic exam is unremarkable. A trial of nonsteroidal anti-inflammatories has given only partial relief. The best treatment option for this patient is

a: hysterectomy b: combined oral contraceptive c: administration of a GnRH agonist d: pelvic floor physical therapy e: danazol sodium therapy

20: A 47-year-old woman has long-standing pelvic pain associated with endometriosis. A previous laparoscopic ablation of endometriosis has given her several years of relief. Over the last 6 months her symptoms have gotten progressively worse. The best treatment option for this patient is

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a: combined oral contraceptive b: administration of a GnRH agonist c: danazol sodium therapy d: hysterectomy e: pelvic floor physical therapy

21: A 23-year-old divorced mother of three, on public assistance, comes to your office seeking help for symptoms of lower abdominal pain that began 8 months previously. This coincided with her divorce and the loss of her job at a textile mill. Her pain is located in her left lower quadrant, but spreads to the right and her back. The pain is worse with menstruation, bowel movements, and intercourse. She has tried multiple medications without benefit. Past history reveals an abusive marriage and two previous laparotomies for "ovarian cysts." Vital signs are temperature 37.0 degrees C (98.6 degrees F), pulse 68/minute, respirations 18/minute, Bp 118/64 mm Hg. weight 56 kg (123 lb). The examination or procedure that would best support your working diagnosis is

a: labaroscopy b: pelvic ultrasonography c: bimanual pelvic examination d: sigmoidoscopy e:

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psychological profile and depression index.

22: Before the label "chronic pelvic pain" is applied, the pain generally must be

a: present for three or more consecutive menstrual periods b: 6 months or longer c: of gynecologic origin d: three or more of a woman's first six menstrual cycles e: unaltered by hormonal therapy

23: The most appropriate initial management is to administer analgesic therapy

a: on a regular basis around the clock b: only when the pain is severe c: in combination with menstrual suppression d: more frequently than specified by package labeling to avoid loss of effect e: in tapering doses to avoid tolerance

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24: Physical examination is normal except for distractible tenderness around the adnexa, the posterior culde-sac, and on uterine motion. The most likely dianosis is

a: pelvic adhesive disease b: depression c: endometriosis d: conversion disorder e: irritable bowel syndrome

25: A 19-year-old nulligravid patient comes to the community health center with complaints of sharp, laborlike, lower abdominal pain on the first 2 days of menstrual flow. The pain has worsened over the past 2 years. The patient is not sexually active and takes no medications. Vital signs are temperature 37.0 degrees C (98.6 degrees F), pulse 68/minute, respirations 18/minute, and blood pressure 118/64 mm Hg. She weighs 56 kg (123 lb) and is 155 cm (5 ft 1") tall. Physical examination, including pelvic examination, is normal. To establish the diagnosis prior to therapy, you should obtain

a: a menstrual calendar b: a transabdominal ultrasonography c: no additional tests are required d:

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a transvaginal ultrasonography e: a late luteal phase endometrial biopsy ANS: cabac ebead cbaeb ababb cbabc

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Chapter 33: Disorders of the Breast 1: A 23-year-old woman is diagnosed with a fibroadenoma of the left breast and she is worried that this will affect her risk of breast cancer later in life. You should tell her that the relative risk of developing invasive breast cancer in a woman with fibroadenoma is

a: 1.0 b: 6.0 c: 10.0 d: 15.0 e: 1.5

2: You should also counsel her that currently a woman living in the United States has a lifetime risk of developing a breast cancer of approximately

a: 1 in 15 b: 1 in 8 c: 1 in 5 d: 1 in 2 e:

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1 in 70

3: The historical factor that would most increase her risk of breast cancer would be

a: late menarche b: cessation of menses before age 45 years c: age greater than 50 years d: grand multiparity e: breastfeeding more than one infant

4: A 23-year-old patient presents with a 2 cm to 3 cm firm, painless, freely movable mass in her left breast.

She reports that the mass does not change during her menstrual cycle and has grown slowly over the past year. The patient found the mass during breast self-examination. What is the most likely diagnosis?

a: Fibrocystic change b: Fibroadenoma c: Mastitits d: Intraductal carcinoma

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e: Ductal ectasia

5: A 34-year-old patient complains of cyclic breast tenderness and diffuse nodulatirty on monthly breast self examination. Your examination finds multiple firm, mobile masses, predominantly in the upper outer quadrants of each breast. You aspirate one of these masses and obtain clear, straw-colored fluid.

What is the best initial management of this condition?

a: Danazol sodium therapy b: Gonadotropin-releasing hormone agonist therapy c: Mechanical support of the breast d: Excisional biopsy e: Broad-spectrum antibiotic therapy

6: A 40-year-old woman presents with a green, sticky nipple discharge that has been present for a few weeks. This patient most likely has

a: mastitis b: ductal ectasia c: tricyclic antidepressant exposure

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d: invasisve ductal carcinoma e: hyperprolactinemia

7: A 45-year-old woman has an abnormal screening mammogram. The next step in management should be

a: ultrasonography b: diagnostic mammogram c: MRI of the breast d: immediate biopsy e: CT of the chest

8: A 30-year-old patient with a family history of breast cancer undergoes needle aspiration of a cystic breast mass. The fluid obtained is clear. Your next step in the management of this patient would be to

a: perform ultrasonography b: send the fluid for cytology c: obtain a mammogram

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d: check the site later for recurrence of the mass e: perform a needle biopsy of the cyst wall

9: A BI-RADS category 1 report in a 55-year-old should be followed up with a mammogram in

a: 6 months b: 24 months c: 3 months d: 12 months e: 1 month

10: A 53-year-old patient has a category 4 finding on a BI-RADS mammography report. The most appropriate next step in the management of this patient is

a: CT of the chest wall b: MRI of the breast c: ultrasound in 3 months

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d: biopsy e: routine mammography in 1 year

11: You receive a mammogram report of a category 0 BI-RADS report. You explain this to the patient as follows:

a: Breasts are symmetric and masses, architectural disturbances, or suspicious calcifications are noted b: A finding is noted that warrants further imaging c: The finding has a high probability of being benign, but the mammographer would prefer to establish its mammographic stability over a short interval d: Lesions are noted that do not have the characteristic morphologies of breast cancer but have a definite probablility of being malignant

12: A 61-year-old woman has been diagnosed with a 2 cm breast tumor. Her stage of breast cancer is

a: T3 b: T4 c: T1 d:

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T2

13: A 21-year-old patient complains of a breast mass present for a few days. The initial evaluation modality should be

a: diagnostic mammography b: screening mammography c: excisional biopsy d: MRI e: ultrasonography

14: A 33-year-old woman presents for evaluation of a palpable mass in the upper outer quadrant of her left breast. The mass was found on breast self-examination roughly 3 months ago and its presence is confirmed on clinical breast examination. A diagnostic mammography is reported as normal. The most appropriate next step in the management of this patient is

a: ultrasonography b: tissue diagnosis c: magnetic resonance imaging (MRI) d:

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repeat mammogram in 3 months e: no further evaluation

15: A 25-year-old G1P0010 woman with an LMP 3 weeks ago presents to your office with a "lump" noted in her right breast, 10 days ago. On examination, there is a 1 cm, cystic, mobile, tender mass beneath the areola of the right breast at 12 o'clock postion. There is no accompanying lymphadenopathy.

Management at this point should be

a: observation only b: observation with monthly clinical examinations c: mammography d: repeat examination at the end of the next menstrual cycle e: biopsy of the mass

16: A 46-year-old woman comes to the office for a periodic health evaluation. She asks for your advice regarding screening mammography. She has had 3 children, and her first child was born when she was 24 years. She did not breastfeed any of her infants. She had a paternal aunt who died of breast cancer at age 42 years. On physical examination she is 152 cm (60") tall and weighs 55 kg (121 lb). Based on current screening guidelines and this patient's history, you would recommend that she have screening mammography

a: once now, again at age 50 years, then annually after age 65 years b:

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once now and then annually after age 50 years c: annually d: every 2-3 years until age 50 years, then annually e: every 6 months

17: A 20-year-old patient comes to the community health center for the evaluation of a gradual growth of a mass in her left breast. The mass is tender prior to her periods. The patient has had one pregnancy and breastfed for 3 months after delivery, ending 1 year ago. Vital signs are temperature 37.0 degrees C (98.6 degrees F), pulse 68/minute, respirations 18/minute, and blood pressure 118/64 mm Hg. She weighs 56 kg (123 lb) and is 155 cm (5 ft 1") tall. Physical examination is normal except for a mobile, firm and approximately 1 cm nodule in the upper outer quadrant of the left breast. She has no expressible nipple discharge and no adenopathy. Based on this patient's history and physical findings, the most likely diagnosis is

a: fibroadenoma b: lipoma c: intraductal papilloma d: fat necrosis e: phyllodes tumor

18: A 28-year-old patient comes to the community health center for the evaluation of a tender, firm mass in her right breast in the same general location where she was hit by a softball 2 years ago. Vital signs are

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temperature 37.0 degrees C (98.6 degrees F), pulse 68/minute, respirations 18/minute, and blood pressure 118/64 mm Hg. She weighs 56 kg (123 lb) and is 155 cm (5'1'') tall. Physical examination is normal except for an indurated and poorly defined mass with local skin retraction. Mammography shows fine, stippled calcification. There is no palpable adenopathy. Based on the most likely diagnosis you recommend

a: fine needle aspiration b: excisional biopsy c: observation with repeat mammography in 6 months d: modified radical mastectomy e: segmental resection of the breast

19: A 29-year-old female Medicaid patient comes to the office for breast cancer screening because she recently had a 28-year-old friend diagnosed with cancer. She has never had any breast problems and has not had a mammogram. She is not aware of any family members with breast cancer. Gynecologic history finds that she began her periods at age 15 years but had the first of her 5 children at age 17 years. She breastfed two of her children. Her periods are regular and she has had a sterilization procedure. She weighs 83 kg (183 lb) and is 150 cm (4 ft 11 in) tall. Vital signs are temperature 38.0 degrees C (100.4 degrees F), pulse 118/minute, respirations 22/minute, and blood pressure 85/44 mm Hg. Physical examination is normal. The factor that most adversely affects this patient's risk for breast cancer is

a: late menarche b: early childbearing c: obesity

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d: multiparity e: low socioeconomic status

20: A 35-year-old G1 with an intrauterine pregnancy at 31 weeks gestation presents complaining of a firm lump in her left breast. On examination, a 2 x 3 cm firm nodule surrounded by some erythema in the upper outer quadrant is discovered. There is no skin retraction and the nodule is somewhat mobile. The most appropriate plan of management is

a: mammography b: observation with monthly clinical examinations c: observation only d: repeat examination at the end of the next menstrual cycle e: biopsy of the mass ANS: [abcbc bbddd bbebd cabce]

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Chapter 34: Gynecologic Procedures 1: A 46-year-old patient is referred for the biopsy of a vaginal lesion. Vaginal biopsy typically requires what type of anesthesia?

a: General b: Caudal c: None d: Conscious sedation e: Pudendal

2: A 36-year-old patient is to undergo removal of her uterus for benign disease. Which of the following is an advantage of abdominal hysterectomy over vaginal hysterectomy?

a: Repair of rectocele more readily accessible b: Fewer incisional complications c: Ability to deal with smaller uterine sizes d: Ability to visualize associated pelvic pathology e:

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Shorter recovery period

3: She undergoes removal of only her uterus. Which term refers to the surgical removal of only the uterine corpus?

a: Complete hysterectomy b: Vaginal hysterectomy c: Total hysterectomy d: Subtotal hysterectomy e: Radical hysterectomy

4: A 53-year-old is referred to you for the evaluation of an adnexal mass found at the time of annual physical examination. In the initial evaluation of a possible adnexal mass, the most appropriate imaging technique is

a: computed axial tomography scanning b: ultrasonography c: flat plate of the abdomen d: magnetic resonance imaging

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e: positron emission tomography (PET) imaging

5: What is the most appropriate biopsy location for a 45-year-old woman with abnormal vaginal bleeding for 5 days and a normal physical examination?

a: Vulva b: No biopsy indicated if less than 7 days c: Endometrium d: Vagina e: Cervix

6: A 25-year-old patient had an IUD inserted last year, but no longer feels the string. Which of the following is the most appropriate next step in management?

a: Dilation and curettage b: MRI c: Hysteroscopy d:

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"Flat-plate" X-ray of the lower abdomen e: Ultrasonography

7: A 35-year-old patient does not recall why she had a laparoscopy 3 years ago. Which of the following conditions is most likely to be associated with a laparoscopy for evaluation?

a: Pelvic pain b: Abnormal Pap smear c: Abnormal bleeding d: Recurrent cystitis

8: A 32-year-old patient recovering from a gynecologic procedure complains of shoulder pain. The procedure she had was most likely a(n)

a: LEEP b: cervical biopsy c: endometrial ablation d: dilation and curettage

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e: laparoscopy

9: What is the most appropriate initial imaging study in an asymptomatic patient with 18-week-size fibroids?

a: Positron emission tomography (PET) b: computed tomography (CT) c: Transabdominal ultrasonography d: Sonohysterography e: Magnetic resonance imaging (MRI)

10: A 20-year-old patient at 6 weeks of gestation is suspected of having an ovarian neoplasm. The most appropriate initial imaging technique is

a: Computed tomography (CT) b: Positron emission tomography (PET) c: transvaginal ultrasonography d:

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transabdominal ultrasonography e: Magnetic resonance imaging (MRI)

11: 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 medical history and physical examination is within normal limits, as is her husband's semen analysis. Normal ovulatory status has been documented by basal body temperature monitoring and luteal-phase progesterone measurement. Your next best step is to recommend

a: normal pelvic ultrasonography b: hysterosalpingogram (HSG) c: in vitro fertilization - embryo transfer (IVF-ET) d: myomectomy e: arterial embolization of the fibroids

12: A 36-year-old woman with regular, monthly, 5-day menstrual cycles presents with a 2-year history of severe right-sided pelvic pain. Pelvic examination reveals no abnormalities. She reports insomnia, loss of appetite, and decreased libido. The patient once considered evaluation for infertility but now does not desire childbearing. She has had three laparoscopic procedures in the last 18 months that showed minmal peritoneal adhesions, with no change in the pain. Appropriate management of this includes

a:

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repeat diagnostic laparoscopy b: barium enema, intravenous pyelography, and plevic ultrasonography c: presacral neurectomy d: transabdominal hysterectomy and bilateral salpingo-oophorectomy e: psychological counseling with antidepressant therapy

13: A 63-year-old woman with 6 months of early satiety and increased abdominal girth has an abdominal fluid wave and a palpable 12 cm nodular right adnexal mass. The next BEST step would be for her to obtain

a: a diagnostic laparoscopy b: a staging laparotomy and debulking for her presumed ovarian cancer c: a CT scan to get the exact dimensions of the mass d: chemotherapy e: an ultrasonography to determine if the mass is cystic or solid

14: A 42-year-old woman, G2P2, who had a laparoscopic tubal fulguration 7 years 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 to 35 days and the menstrual flow has lasted from 1 to 14 days.

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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

a: endometrial sampling b: laparoscopy c: transabdominal ultrasonography d: pelvic CT e: hysteroscopy

15: 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. Of the following, the most appropriate management of this patient's condition is

a: combination oral contraceptive pills b: methotrexate intramuscular injection c: depot medroxyprogesterone acetate d: oral broad-spectrum antibiotic thearpy e: mifepristone pills and vaginal misoprostol ANS: [cddbc eaecc beaae]

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Chapter 35: Human Sexuality 1: A 42-year-old married woman shares at her yearly exam that her sexual desire has decreased. Which of the following represents a percentage of women who report some type of sexual complaint?

a: 20%-30% b: 35%-45% c: 5%-15% d: 50%-60% e: 70%-80%

2: A 32-year-old woman reports the persistent or recurrent absence of sexual fantasies, thoughts, and/or desire for or receptivity to sexual activity. This is typical of

a: an orgasmic disorder b: hypoactive sexual desire disorder c: female sexual arousal disorder d: bipolar sexual idnetity disorder e:

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libidinal mismatch disorder

3: If she reported persistent or recurrent inability to attain or maintain sufficient sexual excitement, causing personal distress, the diagnosis would be

a: bipolar sexual identity disorder b: libidinal mismatch disorder c: an orgasmic disorder d: female sexual arousal disorder e: hypoactive sexual desire disorder

4: You determine that the patient is clinically depressed. You should counsel her that approximately what percent of women presenting with sexual dysfunction are clinically depressed?

a: 90% b: 60% c: 30% d: 10%

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e: 5%

5: A new mom inquires, when does an individual's gender first develop? You tell her

a: at the time of first sexual encounter b: by the end of puberty c: at the start of puberty d: at birth e: in early childhood

6: When counseling a woman on sexual desire, one common flaw in the traditional model of female sexual response is its failure to account for the frequent overlap of desire and

a: involution b: orgasm c: plateau d: resolution

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e: arousal

7: A patient shares with you that her husband has begun drinking excessively and seems distracted and distant. She is lacking a sexual desire. You counsel her that a woman's primary motivation for sexual response often is to

a: be closer to her partner b: reduce vaginal engorgement c: experience sexual release (resolution) d: experience arousal e: experience orgasm

8: At the end of an annual health maintenance examination, a 23-year-old woman who has been married for 3 years tells you that she has never had an orgasm. Physical examination of this patient is normal. As part of the process of counseling, You should tell her that lack of orgasms occurs in

a: the presence of psychiatric disease b: women with homosexual tendencies c: the presence of organic disease

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d: most marriages of less than 5 years duration e: 10%-15% of women

9: A 24-year-old woman comes to the office with concerns about sexual function. The patient has recently remarried after being divorced from an abusive partner. She is currently unable to consummate the marriage due to intense vaginal pain on attempts at penetration. She was able to successfully have intercourse early in her first marriage. She is orgasmic with other stimulation but cannot tolerate digital or other penetration. Vital signs are temperature 37.0 degrees C (98.6 degrees F), pulse 72/min, respirations 18/min, and blood pressure 118/64 mm Hg. Physical examination is normal; however, the patient is unable to tolerate the speculum examination because of pain. The most likely mechanism for this condition is

a: conversion reaction b: change in vaginal flora because of a new partner c: vaginal muscle spasm d: inflammation of vestibular glands e: inadequate lubrication

10: During the pelvic examination, particular attention should be given to vaginal

a: muscle tone

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b: wall rugations c: secretions d: odor e: opening size

11: The most appropriate initial management of these symptoms is

a: use of adjunctive lubrication b: antidepressant therapy c: vaginal antibiosis d: laser ablation of the vestibular glands e: self-dilation

12: A 23-year-old woman comes to the health center because of variable, but severe, achy lower abdominal pain and weight loss. She says the pain worsens around the time of ovulation and menstruation. At times the pain brings her to tears, causes her to lose sleep, and she frequently has to take time off from work. Her menstrual cycles are regular. She uses condoms because she says the pills made her sick. She has no history of dysuria or urinary frequency or urgency. Bowel movements have been normal and have no effect on her pain. She has taken multiple analgesics during the past 4 years and has sought other medical opinions. She had a laparoscopy 3 years ago that was negative, and she has had no

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significant improvement in her pain since then. Physical examination is normal except for distractible tenderness around the adnexa, the posterior cul-de-sac, and on uterine motion. You are concerned that you may be missing the diagnosis of sexual dysfunction in this and similar patients. The most sensitive and cost-effective way to identify sexual dysfunction is

a: three-question review of systems b: written questionnaire filled out at home c: extended review of sexual function d: computer-based interactive query e: intake interview with same-gender nurse or assistant

13: The sexual dysfunction that is most likely to occur for this patient is

a: female sexual arousal disorder b: an orgasmic disorder c: hypoactive sexual desire disorder d: bipolar sexual identity disorder e: libidinal mismatch disorder

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14: A 23-year-old woman comes to the office for evaluation of painful intercourse and pain when inserting tampons. These symptoms began approximately 5 months ago as mild vulvar irritation. She was diagnosed by another health care provider as having a "vaginal infection" for which she received multiple cycles of various medications with no benefit and progressively worsening symptoms. She is now unable to have intercourse and can insert only the smallest tampon, though she can wear them comfortably once they are in place. She weighs 63 kg (139 lb) and is 160 cm (5 ft 3 in) tall. Vital signs are temperature 37.0 degrees C (98.6 degrees F), pulse 78/min, respirations 16/min, and blood pressure 118/54 mm Hg. The general physical examination is normal. The test or procedure most likely to establish the diagnosis for this patient is

a: cystoscopy b: viral culture of vaginal secretions c: inspection and palpation of the vulva d: bacterial culture of vaginal secretions e: fungal culture of vaginal secretions

15: Examination of the vulva shows an intensely sensitive area with small erythematous punctations, located at the posterior fourchette. A small amount of thin, white discharge is present in the posterior fornix. Cervical cytology and cultures are obtained and submitted. A urinalysis is requested. Results of these tests are pending. The most effective treatment of this condition is

a: oral metronidazole b: oral diazepam c:topical lidocaine d:topical steroid cream e: intravaginal clotrimazole ANS: [bbdce eaeca eaccc]

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Chapter 36: Sexual Assault and Domestic Violence 1: When evaluating and examining a sexual assault patient, it is very important that the provider recognize that her most serious emotional concern is

a: gender identity conflict b: loss of control c: uncontrolled anger d: fear of infection

2: You are called to the emergency department to evaluate a patient who may have been sexually assaulted. Minor trauma is seen in approximately what percent of sexual assault victims?

a: 75% b: 50% c: 10% d: 25% e: 1%

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3: Which of the following is routinely required as part of laboratory testing for this patient?

a: Hepatitis screen b: Renal function tests c: Urinalysis d: Liver function tests e: Complete blood count

4: If a female victim of sexual assault of menstrual age is using an effective method of contraception, a pregnancy test should be included as part of the sexual assault evaluation

a: only if she is using a non-hromonal method b: in all cases c: never d: only if she does not know her assailant e: only if she tells you that she in not pregnant

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5: Antibiotics for sexually transmitted disease should be offered to this patient

a: if cultures taken after the assault are positive b: routinely for prophylaxis c: if follow-up compliance is unlikely d: if there is evidence that the assailant is infected e: if there is evidence of vaginal penetration

6: A 17-year-old woman reports an assault by a male acquaintance. In the context of the rape, she is threatened with a knife and is beaten. Authorities would most likely define this as a case of

a: assault and battery b: date rape c: intimate partner violence d: statutory rape e: aggravated crminal sexual assault

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7: For which of the following should routine prophylaxis be offered to this patient?

a: herpes simplex virus (HSV) b: Human immunodeficiency virus (HIV) c: Syphilis d: Hepatitis B e: Human papilloma virus (HPV)

8: You have just evaluated a sexual assault victim in the ER and after her counseling she asks how common it is for victims of sexual assaults to seek any kind of help. You tell her

a: 25% b: 5% c: less than 1% d: 55% e: 10%

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9: A 19-year-old G1P1 suffered an alleged sexual assault approximately 3 weeks ago. She did not report the assault and sought no treatment out of fear and a sense of guilt because it happened at a friend's house after a night of drinking. She reports that she was not physically injured in the assault, was taking oral contraceptive, and has continued to do so. She has had her normal menstrual period in the interim. In the past few days she has experienced flashbacks, nightmares, and phobias as well as somatic and gynecologic symptoms. She has broken off her friendship with the host of the party and has become virtually reclusive, seldom venturing out of her home. She has lost approximately 5 lb and finds it difficult to eat. The most likely cause of this patient's symptoms is

a: pregnancy b: viral meningitis acquired during the assault c: organization phase of rape trauma syndrome d: depression e: situational guilt

10: A 20-year-old college student presents for evaluation after being forced to have unprotected sexual intercourse by her date. She is concerned that she may become pregnant and asks your advice. Her last menstrual period was about 3 weeks ago; she has no medical problems and is taking no medication. Her urine pregnancy test is negative. You offer her combined oral contraceptives for emergency contraception using 0.1 mg of ethinyl estradiol and 1.0 mg of dl-norgestrel. You advise her that treatment is at least 75% a: 24 hours after exposure b: 96 hours after exposure c: 48 hours after exposure d:120 hours after exposure e: 72 hours after exposure ANS: [bdab eddce]

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Chapter 37: Reproductive Cycles : A mother with a 9-year-old daughter inquires at what age a regular, predictable reproductive cycle is established. You should tell her that the average age is

a: 11 years b: 15 years c: 13 years d: 17 years e: 19 years

2: A 49-year-old woman presents for her annual examination and inquires about the average age of menopause. You tell her it is

a: 51 years b: 41 years c: 55 years d: 45 years

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3: A 22-year-old presents and is complaining of abnormal menstrual cycle. She believes her menses are too frequent. You inform her that the average length of the female reproductive cycle is

a: 26 days b: 32 days c: 30 days d: 28 days

4: A mother presents with her 15-year-old daughter to discuss her daughter's abnormal menses with varying menstrual intervals. The mother has a PhD in reproductive biology. You explain to her that irregular menses is due to maturation of the hypothalamic-pituitary-ovarian axis and ovarian function requires the pulsatile secretion of hypothalamic gonadotropin-releasing hormone at what interval?

a: 60-240 minutes b: 10-30 minutes c: 10-24 hours d: 6-8 hours

5:

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Because the mother has a PhD in reproductive biology, she further inquires as to which hormone stimulates the granulose cells of the primary ovarian follicle?

a: FSH b: LH c: Estradiol d: Progesterone

6: The same mother then inquires, which hormone triggers ovulation?

a: TSH b: Androstenedione c: LH d: Estradiol

7: What principal sex steroid is secreted by the granulose cells of the ovarian follicle?

a: Estradiol

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b: Progesterone c: Estriol d: Testosterone

8: The mother of a 12-year-old girl asks as to what the average volume of blood lost in each menstrual cycle is. You should reply that it is

a: 120-150 mL b: less than 15 mL c: 200-230 mL d: 70-90 mL e: 20-30 mL

9: A couple in their early thirties is being evaluated for infertility. In counseling a patient trying to conceive regarding the basal body temperature chart, the woman should be told to take her temperature

a: after breakfast b:

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immediately in the morning c: at bedtime d: before dinner e: at noon

10: A 25-year-old patient with regular periods has an ultrasonographically diagnosed 3-cm unilocular ovarian cyst on day 21 of her menstrual cycle. This is most likely a

a: follicular cyst b: pedunculated fibroid c: epithelia neoplasia d: corpus luteum cyst e: dermoid cyst

11: A 24-year-old woman presents for care because she has not resumed her menses following the birth of her daughter 14 months ago. She underwent menarche at age 12 years and has had regular menses every 29 to 31 days until she conceived her only child. Her pregnancy was uncomplicated until delivery when she had a retained placenta, resulting in significant blood loss and multiple transfusions. She attempted breastfeeding once she recovered but was unable to produce sufficient milk for the infant.

Since delivery she has noted cold intolerance and mild weight gain. Preliminary laboratory evaluation finds FSH, LH, prolactin, and TSH levels to be low. The most likely cause of this patient's amenorrhea is an abnormality at the level of the

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a: hypothalamus b: ovary c: cervix d: uterus e: pituitary

12: A 32-year-old G0P0 woman presents for evaluation of amenorrhea. Her last menstrual period was approximately 8 months ago. A pregnancy test is negative. In reviewing her history, she tells you that she underwent menarche at age 15 years and had somewhat irregular periods for the first several years thereafter. Over the past several years, they have again been irregular in frequency and light in character. Other than being of short stature, she appears clinically normal. A review of systems is negative with the exception of mild chronic constipation and recent onset of vagina dryness with intercourse. Vital signs are normal. The most likely cause of this patient's amenorrhea is an abnormality at the level of the

a: ovary b: pituitary c: hypothalamus d: uterus e:

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cervix

13: The test or procedure most likely to be abnormal is

a: pelvic ultrasonography b: FSH c: computed tomography of the pituitary d: prolactin e: adrenocorticotropic hormone

14: A 16-year-old girl is brought by her mother for evaluation of her daughter's failure to menstruate over the past 18 months. The girl reports that her periods started at age 12 years and were fairly regular for the first 2 years thereafter. Her periods became briefly irregular and stopped altogether about the time she joined the track team at school. She has been otherwise healthy over this time and her most recent school physical was reported to be normal with the exception that her 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 25% under ideal body weight for her age and height. Which of the following serum levels would you expect to be below normal?

a: Prolactin b: FSH c:

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estrogen d: LH e: TSH

15: The most likely cause of this patient's amenorrhea is an abnormality at the level of the

a: cervix b: ovary c: uterus d: hypothalamus e: pituitary ANS: [badaa caebd eabcd]

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Chapter 38: Puberty 1: A mother presents with her 14-year-old daughter and inquires about puberty. You tell her the event that is most associated with the onset of puberty is

a: presence of thelarche b: achieving a critical body weight c: achieving a critical height d: adequate sun exposure e: turning age 16 years

2: The mother of a 9-year-old girl asks what is the usual length of time from the first physical signs of secondary sexual maturation until sexual maturation is complete. You should tell her that it is approximately

a: 1 year b: 6 months c: 3 years d: 4 years e:

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2 years

3: When explaining the sequence of secondary sexual development to a mother of a preteen daughter, which of the following is correct?

a: Growth spurt, thelarche, pubarche, menarche b: Thelarche, pubarche, growth spurt, menarche c: Menarche, growth spurt, pubarche, thelarche d: Thelarche, growth spurt, menarche, pubarche e: Growth spurt, menarche, pubarche, thelarche

4: A mother presents concerned that her 12-year-old stepdaughter has not experienced menarche. You explain to her that the earliest sign of delayed puberty in girls is lack of

a: breast budding by age 13 years b: ovulation by age 17 years c: menarche by age 12 years d: growth spurt by age 10 years

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e: adrenarche by age 11 years

5: A 7-year-old girl is referred for precocious puberty. The medical student rounding with you asks what the most likely cause for this could be. Which of the following may cause precocious puberty in girls?

a: Deletion of the long arm of the X chromosome b: Alkylating chemotherapy c: Irradiation of the thymus d: Turner syndrome (45X karyotype) e: Ovarian neoplasm

6: When lecturing to the medical students, you educate them that the most common cause of primary amenorrhea is

a: congenital absence of the uterus b: pregnancy c: imperforate hymen d:

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Asherman's syndrome e: premature ovarian failure

7: You are a medical student in your twenties. The Beckman & Link textbook asks which of the following is a method for treating vaginal agenesis? Your answer should be

a: vulvectomy b: vaginal vault suspension c: pressure dilation of the vaginal space d: vulvar flap e: colpocleisis

8: A 15-year-old girl presents with anosmia and amenorrhea. What condition is associated with olfactory tract hypoplasia and failure of gonadotropin-releasing hormone secretion?

a: Sawyer syndrome b: Rokitansky-Kuster-Hauser syndrome c: Turner syndrome

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d: Cushing syndrome e: Kallmann syndrome

9: A 14-year-old girl is referred for the evaluation of failure to start pubertal changes. Your examination confirms the absence of secondary sexual changes and finds a webbed neck and short stature. What condition is associated with failure to establish secondary sexual development, a webbed neck, and short stature?

a: Cushing syndrome b: Kallmann syndrome c: Sawyer syndrome d: Rokitansky-Kuster-Hauser syndrome e: Turner syndrome

10: A family doctor refers a young woman to your practice believing that her delayed puberty may be due to Kallmann syndrome. During clinical evaluation, Kallmann syndrome can be recognized by

a: measurement of arm carrying angles b: visual field evaluation

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c: absence of the vagina d: measurement of body mass index e: olfactory challenge

11: You determine that the patient does, indeed, have Kallmann syndrome. Which of the following would help this patient to become pregnant?

a: Wedge resection of the ovaries b: Administration of clomiphene citrate c: Artificial insemination d: Pulsatile administration of gonadotropin-releasing hormone e: Administration of sequential estrogen and progesterone

12: A 14-year-old competitive female gymnast is referred for the evaluation of delayed puberty. Your examination documents a fit, healthy, but underweight girl of normal height. After weight gain, adolescent girls who have delayed puberty or secondary amenorrhea due to participation in competitive athletics can anticipate

a: mammary hypoplasia

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b: infertility c: an increased incidence of congenital anomalies in offspring d: normal secondary sexual development e: early menopause

13: An 11-year-old girl with precocious puberty, a history of bone fractures, and cafe-au-lait spots likely is suffering from

a: Kallmann syndrome b: Rokitansky-Kuster-Hauser syndrome c: McCune-Albright syndrome d: congenital adrenal hyperplasia e: Turner syndrome

14: While evaluating a young woman with primary amenorrhea you find normal breast and pubic hair development. Statistically, this patient most likely has

a:

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congenital adrenal hyperplasia b: Kallmann syndrome c: Mayer-Rokitansky-Kuster-Hauser syndrome d: androgen insensitivity syndrome e: McCune-Albright syndrome

15: During your evaluation you identify complete uterine and vaginal agenesis as the cause of the patient's amenorrhea. This is most consistent with a diagnosis of

a: Cushing syndrome b: Rokitansky-Kuster-Hauser syndrome c: Kallmann syndrome d: Turner syndrome e: Sawyer syndrome

16: This woman can have her own genetic child through

a:

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sequential administration of estrogen and progesterone b: tonic administration of estrogen alone c: artificial insemination d: ovum donation e: pelvic reconstructive surgery

17: Radiologic examination of a patient with delayed puberty shows a (supra)sellar calcified cyst associated with the pituitary stalk. This patient most likely has

a: Kallmann syndrome b: Rokitansky-Kuster-Hauser syndrome c: congenital adrenal hyperplasia d: McCune-Albright syndrome e: craniopharyngioma

18: 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

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and, other than being slightly overweight, has up to this point been developmentally normal. The most likely source for the girl's androgenic change is

a: ingestion of exogenous hormones (e.g., mother's birth control pills) b: adrenal gland androgens c: an abnormality of her androgen receptors d: peripheral conversion of estrogens to androgens e: ovarian androgen secretion

19: The most appropriate next step in the evaluation of this girl is

a: no additional evaluation is necessary b: measurement of serum 17-OH progesterone c: measurement of serum estradiol d: computed tomography of the pituitary gland e: measurement of serum FSH and LH

20:

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The most appropriate next step in the management of this girl is

a: institution of a vigorous weight loss program b: reassurance only c: administration of a GnRH agonist d: administration of estrogen supplementation e: administration of cortisol therapy

21: 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 hitting her growth spurt but is now the tallest 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 her 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. The most appropriate next step in the management of this patient is

a: institution of a vigorous weight gain program b: administration of a GnRH agonist c: administration of cortisol therapy d: reassurance only e:

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administration of oral contraceptives

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

a: Rokitansky-Maier-Kuster-Hauser syndrome b: female pseudohermaphrodite c: androgen insensitivity d: male pseudohermaphrodite e: polycystic ovarian syndrome ANS: [bdaae eccee ddccd debabec]

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Chapter 39: Amenorrhea and Abnormal Uterine Bleeding 1: A mother brings her 11-year-old daughter to you because she has not begun menstruation yet. On physical exam, you note absence of secondary sexual development. You assure the mother that with no secondary sexual characteristics, primary amenorrhea is not diagnosed until age

a: 16 years b: 15 years c: 13 years d: 9 years e: 11 years

2: A 16-year-old presents with menses every 19 days. You correctly classify her bleeding as

a: menorrhagia b: polymenorrhea c: oligomenorrhea d: menometrorrhagia e:

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metrorrhagia

3: An 18-year-old girl presents to the office with 4 months of no menses. When investigating her secondary amenorrhea, you note that the most common etiology is

a: ovarian failure b: vaginal agenesis c: pregnancy d: Sheehan's syndrome e: cervical stenosis

4: A 25-year-old woman inquires about the distinguishing factor between secondary and primary amenorrhea. You tell her which of the following is the distinguishing factor?

a: Chance of future fertility b: Absence of anatomic defects c: History of prior menses d: Amount of bleeding at times other than menses

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5: A 34-year-old woman is concerned that "all the women in my family have premature ovarian failure." To assess the possibility that this may have occurred to this patient you recall that ovarian failure is associated with

a: menorrhagia b: oligomenorrhea c: amenorrhea d: hypomenorrhea e: short stature

6: A 35-year-old patient comes to the office concerned that her menses have ceased. A pregnancy test is negative. The patient is 5'11" tall and weighs 105 lb. She indicates that she is a marathon runner and regularly runs 10 miles a day. The patient's history suggests which of the following causes for her amenorrhea?

a: Premature natural menopause b: Endometriosis c: Missed abortion d:

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Hypothalamic-pituitary dysfunction e: Ovarian dysfunction

7: A 28-year-old woman presents with secondary amenorrhea. She has read on the Internet about Asherman's syndrome and wants to know if this might be what she has. To evaluate this possibility, you recall that the endometrial scarring that characterizes Asherman's syndrome is most likely to occur after

a: intrauterine device use b: cervical infection c: hysterosalpingography d: vaginal delivery e: dilatation and curettage

8: If you determine that indeed she has intrauterine scarring, what is the best treatment for mild cases?

a: Laparoscopy b: Vaginal estrogen administration c: Hysterectomy

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d: Oral estrogen administration e: Dilatation and curettage

9: In cases of Asherman's syndrome, the regeneration of endometrium in previously denuded areas is stimulated by what hormone?

a: Androstenedione b: Estrogen c: Testosterone d: Progesterone e: Oxytocin

10: A 38-year-old obese woman is diagnosed as having polycystic ovary syndrome. Because of a history of irregular vaginal bleeding and oligomenorrhea for 1 year, an ednometrial biopsy is performed. The most likely finding in this case would be

a: endometritis b: atrophic endometrium c:

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secretory endometrium d: endometrial hyperplasia e: endometriosis

11: A 24-year-old woman comes to the office with concerns about heavy vaginal bleeding that started 3 days ago. The patient says that her menstrual periods have been regular in the past and this bleeding roughly corresponded with the onset of her expected period, though it was "3 days late." On physical examination today, she weighs 47 kg (104 lb) and is 160 cm (5 ft 3 in) tall, blood pressure is 118/64 mm Hg. Her general physical and pelvic examinations are unremarkable. In assessing the need for therapy, the most useful information would be the results of a

a: pelvic ultrasonography b: sensitive thyroid stimulating hormone level c: endometrial biopsy d: pregnancy test e: bleeding time

12: A 47-year-old woman comes to your office for routine care. In the course of your review of systems she reports a long history of heavy menstrual periods, which are associated with cramps and the passage of clots. This pattern has been present for many years but over the past 6 months it appears to have worsened. Her periods are regular, coming every 26 to 32 days and lasting 5 to 7 days. A review of symptoms is negative with the exception of mild constipation, increasing abdominal girth, and pelvic heaviness. These symptoms are most suggestive of

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a: an endometrial polyp b: endometrial cancer c: uterine leiomyoma d: menopause e: hypothyroidism

13: A 19-year-old woman who has never been pregnant presents for the evaluation of 2 months of amenorrhea. Her menstrual periods started at age 13 years and had been regular up until this time. She complains of fatigue, lassitude, and breast tenderness. Which of the following tests would be the most appropriate first step in the laboratory evaluation of this patient?

a: Serum FSH b: Serum TSH c: Serum prolactin d: Pregnancy test e: Serum LH

14:

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A 24-year-old G2P2002 woman presents for evaluation of menstrual periods that have been absent since the birth of her last child, 7 months ago. Her menarche was at age 11 years and she had normal periods until 5 years ago when she conceived her first pregnancy. Following delivery of that child, her menses were slightly delayed in returning, but this delay was attributed to her breastfeeding that infant.

Periods were eventually regular and she and her husband had no problem conceiving their second child.

That pregnancy resulted in a term delivery that was complicated by bleeding and fever 10 days postpartum. Retained placental products were diagnosed and she underwent a dilatation and curettage and was hospitalized for 3 days of antibiotic therapy. Despite this interruption, she has successfully breastfed this infant for 4 months, when she discontinued to return to work. A review of symptoms is negative. She reports no vaginal dryness or dyspareunia. Physical examination, including pelvic examination, is normal. Based on this patient's symptoms, the most likely cause of this patient's amenorrhea is

a: Sheehan's syndrome b: Asherman's syndrome c: lactational amenorrhea d: pituitary adenoma e: Sawyer syndrome

15: A 38-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 fairly regular, but over the past 8 to 10 years they became less common, with only 5 periods over the past 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 of 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. If an endometrial biopsy were to be performed, you would expect to find

a:

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endometrial hyperplasia b: normal endometrium c: endometrial adenocarcinoma d: endometrial atrophy e: chronic endometritis ANS: [cbccc deebd dcdba]

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Chapter 40: Hirsutism and Virilization 1: A 34-year-old woman comes to see you in the office complaining of facial and abdominal hair growth and severe acne. She tells you that although her sister also has some facial hair, her worsening changes are dramatic as compared with family members. Which of the following is the most likely explanation for her symptoms?

a: Sertoli-Leydig tumor b: Oral contraceptive use c: Exogenous testosterone administration d: Polycystic ovarian disorder e: Hilar cell tumor

2: This same patient inquires if there is a blood test to assist in making the diagnosis. You tell her that the blood test result most consistent with supporting the diagnosis of polycystic ovarian syndrome is

a: androstenedione at the upper limits of normal or increased b: decreased luteinizing hormone-follicle-stimulating hormone ratio c: testosterone at or below normal limits d:

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estradiol in greater concentration than estrone e: fasting blood glucose above the normal limits

3: A 41-year-old patient comes in for her well-woman visit. On examination you note that her acne, for which you have previously treated her, is worsening. Additionally you note enlargement of the clitoris and an increase in facial and abdominal hair growth. When questioned, she admits that her menstrual cycles have been increasingly irregular. The hormone disorder responsible for her findings is

a: androgen-excess disorder b: androgen receptor disorder c: proesterone-excess disorder d: estrogen-excess disorder e: prolactin-excess disorder

4: You see a 22-year-old woman for control of her hypertension. You note that she is currently seeing the dermatologist for electrolysis for treatment of her facial hair. She tells you that she has been on blood pressure medications for as long as she can remember and has always had irregular menses, along with facial and unwanted body hair. You check a basic metabolic profile and note normal sodium and potassium levels. Given these circumstances, she most likely has an elevation in

a: desoxycorticosterone b:

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follicle-stimulating hormone c: 17-alpha-hydroxyprogesterone d: cortisol e: dehydroepiandrosterone sulfate

5: A 28-year-old patient is diagnosed with PCOS and is given oral contraceptive pills to improve her symptoms. This treatment is intended to improve her symptoms through

a: suppression of luteinizing hormone b: suppression of androgen production c: stimulation of feminizing hormones d: induction of estrogen receptors e: reduction of hair growth

6: Testosterone is converted to dihydrotestosterone in

a: adrenal cortex b:

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hair follicles c: pituitary d: ovaries e: adipose tissue

7: 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 indicate a high-normal level of free and total testosterone. The most likely cause of her hirsutism is

a: obesity b: genetic predisposition c: Sertoli-Leydig cell tumor d: polycystic ovarian disease e: luteinizing hormone excess

8: A 24-year-old patient with excessive hair growth, anovulation, and acne is seen for follow-up after initiation of therapy with oral progesterone for treatment of oligomenorrhea. Although she now has predictable menses, she complains of bloating and worsening acne and states she was happier just not getting her period. You would stop the progesterone and try a course of oral contraceptive pills in order to

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a: increase production of androstenedione b: increase production of testosterone c: decrease production of FSH d: increase luteinizing hormone production e: decrease ovarian androgen secretion

9: A 36-year-old mother of two comes to you because of worsening striae, increased abdominal fat, and weakness. She tells you that she no longer has the energy she once had to play with her children. She admits to excessive eating but feels she can't help snacking. She denies all symptoms of depression, has no increased hair loss, and has completely unpredictable menses. You order a 24-hour free cortisol level, which is elevated. Her most likely diagnosis is

a: polycystic ovarian disease b: Cushing disease c: sarcoidosis d: Sertoli-Leydig cell tumor e: porphyria

10:

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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 follwoing?

a: New terminal hair growth b: Facial acne c: Hirsutism d: Weight e: Ovulation

11: 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 17alpha-hydroxyprogesterone and begin to suspect the less common 11-beta-hydroxylase deficiency. The finding that would support your diagnosis is

a: increased serum desoxycorticosterone b: severe hirsutism c: decreased serum LH d: severe hypertension

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e: reduced conversion of progeterone to cortisol

12: A 30-year-old patient with the diagnosis of polycystic ovary sydrome established 8 years ago was lost to follow-up until she presents to your office for the evaluation of irregular vaginal bleeding. The patient's lack of care during this interval has placed her at an increased risk for

a: fibrocystic breast disease b: endometrial cancer c: adrenal suppression d: basal cell cancer of the skin e: clitoral regression

13: 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

a: weight reduction b: human menopausal gonadotropins c: oral contraceptives

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d: clomiphene citrate e: estrogen supplementation

14: A 46-year-old patient has undergone surgical resection of a left ovarian Sertoli-Leydig cell tumor. She is concerned about what will happen to the facial hair that she developed that prompted the diagnosis.

The most appropriate management of this patient's facial hair should be a recommmendation for

a: no therapy needed, spontaneous regression should be expected b: estrogen replacement therapy c: progesterone therapy d: mechanical hair removal e: oral contraceptive therapy

15: A 38-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 fairly regular, but over the past 8 to 10 years they became less common, with only 5 periods over the past 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 of 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. The most appropriate next step in the evaluation of this patient is

a:

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pelvic ultrasonography b: surgical exploration c: laparoscopy d: serum FSH, LH, prolactin e: endometrial biopsy

16: In addition to weight loss, the most appropriate next step in the management of this patient is

a: thyroid replacement b: combination oral contraceptives c: GnRH agonist d: insulin therapy e: depot medroxyprogesterone acetate

17: A 24-year-old woman, G3P2012, presents for evaluation of amenorrhea and facial hair growth that have occurred abruptly over the past 6 months. Your nurse tells you a pregnancy test is negative. The patient's menstrual periods have been regular with the exception of her three pregnancies. Following her last delivery she underwent a tubal ligation. About 6 months ago, she noticed that her periods abruptly stopped and that she had lost breast volume that was sufficient to go to a smaller cup size for

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her bra. Over the past 3 months, she has noted some clitoral enlargement, the development of facial and body hair, and a deepening of her voice. The most likely cause of this patient's symptoms is

a: polycystic ovarian disease b: porphyria c: Sertoli-Leydig cell tumor d: sarcoidosis e: Cushing disease

18: The most appropriate next step in the evaluation of this patient is

a: measurement of serum TSH b: measurement of serum FSH and LH c: computed tomography of the pituitary gland d: ACTH challenge testing e: pelvic ultrasonography

19:

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An 18-year-old woman who is new to your practice comes to the office for evaluation of amenorrhea.

The patient had noted a gradual diminution of flow and frequency of periods during the past 2 to 3 years, but prior to this her periods had been regular. She is not currently using anything for contraception. Vital signs are temperature 37.0 degrees C (98.6 degrees F), pulse 48/min, respirations 18/min, and blood pressure 118/64 mm Hg. She weighs 73 kg (161 lb) and her height is 5'1". Physical examination is normal except for excessive hair growth, primarily along the angle of the jaw, upper lip, and chin. A urine pregnancy test is negative. The most appropriate treatment of this patient is

a: combination oral contraceptives b: thyroid replacement therapy c: replacement doses of corticosteroids d: danocrine sodium therapy e: cyclic progestin therapy

20: Of the following, the most likely test to be abnormal is

a: computed axial tomography of the pituitary b: serum prolactin c: serum LH d:serum ACTH e: pelvic ultrasonography ANS: [d,a,a,a,b,b,d,e,b,e,b,b,a,d,d,b,c,e,a,c]

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Chapter 41: Menopause 1: Which of the following has been shown to influence the age of menopause?

a: Height and race b: Use of oral contraceptives c: Tobacco use d: Age of menarche

2: Ovarian function ceases by 55 years of age in what percent of women?

a: 95% b: 80% c: 90% d: 85%

3: In postmenopausal women, endometrial hyperplasia is most associated with which of the following factors?

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a: Calcium supplementation b: Obesity c: Significant exercise d: Smoking

4: Approximately how many oocytes does a woman have at the time of puberty?

a: 4 million b: 40,000 c: 4,000 d: 400,000

5: Which hormone is the major product of the postmenopausal ovary?

a: Luteinizing hormone b: Testosterone c:

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Androstenedione d: Estrone

6: Vaginal dryness associated with menopause is a function of a decrease in which hormone?

a: LH b: Estrogen c: Progesterone d: FSH

7: What is the typical FSH level during a woman's prime reproductive years?

a: 1-44 mIU/mL b: 14-24 mIU/mL c: 30-35 mIU/mL d: 6-10 mIU/mL

8:

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What is the typical FSH level during perimenopause?

a: 30-35 mIU/mL b: 13-24 mIU/mL c: 1-44 mIU/mL d: 6-10 mIU/mL

9: Bisphosphonates act to manage bone loss associated with menopause by

a: stimulating the development of trabecular bone b: stimulating sex hormone-binding globulin c: promoting calcium absorption d: inhibiting osteoclast bone resorption

10: Which of the following is generally the first physical manifestation of decreasing ovarian function?

a: Hot flushes b:

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Vaginal dryness c: Mood changes d: Sleep disturbance

11: Decrease in the level of which of the following hormones is responsible for the vasomotor symptoms of menopause?

a: Progesterone b: Estrogen c: Follicle-stimulating hormone d: Testosterone

12: Perimenopause is associated with a decrease in

a: low-density lipoprotein b: total cholesterol c: high-density lipoprotein d:

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free fatty acids

13: What is the effect of decreasing estrogen on the sleep cycle?

a: Latent phase lengthened, sleep period shortened b: Latent phase lengthened, sleep period lengthened c: Latent phase shortened, sleep period lengthened d: Latent phase shortened, sleep period shortened

14: A 48-year-old woman with her last menstrual period 2 weeks ago presents to your office complaining of irregular menses at 15-day to 45-day intervals for the past 6 months. Past medical and surgical histories are noncontributory. There is no history of tobacco use. Her BMI is 28.3. A pelvic examination suggests several small fibroids. Which of the following would be the most efficacious initial therapy for this woman?

a: Low-dose oral contraceptive agent b: Cyclic medroxyprogesterone acetate c: Cyclic ethinyl estradiol d: Cyclic estrogen and progesterone

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15: Partial deletion of the long arm of one X chromosome results in

a: Savage syndrome b: increased ovarian reserve c: premature ovarian failure d: Turner syndrome

16: Increasing free testosterone associated with menopause is directly mediated by a decrease in

a: FSH b: prolactin c: sex hormone-binding globulin d: LH

17: Approximately what percent of women in the United States experience vasomotor symptoms (hot flushes) in the perimenopausal and menopausal period?

a:

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95% b: 75% c: 55% d: 35%

18: Administration of continuous unopposed estrogen can result in

a: excessive weight gain b: increased free cholesterol c: endometrial hyperplasia d: excessive bone loss

19: What is the expected rate of bone loss in perimenopausal women?

a: 0.1% per year b: 5% per year c: 1% per year

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d: 0.5% per year

20: Which of the following is a contraindication to hormone therapy associated with menopausal symptoms?

a: Family history of breast cancer b: Smoking more than 6 cigarettes/day c: Body mass index greater than 40 d: Recent arterial thromboembolic disease

21: Which of the following is responsible for early menopause in the women with Savage syndrome?

a: Partial deletion of the long arm of one X chromosome b: Development of autoantibodies against ovarian endocrine tissue c: Total deletion of the long arm of one X chromosome d: Resistance of ovarian follicles to FSH and LH

22:

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Cigarette smoking has what effect on the timing of menopause?

a: Smokers experience a longer period of menopausal symptoms b: Smokers experience a shorter period of menopausal symptoms c: Smokers experience menopause later than nonsmokers d: Smokers experience menopause earlier than nonsmokers

23: St. John's wort may be helpful in managing which of the following associated with menopause?

a: Vasomotor symptoms b: Mild depression c: Osteopenia d: Elevated total cholesterol

24: Which of the following is a known risk of unopposed estrogen therapy?

a: Leiomyoma uteri b:

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Endocervical adenocarcinoma c: Squamous cell carcinoma of the cervix d: Endometrial adenocarcinoma

25: Alendronate is a member of which drug class?

a: Anti-progestin b: Bisphosphonate c: Selective estrogen receptor modulator (SERM) d: Aromatase inhibitors ANS: [c,a,b,d,b,b,d,d,a,b,c,a,a,c,c,b,c,d,d,d,d,b]

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Chapter 42: Infertility A couple presents for evaluation of infertility; they have been trying to conceive for 4 months. You tell them to return if they are not pregnant in another 8 months because the percent of couples that will conceive within 1 year is approximately

a: 85% b: 55% c: 75% d: 65%

2: In a semen analysis, what portion of an ejaculate contains the greatest density of sperm?

a: Third quarter b: First quarter c: Second quarter d: Last quarter

3: The results of the semen analysis exclude a male cause for infertility in what percent of cases?

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a: 60% b: 70% c: 90% d: 85%

4: Which of the following is the most appropriate initial test for infertility in the case of a 32-year-old woman who has never been pregnant and who has regular menstrual cycles every 28 days who has resently married a 35-year-old man with two children?

a: Diagnostic laparoscopy b: Endometrial biopsy c: Basal body temperature record d: Hysterosalpingogram

5: Which of the following is the most appropriate initial test for infertility in the case of a 28-year-old woman who wishes to increase her chance of pregnancy by the timing of intercourse?

a: Urinary luteinizing hormone detection kit

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b: Endometrial biopsy c: Luteal phase progesterone d: Hysterosalpingogram

6: Which of the following is the most appropriate initial test for infertility in the case of a 32-year-old woman who has never been pregnant and who has a history of chronic pelvic pain and dysmenorrhea whose partner has a normal semen analysis?

a: Diagnostic laparoscopy b: Endometrial biopsy c: Hysteroscopy d: Hysterosalpingogram

7: A 38-year-old woman and her husband have been trying to conceive for 3 years. Their infertility evaluation reveals regular ovulatory mentrual cycles, bilateral proximal tubal occlusion on hysterosalpingogram, and a semen analysis with decreased sperm concentration (10 million/mL). Their best option for conception is

a: controlled ovarian hyperstimulation + intrauterine inseminations b:

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intrauterine inseminations c: in vitro fertilization d: clomiphene citrate + intrauterine inseminations

8: A 25-year-old woman presents with an inability to conceive for 9 months. She has irregular menstrual cycles that occur every 1 to 3 months. She also reports a 20-lb weight gain (current BMI 32 kg/m2), worsening of acne, fatigue, and dark hairs on her chin that she removes. Her most likely diagnosis is

a: polycystic ovary syndrome b: hypothyroidism c: depression d: hyperprolactinemia

9: A 30-year-old woman presents for evaluation of infertility. Her partner has never had a child, and she had two first-trimester pregnancy terminations in her early twenties. Her history is otherwise significant for hypothyroidism that is reasonably controlled with levothyroxine, dysmenorrhea that requires nonsteroidal anti-inflammatory agents during her menses, and an episode of chlamydia that required hospitalization and intravenous antibiotics. The most likely etiology of the couple's infertility is

a: tubal scarring b: uterine scarring

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c: male partner infertility d: hypothyroidism

10: Clomiphene citrate acts directly to

a: suppress gonadotropin release from the pituitary b: competitively inhibit estrogen binding to receptors in the hypothalamus and pituitary c: reverse hypothyroid-induced causes of anovulation d: support development of the secretory endometrium

11: Which of the following presents the highest risk of multiple gestation?

a: Controlled ovarian hyperstimulation b: Induction of ovulation by clomiphene citrate c: Laparoscopy to correct anatomic causes of infertility d: IVF

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12: Fecundability in a healthy young couple is estimated to be

a: 20%-25% b: 10%-15% c: 35%-40% d: 50%-55%

13: Ovulation occurs approximately how long after urinary evidence of an LH surge?

a: 12 hours b: 48 hours c: 2 hours d: 24 hours

14: Which of the following is the most appropriate test for the initial evaluation of the fallopian tubes?

a: Hysterosalpingography

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b: Hysteroscopy c: MRI of the pelvis d: Laparoscopy with chromotubation

15: Fecundity is defined as the probability of achieving

a: pregnancy in one menstrual cycle b: a live birth in one menstrual cycle c: pregnancy in 1 year d: a live birth in 1 year

16: A 25-year-old woman presents with an inability to conceive for 9 months. She has irregular menstrual cycles that occur every 1 to 3 months. She also reports a 20-lb weight gain (current BMI 32 kg/m2), worsening of acne, fatigue, and dark hairs on her chin that she removes. The test that is most likely to establish the cause of this woman's inability to conceive is

a: serum testosterone b: serum insulin c:

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serum estrogen d: serum prolactin

17: A 32-year-old woman presents with an inability to conceive for 18 months. She has regular menstrual cycles that occur monthly. She has been treated for mild premenstrual symptoms in the past. The couple has intercourse as often as four times per week. She has a child from a different relationship who is now 10 years old. The test that is most likely to establish the cause of this couple's inability to conceive is

a: semen analysis b: postcoital analysis of cervical mucous c: hysterosalpingography d: serum insulin [ANS: a,b,c,d,a,a,c,a,a,b,d,d,a,b,b,a]

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Chapter 43: Premenstrual Syndrome and Premenstrual Dysphoric Disorder 1: The symptoms of premenstrual syndrome typically resolve

a: by the end of menses b: about 2 weeks after the start of menses c: 2 weeks before the onset of menses d: at the time of ovulation

2: In premenstrual syndrome, there is a symptom-free interval of at least

a: 1 week per cycle b: 1 cycle out of 4 c: 2 weeks per cycle d: 2 cycles per year

3: The maximum estimated incidence of women with some physical or emotional premenstrual symptoms is

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a: 60%-70% b: 45%-55% c: 30%-40% d: 75%-85%

4: Premenstrual dysphoric disorder occurs in what percent of women?

a: 5% b: 75% c: 50% d: 25%

5: In making the diagnosis of premenstrual syndrome or PMDD, the characteristic that is most distinguishing is the

a: duration of symptoms b:

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cyclic occurrence of symptoms c: degree of disability in the patient d: severity of symptoms

6: Which of the following is most likely related to the underlying etiology of PMDD?

a: Serotonin b: Catecholamines c: Norepinephrine d: Progesterone

7: The most useful diagnostic tool with respect to premenstrual syndrome is

a: a careful history b: serial progesterone levels c: a prospective menstrual diary d: serial blood glucose determinations

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8: Reduction or elimination of which of the following dietary components appears to have a positive effect in PMS patients?

a: Calcium b: Fat c: Fresh fruit d: Magnesium

9: Which of the following is most likely to help a patient's PMS symptoms

a: Vaginal progesterone b: Transdermal estrogen c: Oral medroxyprogesterone acetate d: Combined oral contraceptives

10: A 25-year-old woman with no medical problems comes in for her annual exam. She expresses the worry that she has PMDD. She reports feeling bloated and moody when she has her period. The most appropriate initial management for this patient is

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a: treating her for hypothyroidism b: asking her to keep a menstrual diary for 2 months c: ordering a pelvic ultrasound d: giving her a prescription of fluoxetine to be taken only during the luteal phase

11: A patient keeps a menstrual diary for 2 months. The diary reveals that she has bloating, fatigue, anxiety, insomnia, and tearfulness in the days prior to her menses and that the symptoms resolve completely after her menses starts. She reports that her insomnia is so bad that it prevents her from being efficient at work because she is not well rested. The most likely diagnosis for this patient is

a: bipolar disorder b: PMDD c: major depressive disorder d: PMS

12: A patient with PMDD asks for some treatment options. You respond that the treatment that has clearly demonstrated benefit for her condition is

a:

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GnRH agonist b: sertraline c: danazol d: ovarian suppression with high-dose depot medroxyprogesterone

13: Which of the following has been shown to significantly improve the symptoms of women with PMS?

a: Light therapy b: Vitamin E c: Evening primrose d: Aerobic exercise

14: Which of the following would be the first line of treatment in the management of symptoms of PMS?

a: Selective serotonin reuptake inhibitors b: GnRH agonist c: Complex carbohydrate diet

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d: Oral contraceptive

15: An important diagnosis to distinguish from PMDD is major depressive disorder. Which of the following is increased in patients with major depressive disorder but not in patients with PMDD?

a: Sleep disturbance b: Suicide risk c: Anxiety d: Disordered eating

[ANS: a,a,d,a,b,a,c,b,d,b,b,b,d,c,b]

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Chapter 44: Cell Biology and Principles of Cancer Therapy 1: In order to maximize the reponse of a tumor to therapy, the goal should be to utilize therapy when the minimum number of tumor cells is in which phase of the cell cycle?

a: G0 b: G1 c: M d: G2

2: The phase of the cell cycle that is the most variable in length and ultimately influences how reponsive a tumor is to chemotherapy is

a: M b: G2 c: G1 d: S

3:

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The growth fraction is the number of cells in a tumor that are NOT in the

a: G1 phase b: G0 phase c: G2 phase d: S phase

4: Cytoreductive debulking surgery causes

a: the remaining tumor cells to leave the G0 phase b: lengthening of the S phase c: the remaining tumor cells to enter the G0 phase d: the growth fraction of tumor cells to decrease

5: Which of the following best describes the mechanism of action of the alkylating agents?

a: Interfere with DNA replication by cross-linking DNA b:

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Inhibit microtubule assembly c: Interfere with the normal function of enzymes necessary for DNA replication d: Inhibit DNA-directed RNA synthesis

6: Which of the following best describes the mechanism of action of plant (vinca) alkaloids?

a: Inhibition of DNA-directed RNA synthesis b: Inhibition of DNA replication by cross-linking DNA c: Inhibition of microtubule assembly d: Inhibition of enzymes necessary for DNA replication

7: Antitumor antibiotics act during which phase of the cell cycle?

a: S b: G2 c: All phases d: G1

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8: Antimetabolites act during which phase of the cell cycle?

a: G2 b: S c: G1 d: All phases

9: Nephrotoxicity is most strongly associated with which antineoplastic drug?

a: Bleomycin b: Methotrexate c: Paclitaxel d: Cisplatin

10: The intent of adjuvant therapy is to

a:

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reduce the size of the tumor prior to surgery in an effort to make inoperable tumors conducive to surgery b: cure disease in patients who have undergone surgical debulking with minimal to no residual disease c: alleviate the symptoms of advanced cancer with no intent to cure d: treat patients who are poor operative candidates but have advanced-stage cancer

11: Synergistic action between anticancer agents results in

a: enhanced antitumor activity equal to the sum of each of the individual agents b: enchanced antitumor activity equal to or greater than the sum of the individual agents c: less antitumor activity than each individual agent d: decreased toxicity compared with each agent alone

12: Which of the following can be attributed to the fact that radiation affects tumors by first-order kinetics?

a: Fractionated doses of radiation produce a better response b: Smaller tumors are more sensitive to treatment than larger tumors c:

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It can be used in combination with chemotherapy to induce a synergistic effect d: The number of cells killed with each subsequent dose increases exponentially

13: Tamoxifen acts as a competitive inhibitor of

a: progesterone binding b: follicle-stimulating hormone binding c: estrogen binding d: prolactin binding

14: Gene therapy for cancer treatment is designed to

a: reintroduce normal DNA into the tumor cells b: competitively bind to chromosomes c: inhibit vital processes in tumor growth d: upregulate the patient's own immune response

15:

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The goal of induction chemotherapy is to

a: eliminate any residual cancer cells b: maintain remission by inhibiting the growth of remaining cancer cells c: reduce inoperable disease in order to prepare patients for further treatment d: cause a remission

16: The goal of maintenance therapy is to

a: eliminate any residual cancer cells b: maintain remission by inhibiting the growth of remaining cancer cells c: reduce inoperable disease in order to prepare patients for further treatment d: cause a remission

17: A patient has been through surgery for her cancer and it appears that all of the tumor has successfully been removed. The most common follow-up likely would be

a: adjuvant chemotherapy

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b: observation with regular check-ups c: neoadjuvant chemotherapy d: maintenance chemotherapy

18: The antimetabolites inhibit

a: DNA-directed RNA synthesis b: microtubule assembly c: enzymes necessary for DNA replication d: DNA replication by acting to cross-link DNA

ANS: [a,c,b,a,a,c,c,b,d,b,b,a,c,a,d,b,a,c]

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Chapter 45: Gestational Trophoblastic Neoplasia Approximately what percent of patients with molar pregnancy will develop persistent or malignant disease?

a: 10% b: 30% c: 20% d: 40%

2: In comparison to patients with complete molar pregnancies, patients with partial molar pregnancies are more likely to

a: present at an earlier gestational age b: present with severe vaginal bleeding c: experience malignant transformation d: present as a missed abortion

3: A complete molar pregnancy is characterized by

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a: a history of infertility b: uterine growth less than expected for gestational age c: a triploid genotype d: absence of fetal parts on ultrasonography

4: The typical treatment for molar pregnancy in a 35-year-old woman would be

a: single-agent chemotherapy b: induction of labor with prostaglandins c: evacuation of the uterine contents by D&C d: abdominal hysterectomy

5: The recurrence rate for gestational trophoblastic disease in subsequent pregnancies is approximately

a: 4% b: 2%

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c: 8% d: 6%

6: In the United States, the incidence of choriocarcinoma following a molar pregnancy is about

a: 1 in 40 molar pregnancies b: 1 in 5,000 molar pregnancies c: 1 in 150,000 molar pregnancies d: 1 in 15,000 molar pregnancies

7: Which of the following characterizes choriocarcinoma?

a: Slow but steady myometrial invasion b: Selective metastases to the brain and spinal cord c: Metastases through the lymphatic system d: Metastases through hematogenous embolization

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8: On average, the cure rate for a patient with nonmetastatic GTN and a FIGO score of 4 is approximately

a: 75% b: 25% c: 100% d: 50%

9: A 35-year-old woman with no prenatal care presents at 14 weeks gestation with symptoms of hypertension and nausea and vomiting, and a fundal height of 20 cm. The most appropriate way to confirm your suspected diagnosis is

a: bimanual pelvic exam b: serial measurements of quantitative serum hCG levels c: endometrial biopsy d: ultrasonography

10: A 30-year-old pregnant woman with a history of infertility has no fetal cardiac activity at her 10-week new obstetric appointment. Which of the following would specifically establish the diagnosis of a partial mole?

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a: Snowstorm appearance of uterine contents on ultrasonography b: Highly elevated quantitative serum hCG c: Final tissue diagnosis after D&C for missed abortion d: Enlarged ovaries and uterus on physical examination

11: A 30-year-old woman presents with hypertension, proteinuria, nausea and vomiting, bilateral theca lutein cysts, a serum quantitative hCG of 40,000 mIU/mL, and an ultrasound confirming a complete molar pregnancy. What is the appropriate next step in management after necessary laboratory and imaging studies?

a: Methotrexate b: Hysterectomy c: Suction dilation and curettage d: Hysterectomy and bilateral salpingo-oophorectomy

12: A 38-year-old woman reports mild vaginal bleeding for the past 10 weeks, since she had a spontaneous abortion at home. What is the appropriate next step in evaluation of this patient?

a:

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Endometrial biopsy b: Ultrasound c: Quantitative serum hCG d: Complete blood cell count and clotting studies

13: A 23-year-old female nonsmoker presents to the ER with hemoptysis. Chest x-ray reveals three lung lesions. Full-body imaging and skin inspection reveal no obvious tumor. She initially denies a history of pregnancy although eventually admits giving a baby up for adoption 4 years ago. A 5-mm reddish nodule is seen in the upper third of the vagina on pelvic exam. What is the appropriate next step in her evaluation?

a: Biopsy of vaginal lesion b: Bronchoscope and biopsy of lung lesion c: Pelvic magnetic resonance imaging d: Endometrial biopsy

14: A 41-year-old with a history of a molar pregnancy 3 months ago with poor follow-up is diagnosed with choriocarcinoma. Her brain CT scan is normal. Her serum quantitative hCG level is 10,000 mIU/mL. Ultrasound has ruled out a new pregnancy. What aspect of her history and workup would suggest highrisk disease?

a:

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Absolute level of serum hCG b: History of a molar pregnancy c: Her age d: No prior chemotherapy

15: A 35-year-old female presents with a serum quantitative hCG of 90,000 mIU/mL. Total body imaging reveals multiple metastases to the lungs, vagina, spleen, and brain. Her uterus is enlarged. Her last pregnancy was term and 3 years ago. Which of the following represents the best initial course of action?

a: Hysterectomy b: Multiagent chemotherapy c: Single-agent chemotherapy d: Dilation and curettage

16: A 42-year-old patient is diagnosed with a molar pregnancy complicated by theca lutein cysts and preeclampsia. Her serum quantitative hCG on presentation was 100,000 mIU/mL. The patient tolerates her D&C without complication. She lives near the hospital and has reliably shown up to all her appointments. Which of the following represents the most appropriate next step in her management?

a: Hysterectomy

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b: Multiagent chemotherapy c: Serial serum quantitative hCG levels d: Single-agent chemotherapy

17: Six months ago a 33-year-old patient had a D&C to evacuate a molar pregnancy. Although her serum hCG levels have steadily decreased since then, they are still detectable. The patient has been compliant with contraception. Which of the following represents the most appropriate next step in her management?

a: Multiagent chemotherapy b: Dilation and curettage c: Hysterectomy d: Single-agent chemotherapy

18: The pathology report of a D&C performed on a 22-year-old woman for a missed abortion 2 weeks ago reveals a partial mole. Serum quantitative hCG levels are still detectable and over the next 4 weeks there is only a 10% variation in levels. Which of the following represents the most appropriate next step in her management?

a: Dilation and curettage b:

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Hysterectomy c: Single-agent chemotherapy d: Multiagent chemotherapy [ANS: c,d,d,c,b,a,d,c,d,c,c,c,a,c,b,c,d,c]

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Chapter 46: Vulvar and Vaginal Disease and Neoplasia 1: The appearance o lichen simplex chronicus is best described as

a: yellowish pink b: a raised patch with a silvery scale c: diffusely red to reddish brown d: ulcerative

2: A description of lichen planus would include

a: raised patches on an erythematous base b: white lacy bands of keratosis c: an oily appearance d: diffuse redness with hyperpigmented plaques

3: Psoriasis has what characteristic appearance?

a:

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Oily appearing, scaly crust b: Whitish lacy band c: Silver scale d: Hyperpigmented plaque

4: Seborrheic dermatitis has what characteristic appearance?

a: Lesions are pale to red to yellowish pink and may be covered by an oily appearing, scaly crust b: Diffusely reddened areas with occasional hyperplastic or hyperpigmented plaques of red to reddish brown c: Lesions are typically slightly raised, round, or ovoid patches with a silver scale appearance atop an erythematous base d: Areas of whitish lacy bands of keratosis near reddish ulcerated-like lesions

5: Lichen simplex chronicus is best treated with

a: cold tar preparation and exposure to ultraviolet light b: 5% aluminum acetate solution

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c: topical steroid with stronger fluorinated steriod d: antipruritic agents at night and topical steroid cream

6: Lichen planus should be treated with

a: antipruritic agents at night and topical steroid cream b: cold tar preparation and exposure to ultraviolet light c: topical steroid d: 5% aluminum acetate solution

7: Which of the following is the most appropriate treatment for psoriasis?

a: Cold tar preparation and exposure to ultraviolet light b: 5% aluminum acetate solution c: Topical steroids alone d: Antipruritic agents at night with topical steroid during the day

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8: Seborrheic dermatitis management should include

a: topical cold tar preparations, followed by exposure to ultraviolet light b: antipruritic agents to inhibit nighttime itching and topical steroid creams c: topical steroid preparations d: 5% aluminum acetate solution, followed by topical corticosteroid lotions or creams

9: Biopsy is not typically warranted in which of the following conditions?

a: VIN I b: Nevi c: Lichen planus d: Psoriasis

10: A 28-year-old happily married woman presents with new-onset insertional dyspareunia. The most likely diagnosis is

a:

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vulvar vestibulitis b: vulvar dysplasia c: chronic cervicitis d: Bartholin abscess

11: A hydrocele is associated with

a: cystocele b: vulvar neoplasms c: canal of Nuck d: condyloma

12: Hidradenomas arise from

a: sweat glands b: smooth muscle cells c: nerve cells

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d: bladder epithelium

13: Which of the following conditions may be associated with high urinary oxalic acid concentrations?

a: Vestibulitis b: Hidradenoma c: Seborrheic dermatitis d: Lichen simplex chronicus

14: Lichen sclerosis and hyperplastic dystrophy without atypia carry what estimated risk of vulvar carcinoma

a: 8% b: 4% c: 2% d: 6%

15: Mixed acanthosis-lichen sclerosis is treated by

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a: corticosteroid cream for 2-3 weeks, then topical steroid preparation b: topical steroid cream alone c: corticosteroid cream alone d: topical steroid for 2-3 weeks, then corticosteroid cream

16: Which of the following is characteristic of acanthosis?

a: Hyperkeratosis b: Hyperplastic, hyperpigmented plaques c: Hyalinized, glassy appearance d: Thin, white epithelium

17: Paget disease of the vulva may be associated with carcinoma of the

a: skin b: cervix

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c: bone d: bladder

18: Melanoma is most commonly associated with which characteristic?

a: Pain b: Pruritus c: Pigmentation d: Papillomavirus

19: When vulvar melanoma invades to the depth of the subcutaneous tissue, 5-year survival is generally

a: 40% b: 60% c: 10% d: 20%

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20: VIN, usual type, is treated by

a: cryocautery b: laser ablation c: laser cautery d: electrodesiccation

21: Vulvar carcinoma accounts for approximately what percent of all gynecologic malignancies?

a: 12% b: 16% c: 5% d: 22%

22: What percent of vulvar carcinomas are of the squamous cell type?

a: 90%

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b: 70% c: 50% d: 30%

23: In patients with vulvar carcinoma, what is the most common presenting complaint?

a: Vulvar pruritus b: Dysuria c: Dyspareunia d: An exophytic ulcerative labial lesion

24: The spread of squamous cell carcinoma of the vulva is best characterized by which of the following?

a: The mode of spread is dependent on patient age b: Metastasis occurs early in the disease course c: Spread of the disease is typically to the regional lymph nodes d:

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Lesions in the posterior aspect of the vulva may spread directly to the deep pelvic nodes

25: The overall incidence of lymph node metastasis in squamous cell carcinoma of the vulva is approximately

a: 20% b: 10% c: 30% d: 40% [ANS: c,b,c,a,d,c,a,d,d,a,c,a,a,b,a,a,a,c,d,b,c,a,a,c,c]

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Chapter 47: Cervical Neoplasia and Carcinoma 1: Which of the following is a recognized risk factor associated with cervical neoplasia?

a: High socioeconomic status b: Multiple sexual partners c: Alcohol consumption d: Previous pregnancy

2: The transformation zone develops

a: at the time of menopause b: during pregnancy c: before puberty d: during puberty and adolescence

3: During perimenopause, the location of the squamocolumnar junction shifts

a:

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to just outside the external os b: onto the vaginal side wall c: onto the cervical surface d: into the enodcervical canal

4: What percent of lower genital tract neoplasia arise in the squamocolumnar junction?

a: 30% b: 90% c: 70% d: 50%

5: HPV is the etiology for approximately what percent of cervical cancer?

a: 90% b: 70% c: 50%

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d: 30%

6: Which of the following types of human papillomavirus is associated with a high risk of squamous intraepithelial neoplasia?

a: 27 b: 6 c: 16 d: 11

7: An 18-year-old patient who has had four sexual partners undergoes her first Pap smear, which is reported as ASCUS (atypical squamous cells of undetermined significance). Which of the following is the most appropriate next step?

a: Loop electrical excision procedure b: Colposcopy c: Repeat cytology in 6 months d: Testing for sexually transmitted infections

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8: A Bethesda system Pap smear report that reads "low-grade squamous intraepithelial lesion (LSIL)" is most consistent with which of the following classifications?

a: Inflammation b: CIN 3 c: CIN 2 d: CIN 1

9: High-grade SIL (HSIL) on a Bethesda system Pap smear report is likely to suggest

a: invasive cervical carcinoma b: carcinoma in situ c: HPV infection d: CIN 1

10: If squamous cell cancer is suspected and a visible lesion is present, the next step should be

a:

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endocervical curettage b: colposcopy with directed biopsy c: Pap smear d: LEEP procedure

11: A single Pap smear reading of "atypical squamous cells of undetermined significance (ASCUS)" in a patient negative for HPV infection should have which of the following as follow-up?

a: Colposcopy b: Endocervical curettage c: Routine screening d: Endometrial biopsy

12: A Pap smear reading of "low-grade squamous intraepithelial lesions (LSIL)" in a 25-year-old should be followed by

a: colposcopy b: LEEP procedure

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c: HPV DNA testing d: repeat Pap smear in 6 months

13: In a 37-year-old patient who presents with a Pap smear reading of "atypical glandular cells" the most appropriate next step in management would be

a: treatment for bacterial vaginosis b: colpsocopy, HPV testing, endometrial biopsy c: vaginal estrogen therapy d: repeat Pap smear

14: A colposcopy is considered to be satisfactory when the entire

a: external cervical os is visualized b: internal cervical os is visualized c: erosive zone is visualized d: squamocolumnar junction is visualized

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15: The acetic acid solution used to wash the cervix before colposcopy functions as a(n)

a: emulsifier b: stain c: antiseptic d: desiccant

16: Cryocautery is most typically used to treat

a: stage 1B1 carcinoma b: persistent CIN 1 c: stage 1A1 microinvasive carcinoma d: ASCUS

17: Which of the following is typically used to treat stage IIB cervical carcinoma

a:

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Cryocautery b: Debulking surgery followed by adjuvant radiation therapy c: External beam and brachytherapy radiation and cisplatin-based chemotherapy d: LEEP

18: The average age of diagnosis of invasive cervical carcinoma is approximately

a: 30 years b: 50 years c: 60 years d: 40 years

19: Advanced cervical intraepithelial neoplasia is thought to precede the occurrence of invasive cervical carcinoma by an average of

a: 20 years b: 10 years c:

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1 year d: 5 years

20: What percent of cervical cancer is of the squamous cell variety?

a: 40% b: 95% c: 80% d: 60%

21: Approximately what percent of cervical carcinoma is adenocarcinoma or adenosquamous carcinoma?

a: 35% b: 25% c: 15% d: 5%

22:

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The 5-year survival for stage IA cervical carcinoma is

a: greater than 95% b: 90% c: 85% d: 75%

23: The 5-year survival for stage II cervical carcinoma is

a: greater than 95% b: 75% c: 90% d: 85%

24: The 5-year survival for stage III cervical carcinoma is

a: 90% b:

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50% c: 60% d: 70%

25: The 5-year survival for stage IV cervical carcinoma is about

a: 70% b: 50% c: 25% d: 10%

26: Which of the following is present in all patients with invasive cervical cancer?

a: Pain b: Postcoital bleeding c: Abnormal uterine bleeding d: Stromal invasion

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27: Stage IIA cervical carcinoma is defined as

a: minimal evidence of stromal invasion on microscopic examination b: carcinoma involving the lower third of the vagina c: carcinoma extending beyond the cervix but not to the pelvic wall; there is no obvious parametrial involvement d: microscopic lesion(s) no more than 5 mm in depth measured from the base of the epithelial surface or glandular surface from which it originates, and horizontal spread not to exceed 7 mm

28: The definition of stage IIIB cervical carcinoma is

a: carcinoma has spread to adjacent pelvic organs b: carcinoma extends beyond cervix with obvious parametrial involvement c: carcinoma extends to pelvic side wall d: carcinoma has spread to distant organs

29: The definition of stage IVA is

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a: carcinoma has spread to distant organs b: carcinoma has spread to adjacent pelvic organs c: carcinoma extends beyond cervix with obvious parametrial involvement d: carcinoma extends to pelvic side wall

30: The definition of stage IVB is

a: carcinoma has spread to distant organs b: carcinoma extends beyond cervix with obvious parametrial involvement c: carcinoma has spread to adjacent pelvic organs d: carcinoma extends to pelvic side wall [ANS: b,d,d,b,a,c,d,b,b,c,a,b,d,d,b,c,b,b,c,c,a,b,b,c,d,c,c,b,a]

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Chapter 48: Uterine Leiomyoma and Neoplasia Uterine leiomyomata are clinically apparent in what percent of women?

a: 25%-50% b: Greater than 75% c: Less than 5% d: 10%-15%

2: Sensitive DNA studies suggest that each myoma arises from a

a: single connective tissue cell b: dormant leiomyoma cell present at birth c: single smooth muscle cell d: single vascular endothelial cell

3: Leiomyosarcoma develops from

a:

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uterine mucosa b: cervical endothelium c: uterine serosa d: uterine smooth muscle

4: Postmenopausal patients who present with rapidly enlarging uterine masses should be considered at high risk for

a: benign metastasizing leiomyoma b: uterine leiomyoma c: intravenous leiomyomatosis d: uterine leiomyosarcoma

5: What is the most common change occurring in myomas during pregnancy?

a: Red degeneration b: Liquefaction c:

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Calcification d: Modest growth

6: Menorrhagia associated with uterine leiomyoma is defined as menstrual blood loss of greater than

a: 40 mL b: 80 mL c: 160 mL d: 120 mL

7: What is the type of leiomyoma most commonly associated with abnormal uterine bleeding?

a: Submucosal b: Disseminated c: Subserosal d: Intramural

8:

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According to current data, about what percent of patients undergoing hysteroscopic removal of submucous leiomyoma will require additional therapy within 10 years?

a: 30% b: 20% c: 10% d: 50%

9: Vaginal birth after myomectomy is

a: recommended as the standard of care b: best decided on a case-by-case basis c: typically contraindicated d: advisable only in multiparous patients

10: A 35-year-old woman has had a myomectomy to remove uterine fibroids. In her next pregnancy, she is at increased risk for

a:

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oligohydramnios b: twin gestation c: leiomyosarcoma d: uterine rupture

11: A 46-year-old woman is found to have a "12-week" uterus due to the presence of scattered uterine fibroids. While her periods are heavy, she is experiencing no pain and is not anemic. The most appropriate initial management for this patient is

a: myomectomy b: hysterectomy c: observation d: serial ultrasounds

12: A 49-year-old woman has been diagnosed with several large uterine fibroids. If she is started on gonadotropin-releasing hormone agonist therapy, the most likely result will be

a: reduced size of the fibroids b: permanent disintegration of the fibroids

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c: no clinically demonstrated effect d: delayed natural menopause

13: Which of the following would be the strongest single criterion for hysterectomy for leiomyoma?

a: The presence of uterine bleeding that is uncomfortable for the patient, but without anemia b: The presence of acute or severe pelvic discomfort caused by myoma in a postmenopausal patient c: The presence of asymptomatic leimyomas that are palpable abdominally d: Patient concern about the possibility of the leiomyoma progressing to leiomyosarcoma

14: Which type of uterine myoma is most likely to be mistaken for an adnexal mass?

a: Submucosal b: Intramural c: Subserosal d: Pedunculated

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15: A 37-year-old patient who has not completed childbearing has a 7 cm symptomatic fibroid. She has had menorrhagia for 6 months and a normal endometrial biopsy. She wants to know what the best option for treatment of this fibroid is. She would like to utilize the least invasive approach to accomplish her treatment goals. You recommend:

a: myomectomy b: uterine artery embolization c: MRI-guided focused ultrasound surgery d: hysterectomy with surrogacy for future pregnancy

16: A 40-year-old patient with irregular bleeding comes to see you. On physical exam you palpate an enlarged uterus measuring approximately 18 week size. Upon review of her medical record, you notice that a prior ultrasound performed 2 years ago demonstrated a uterus measuring approximately 16 weeks size. She desires definitive management. Prior to performing a hysterectomy, your workup is not complete without a: mammogram to screen for breast cancer b: MRI to evaluate exact location of fibroids c:endometrial biopsy to asses for endometrial pathology d: ultrasound to confirm your physical exam findings

17: GnRH analogs can be helpful to

a: treat hot flushes and vaginal dryness b: promote cyclic bleeding in patients with irregular bleeding from fibroids c: help women with fibroids conceive d: stop uterine bleeding caused by fibroids to rebuild iron stores in preparation for surgery.

[ANS: a,c,d,d,d,b,a,b,b,d,c,a,b,d,a,c,d]

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Chapter 49: Cancer of the Uterine Corpus Among female genital tract malignancies, endometrial carcinoma ranks where in frequency?

a: Second b: Third c: Fourth d: First

2: Not including skin cancer, endometrial carcinoma ranks where in frequency among all cancers?

a: Fifth b: Fourth c: Third d: Second

3: A 42-year-old woman presents to your clinic complaining of abnormal uterine bleeding. She has had this problem for approximately 3 years but it has become bothersome recently. She is 5'0" and 260 lb and has never been pregnant. After performing a complete history and physical, the most appropriate next step would be

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a: transvaginal ultrasound b: transabdominal ultrasound c: endometrial sampling d: computed tomographic scan

4: Endometrial hyperplasia and endometrial carcinoma are often overgrowths of the endometrium in response to

a: prolactin b: estrogen c: progesterone d: prostaglandin

5: Conversion of androstenedione to estrogen occurs mainly in the

a: peripheral muscular tissue b:

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centers of bone marrow activity c: peripheral fat tissue d: peripheral tissue stroma

6: In 1994, the World Health Organization sought to standardize the classification system of endometrial hyperplasia. The major categories central to this classification are

a: histologic grade and lymph node status b: nuclear grade and depth of myometrial invasion c: cytologic atypia and glandular/stromal architecture d: histologic grade, lymph node status, nuclear grade, and depth of myometrial invasion

7: A nulliparous 27-year-old wman with abnormal uterine bleeding returns to your office to obtain the results of a recent endometrial biopsy. The final pathology report read "complex hyperplasia with atypia." The patient is interested in having children in the future and asks you about the risk of this abnormality being associated with or progressing to cancer in the near future. According to current data, the most appropriate answer is

a: less than 1% b: 29%

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c: 8% d: 3%

8: Complex hyperplasia is characterized histologically by

a: marked stromal proliferation with enlarged glands b: disordered maturation with loss of cellular polarity and increased nucleus-to-cytoplasm ratios c: cystic involution of the endometrium d: increased gland-to-stroma ratio giving a "crowded" or "back-to-back" appearance

9: Tamoxifen increases the relative risk of developing endometrial carcinoma because at the level of the endometrium it acts like

a: insulinase b: prolactin c: estrogen d: progestin

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10: When compared with the findings of dilation and curettage or hysterectomy, what is the diagnostic accuracy of office endometrial sampling techniques?

a: 50%-58% b: 70%-78% c: 90%-98% d: 80%-88%

11: A healthy, thin, 70-year-old woman presents to your office complaining of one episode of vaginal spotting. She has no medical problems and only takes a daily multivitamin. You perform an endometrial biopsy and obtain scant amounts of tissue. The final pathology reads "insufficient tissue for diagnosis."

What is the recommended follow-up for this patient?

a: Dilation and curettage b: Ultrasound to evaluate endometrial stripe c: Vaginal hysterectomy and bilateral salpingo-oophorectomy d: Hysteroscopy

12:

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On morning rounds, you look up Ms. Smith's final pathology from her recent total abdominal hysterectomy and staging for endometrial cancer. You report that the pathologist found "tumor involving less than 50% of the myometrium and the serosa, along with (+) cells in the peritoneal washings. All lymph nodes were negative." The senior resident asks you to characterize her stage. Your (correct) response should be

a: IIA b: IB c: IVA d: IIIA

13: On morning rounds, you look up Ms. Jones' final pathology from her recent total abdominal hysterectomy and staging for endometrial cancer. You report that the pathologist found "tumor limited to the uterus invading greater than 50% of the myometrium with cervical stromal involvement." The senior resident asks you to characterize her stage. Your (correct) response should be

a: IIA b: IB c: IIIA d: IIB

14:

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On morning rounds, you look up Ms. Doe's final pathology from her recent total abdominal hysterectomy and staging for endometrial cancer. You report that the pathologist found "tumor invading the lower uterine segment extending into the bladder, (+) periaortic lymph node." The senior resident asks you to characterize her stage. Your (correct) response should be

a: IIIC b: IVA c: IIIA d: IIIB

15: On morning rounds, you look up Ms. Jones' final pathology from her recent total abdominal hysterectomy and staging for endometrial cancer. You report that the pathologist found "tumor was carcinoma in situ with one focus of adenosquamous carcinoma (2 mm wide x 4 mm deep in size) limited to the upper one-third of the vagina." The senior resident asks you to characterize her stage. Your (correct) response

a: IB b: IIB c: IVB d: IIIB

16:

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After a failed attempt at an office endometrial biopsy on a 74-year-old woman with an episode of vaginal bleeding, you decide to order a transvaginal ultrasound. Which of the following would indicate the need for another attempt at endometrial sampling?

a: Mild amount of fluid in the cul-de-sac b: Endometrial stripe of less than 4 mm c: A 4 cm left adnexal mass d: A polypoid mass in the center of the uterus

17: A 44-year-old woman returns to obtain the results of a recent endometrial biopsy. The final report reads "poorly differentiated endometrioid cancer." What therapy would you recommend?

a: Pelvic exenteration b: Whole-body radiation therapy c:Vaginal hysterectomy d:Total abdominal hysterectomy with bilateral salpingo-oophorectomy, pelvic and periaortic lymph node sampling

18: A 62-year-old woman presents with postmenopausal bleeding, pelvic pain, and a rapidly enlarging uterus. She is not taking hormone replacement therapy. These findings present a strong index of suspicion for

a: cervical carcinoma b: uterine sarcoma c: adenomyosis d:endometrioid carcinoma ANS: [d,b,c,b,c,c,b,d,c,c,b,d,d,b,d,d,d,b]

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Chapter 50: Ovarian and Adnexal Disease 1: Which of the following is an epithelial cell tumor?

a: Mucinous cystadenoma b: Lymphoma c: Seroli-Leydig cell d: Dermoid cyst

2: Which of the following is an example of a stromal cell neoplasm?

a: Serous cystadenoma b: Endometrioid c: Dysgerminoma d: Sertoli-Leydig cell

3: Which of the following is a germ cell tumor?

a: Brenner cell b: Teratoma c: Lymphoma

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d: Endometrioid

4: Which of the tumors of the ovary should always be treated with hysterectomy, bilateral salpingooophorectomy, and staging?

a: Dysgerminoma b: Cystadenocarcinoma c: Brenner cell tumor d: Theca lutein cyst

5: Stage I carcinoma of the ovary is defined by the International Federation of Gynecology and Obstetrics (FIGO) as

a: tumor involving one or both ovaries with peritoneal implants outside the pelvis and/or positive retroperitoneal or inguinal nodes b: growth involving one or both ovaries with distant metastasis c: growth limited to the ovaries d: growth involving one or both ovaries with pelvic extension

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6: Stage II carcinoma of the ovary is defined by the International Federation of Gynecology and Obstetrics (FIGO) as

a: growth limited to the ovaries b: tumor involving one or both ovaries with peritoneal implants outside the pelvis and/or positive retroperitoneal or inguinal nodes c: growth involving one or both ovaries with pelvic extension d: growth involving one or both ovaries with distant metastasis

7: Stage III carcinoma of the ovary is defined by the International Federation of Gynecology and Obstetrics (FIGO) as

a: growth involving one or both ovaries with pelvic extension b: tumor involving one or both ovaries with peritoneal implants outside the pelvis and/or positive retroperitoneal or inguinal nodes c: growth involving one or both ovaries with distant metastasis d: growth limited to the ovaries

8:

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Stage IV carcinoma of the ovary is defined by the International Federation of Gynecology and Obstetrics (FIGO) as

a: growth involving one or both ovaries with distant metastasis b: tumor involving one or both ovaries with peritoneal implants outside the pelvis and/or positive retroperitoneal or inguinal nodes c: growth limited to the ovaries d: growth involving one or both ovaries with pelvic extension

9: Which structure in the genitourinary system may mimic a solid adnexal mass?

a: Ureter b: Urethra c: Pevic kidney d: Bladder

10: Compared with reproductive-age patients, palpable ovarian enlargement in the postmenopausal patient is

a:

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less likely to be the result of a malignancy b: equally as likely to be the result of a malignancy c: unable to be determined based on the data available d: more likely to be the result of a malignancy

11: Functional ovarian cysts are defined as

a: anatomic variations b: malignant tumors c: sarcomas d: neoplasms

12: A patient not using oral contraceptives, with regular periods, presents with acute pain late in the luteal phase. This clinical picture is most consistent with

a: mucinous cystadenoma b: serous cystadenoma c:

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dermoid cyst d: hemorrhagic corpus luteum

13: Corpus luteum cysts are often associated with a delay in menstruation for 1 to 2 weeks and dull lower quadrant pain. Which of the following must be measured before consideration of conservative managment of this situation?

a: Progesterone b: beta-Human chorionic gonadotropin c: Estradiol d: Estrogen

14: Coelomic epithelium gives rise to what ovarian neoplasm?

a: Choriocarcinoma b: Granulosa theca c: Serous cystadenoma d: Teratoma

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15: Gonadal stroma gives rise to what ovarian tumor?

a: Granulosa theca b: Teratoma c: Choriocarcinoma d: Mucinous cystadenoma

16: Germ cells result in what ovarian neoplasm?

a: Granulosa theca b: Mucinous cystadenoma c: Serous cystadenoma d: Teratoma

17: Approximately what percent of serous cystadenomas are benign?

a:

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50% b: 70% c: 30% d: 10%

18: The most common type of benign epithelial cell neoplasm is

a: endometrioid b: Brenner cell c: mucinous d: serous

19: When a child or adolescent presents with an ovarian neoplasm, the most common type is

a: ovarian fibroma b: benign cystic teratoma c: mucinous cystadenoma

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d: Brenner cell tumor

20: Brenner cell tumors may be associated with

a: mucinous tumors b: serous tumors c: dermoid tumors d: endometrioid tumors

21: Which of the following neoplasms can contribute to precocious puberty in a female child?

a: Ovarian fibroma b: Granulosa theca cell tumor c: Sertoli-Leydig cell tumor d: Serous cystadenoma

22: In the reproductive-age group, about what percent of nonfunctional ovarian neoplasms are benign?

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a: 70% b: 10% c: 90% d: 50%

23: Approximately what percent of patients with ovarian cancer have advanced-stage disease at the time of diagnosis?

a: 15%-20% b: 25%-30% c: 65%-70% d: 44%-50%

24: Which ovarian tumor has the highest malignant potential?

a: Mucinous cystadenoma b:

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Brenner tumor c: Serous cystadenoma d: Dermoid

25: Malignant ovarian epithelial cell tumors spread primarily by

a: hematogenous dissemination b: direct extension within the peritoneal cavity c: lymphatic dissemination d: neurologic dissemination

ANS: [a,d,b,b,c,c,b,a,c,d,a,d,b,c,d,d,b,d,b,a,b,a,c,c,b]