Question bank

A healthy 38-year-old G4P3003 presents for amniocentesis. The karyotype returns as shown in the Figure You counsel the patient that which of the following was likely her biggest risk factor for the development of this karyotype?

A healthy 38-year-old G4P3003 presents for amniocentesis. The karyotype returns as shown in the Figure. What is the diagnosis?

Preconception counseling is an important component of health care encounters with reproductive age women. As a general recommendation, women of childbearing age should be advised to consume what dose of folic acid for prevention of neural tube defects?

A29-year-old nonhelmeted motorcycle driver is involved in a single vehicular crash, resulting in a significant closed-head injury. He is intubated in the field and transported to a level 1 trauma center. On arrival, he is oxygenating well with assisted ventilation and has a normal blood pressure and moderate tachycardia. His Glasgow Coma Score is 7, and his pupils are equal and sluggishly reactive. After stabilization in the emergency department, the patient undergoes a CT scan of the head that demonstrates a small amount of subarachnoid blood and a right frontal lobe contusion with edema with no midline shift. CT scan of the abdomen is normal. The patient is transferred to the ICU. The optimal initial management of this patient's intracranial pressure (ICP) would be which of the following?

You are called by the labor and delivery nurse to evaluate the fetal monitoring strip of a patient. She is a 24-year-old G1 female at 40 weeks' gestation that went into spontaneous labor earlier today. She is currently on IV oxytocin (Pitocin). You review the fetal monitoring strip shown in figure below. What is the most appropriate management at this point?

A 16-year-old nulligravid high school student is on your afternoon office schedule for a "talk visit." She was seen last year by one of your colleagues for an initial GYN evaluation. She is healthy and has no medical problems. Today she tells you that she and her new boyfriend had intercourse the night before, and the condom they were using broke. Your initial course of action should include which of the following?

A 4-year-old previously healthy girl presents to the emergency department with a 24-hour history of rectal bleeding and dizziness. She has no other gastrointestinal symptoms. On examination, she appears pale. Her heart rate is 140 beats/min, and she has a 20 mmHg postural drop in systolic blood pressure. The child's abdomen is nondistended and nontender, and fresh blood and clots are in the rectal vault on rectal examination. Definitive management of this child should include which of the following?

You are called by the labor and delivery nurse to evaluate the fetal monitoring strip of a patient. She is a 24-year-old G1 female at 40 weeks' gestation that went into spontaneous labor earlier today. She is currently on IV oxytocin (Pitocin). You review the fetal monitoring strip shown in figure below. What physiologic process causes this to occur?

You are called by the labor and delivery nurse to evaluate the fetal monitoring strip of a patient. She is a 24- year-old G1 female at 40 weeks' gestation that went into spontaneous labor earlier today. She is currently on IV oxytocin (Pitocin). You review the fetal monitoring strip shown in figure below. What fetal heart rate condition does this monitor strip reveal?

A 4-year-old previously healthy girl presents to the emergency department with a 24-hour history of rectal bleeding and dizziness. She has no other gastrointestinal symptoms. On examination, she appears pale. Her heart rate is 140 beats/min, and she has a 20 mmHg postural drop in systolic blood pressure. The child's abdomen is nondistended and nontender, and fresh blood and clots are in the rectal vault on rectal examination. Which of the following is the most likely diagnosis? a bleeding Meckel's diverticulum

A25-year-old woman was involved in a motor vehicle crash and sustained a significant closed-head injury, a pulmonary contusion, and a pelvic fracture. She is unresponsive and is ventilated in the intensive care unit (ICU). Which of the following is the best initial approach to the management of this patient's nutritional needs?

A 37-year-old female presented to your office with an ultrasound report suggestive of bilateral ovarian masses. You take her to the operating room for an exploratory laparotomy and note the left ovary to be replaced by an 8 9 cm neoplastic process. The right ovary appears to have a small 2 x 2 cm cystic process, similar in appearance to the left ovary, involving only a small portion of the right ovary. After obtaining pelvic and upper abdominal washings, you remove the left ovary and then perform a cystectomy on the right ovary, removing all visible disease without rupture. The frozen section on both resected specimens reveals a serous tumor of low malignant potential (LMP). The best procedure for the patient at this point is which of the following?

A 64-year-old White female presents to your office with complaints of vulvar pruritis and pain. You examine her and find an ulcerated lesion in the medial aspect of the left labia majora, 3.0 1.5 cm, that is thickened and indurated. You biopsy this lesion and the findings confirm a squamous cell carcinoma of the vulva. The groin nodes are palpably normal bilaterally. The next step in the patient's management would be which of the following?

A40-year-old previously healthy man presents with sudden onset of severe abdominal pain that radiates from the right loin (flank) to groin. This pain is associated with nausea, sweating, and urinary urgency. He is distressed and restless, but an abdominal examination is normal. Which of the following is the most likely diagnosis? torsion of the right testicle

A 62-year-old female with newly diagnosed International Federation of Gynecology and Obstetrics (FIGO) stage IIIC epithelial ovarian cancer is without evidence of visible remaining disease following a total abdominal hysterectomy, bilateral salpingo-oophorectomy, complete omentectomy, bilateral pelvic and paraaortic lymph node sampling, and rectosigmoid resection with reanastomosis. She is seen now for further treatment planning. The appropriate adjuvant therapy indicated in this setting is which of the following?

A50-year-old man is admitted to the hospital with a UGI bleed from acute erosive gastritis, secondary to chronic nonsteroidal anti-inflammatory use. His hematocrit is 28%. With fluid resuscitation, his blood pressure normalizes, but he has a persistent hyperdynamic precordium, tachycardia, and flow murmur on auscultation. He complains of shortness of breath on ambulation. An ECG shows depressed ST-T segments. Which of the following is the next appropriate step in management?

An 82-year-old woman is admitted to the surgical ward after suffering a fracture of her right hip due to a fall down her stairs. Her surgery and recovery are uneventful, but 3 days later, the nurses are frustrated when she does not let them take her vitals or draw blood. On interview, she exhibits drowsiness with occasional agitation. She is unable to answer questions well and is oriented only to person. She also picks at the empty air and begins yelling and swinging at the nurse who is present. 90. Which of the following is the most important in managing this patient?

During diagnostic evaluation, a 14-year-old girl with menorrhagia, frequent nosebleeds, and irondeficiency anemia is found to have a low platelet count with a normal coagulation profile. Bone marrow biopsy reveals abundant megakaryocytes. On abdominal examination, no organomegaly is noted. The patient has a satisfactory response to the initial therapeutic intervention, but over 612 months' time, the response is less dramatic and shorter in duration. There are signs and symptoms of increasing side effects from therapy. The next step in management should be to recommend which of the following?

An 82-year-old woman is admitted to the surgical ward after suffering a fracture of her right hip due to a fall down her stairs. Her surgery and recovery are uneventful, but 3 days later, the nurses are frustrated when she does not let them take her vitals or draw blood. On interview, she exhibits drowsiness with occasional agitation. She is unable to answer questions well and is oriented only to person. She also picks at the empty air and begins yelling and swinging at the nurse who is present. 90. An electroencephalogram (EEG) performed on this patient would most likely show which of the following?

During diagnostic evaluation, a 14-year-old girl with menorrhagia, frequent nosebleeds, and irondeficiency anemia is found to have a low platelet count with a normal coagulation profile. Bone marrow biopsy reveals abundant megakaryocytes. On abdominal examination, no organomegaly is noted. Which of the following is the most appropriate initial therapy for this patient?