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167 questions
A patient with a persistent headache following a postpartum hemorrhage is diagnosed with Sheehan's syndrome. If the patient were subsequently amenorrheic and infertile, what treatment would you recommend to assist this patient to conceive?
A 61-year-old postmenopausal woman, who has been on continuous combined hormone replacement therapy for 5 years, presents to your office complaining of vaginal bleeding. Which of the following is the most appropriate next step in her management?
A37-year-old woman (gravida 3, para 3) presents with a 4-month history of postcoital spotting On pelvic examination, you visualize a 2-cm friable lesion on the anterior lip of the cervix. The next most appropriate step is which of the following?
A22-year-old nulliparous woman who desires future fertility is found to have a pap smear consistent with high-grade squamous intraepithelial lesion (HGSIL). Initial management should be which of the following?
A22-year-old nulliparous woman who desires future fertility is found to have a pap smear consistent with high-grade squamous intraepithelial lesion (HGSIL). The final pathology report indicates a single focus of squamous carcinoma invasive into the cervical stroma to a depth of 2.0 mm. An ECC is negative. There is no lymphvascular space invasion, and the cone margins are negative. The most appropriate therapy for this patient is which of the following?
A39-year-old woman with a long-standing history of normal pap smears undergoes a total abdominal hysterectomy for a large uterine fibroid and menorrhagia. Six months after her hysterectomy she had a negative vaginal pap smear from the vaginal apex. She presents to your clinic today for a routine physical examination. Based on the American College of Obstetricians and Gynecologists recommendations, when should this patient have pap smears?
A 14-year-old nulligravid female is brought to the ER by her parents with a 12-hour history of severe, intermittent left lower quadrant pain. She has had nausea and vomiting for the past 2 hours. On history, the patient experienced menarche at age 12 and denies past or current contact with a sexual partner. Her last normal menstrual period was 3 weeks ago. On examination, she is afebrile, pulse 100, BP 110/70, respiratory rate (RR) 20. She is visibly uncomfortable. She has no costovertebral tenderness, has diminished bowel sounds, her abdomen is nondistended, and exhibits rebound and guarding in both lower quadrants. She is unable to tolerate a pelvic examination due to pain. Laboratory values are as follows: WBC 13, HCT 39, -hCG (-), UA (-). Apelvic ultrasound shows a normal nonpregnant uterus, normal right adnexa, and an 8-cm left adnexal mass with a 3-cm solid component. Which of the following would be the next appropriate step in managing this patient?
A43-year-old Black female (gravida 3, para 3) with a previous tubal ligation, presents to your office complaining of increasing menorrhagia, dysmenorrhea, and fatigue over the past 6 months. On examination, her vital signs are normal, and on abdominal examination you palpate a firm, mobile mass just below the umbilicus. On pelvic examination, there is a moderate amount of old blood coming from the cervical os. A urine pregnancy test is negative, her last pap smear was normal and her spun HCT today is 28%. Which diagnostic test would be most costeffective in confirming a diagnosis?
A43-year-old Black female (gravida 3, para 3) with a previous tubal ligation, presents to your office complaining of increasing menorrhagia, dysmenorrhea, and fatigue over the past 6 months. On examination, her vital signs are normal, and on abdominal examination you palpate a firm, mobile mass just below the umbilicus. On pelvic examination, there is a moderate amount of old blood coming from the cervical os. A urine pregnancy test is negative, her last pap smear was normal and her spun HCT today is 28%. Which pharmacologic agent would potentially result in an improvement in her HCT and help to decrease uterine size?
A 14-year-old nulligravid female is brought to the ER by her parents with a 12-hour history of severe, intermittent left lower quadrant pain. She has had nausea and vomiting for the past 2 hours. On history, the patient experienced menarche at age 12 and denies past or current contact with a sexual partner. Her last normal menstrual period was 3 weeks ago. On examination, she is afebrile, pulse 100, BP 110/70, respiratory rate (RR) 20. She is visibly uncomfortable. She has no costovertebral tenderness, has diminished bowel sounds, her abdomen is nondistended, and exhibits rebound and guarding in both lower quadrants. She is unable to tolerate a pelvic examination due to pain. Laboratory values are as follows: WBC 13, HCT 39, -hCG (-), UA (-). Apelvic ultrasound shows a normal nonpregnant uterus, normal right adnexa, and an 8-cm left adnexal mass with a 3-cm solid component The most likely etiology of this patient's pain is which of the following?
A 22-year-old White female (gravida 2, para 1, abortus 1) comes to your office with a 3-week history of lower abdominal pain and increased vaginal discharge. She has a prior history of an ectopic pregnancy at age 16. Her last menstrual period (LMP) was 7 days ago, and she has had unprotected vaginal intercourse with a new sexual partner several times over the past few weeks. Her temperature is 38.0°C; her vital signs are stable. She has bilateral lower quadrant tenderness but no peritoneal signs. On speculum examination, she has foul smelling green discharge emanating from her cervix. She has cervical motion tenderness on bimanual examination and is tender in both adnexae. Her wet mount shows copious white cells. Her urine - hCG is (-). Which of the following would be the most appropriate treatment regimen for this patient?
A 22-year-old White female (gravida 2, para 1, abortus 1) comes to your office with a 3-week history of lower abdominal pain and increased vaginal discharge. She has a prior history of an ectopic pregnancy at age 16. Her last menstrual period (LMP) was 7 days ago, and she has had unprotected vaginal intercourse with a new sexual partner several times over the past few weeks. Her temperature is 38.0°C; her vital signs are stable. She has bilateral lower quadrant tenderness but no peritoneal signs. On speculum examination, she has foul smelling green discharge emanating from her cervix. She has cervical motion tenderness on bimanual examination and is tender in both adnexae. Her wet mount shows copious white cells. Her urine - hCG is (-).
A 25-year-old nulligravid female, whose LMP was 4 weeks ago, is seen by her OB/GYN for a left breast mass. The patient discovered it 2 weeks ago while in the shower. Her maternal aunt died of breast cancer at age 60, and the patient is very worried about this new finding. On examination, a mobile, nonerythematous, 3-cm nonsolid feeling mass is palpated in the left upper outer quadrant of her left breast. There is no nipple discharge, and the axillary lymph nodes are nonpalpable. Her right breast examination is normal. The patient wants you to schedule a mammogram that same day. Your response is which of the following?
A 31-year-old (gravida 1, para 1) female had a forceps-assisted vaginal delivery 3 months ago. Her infant weighed 4250 g. During the delivery she sustained a fourth degree perineal injury that was repaired. She now complains of fecal incontinence and foul vaginal discharge when her stools are loose, which happens several days a week. The most likely etiology for her fecal incontinence and foul vaginal discharge would be which of the following?
A 22-year-old female (G3P0020) presents to your office for an initial obstetric visit in her third pregnancy. She reports a sure LMP date approximately 6 weeks ago, with a history of regular cycles. Her two previous pregnancies ended in spontaneous abortions. She denies any significant medical or surgical history. She denies use of alcohol, tobacco, or illicit drugs, though she does report a history of IV drug use as a teenager. She is a full-time student. She reports that twins run in her family, but she does not have any family history of diabetes, hypertension, or congenital anomalies. On review of her prenatal labs that have already been drawn, you find that her human immunodeficiency virus (HIV) antibody test (enzyme-linked immunosorbent assay [ELISA]) is positive. Her test results are otherwise normal. Which of the following indicates how you counsel the patient?
A34-year-old Black (G1) female presents to your clinic for an obstetric visit at 16 weeks estimated gestational age (EGA). She has a sure LMP and her estimated date of delivery (EDD) is in December. She is generally healthy and has not had any surgeries. She denies history of sexually transmitted diseases or abnormal pap smears. She has no significant family history. She does not smoke or use alcohol or illicit drugs. She works as an administrative assistant. Her prenatal labs are as follows: blood type O+, antibody screen negative; hepatitis B surface antigen negative; HIV antibody negative; Rubella nonimmune; rapid plasma regain (RPR) nonreactive; pap smear within normal limits; urine culture negative. Based on her laboratory results and history, you recommend that she receive which of the following injections during her pregnancy?
A term infant is born at a small community hospital by cesarean section for failure to progress. The infant is noted to have the following abnormality at birth Which of the following is the most likely diagnosis? umbilical hernia
A 19-year-old (G2P1001) female at 354/7 weeks EGA presents for a routine prenatal visit. Her pregnancy has been uncomplicated. She reports good fetal movement and denies vaginal bleeding, loss of fluid, or contractions. She is excited about the arrival of her baby and is planning to breast-feed. Her past medical history is significant for chlamydia that was treated approximately 1 year ago. She is otherwise healthy. Her blood pressure today is 110/60. Fundal height is appropriate. UA is negative. The patient would like to discuss options for postpartum birth control. Which of the following would be an appropriate and effective option for postpartum birth control for this patient?
A 19-year-old (G2P1001) female at 354/7 weeks EGA presents for a routine prenatal visit. Her pregnancy has been uncomplicated. She reports good fetal movement and denies vaginal bleeding, loss of fluid, or contractions. She is excited about the arrival of her baby and is planning to breast-feed. Her past medical history is significant for chlamydia that was treated approximately 1 year ago. She is otherwise healthy. Her blood pressure today is 110/60. Fundal height is appropriate. UA is negative. The patient wants to know what complications she might experience from breast-feeding. You tell her that the most common complication of breast-feeding is mastitis. If she were to develop mastitis, which of the following treatments would be recommended?
A 25-year-old nulligravid woman presents as a new patient to your gynecology practice. She has recently moved to the area. She is a healthy woman with no medical problems and is currently using oral contraceptives without problems. She informs you that she and her husband are planning to start a family within the next year. On review, you find her family history is unremarkable, but she informs you that her husband's sister has cystic fibrosis. What is the approximate prevalence of cystic fibrosis carrier state in White individuals?