Ob/Gyn MCQ

Ob/Gyn MCQ

26.A 19-year-old primigravid woman at 42 weeks' gestation comes the labor and delivery ward for induction of labor. Her prenatal course was uncomplicated. Examination shows her cervix to be long, thick, closed, and posterior. The fetal heart rate is in the 140s and reactive. The fetus is vertex on ultrasound. Prostaglandin (PGE2) gel is placed intravaginally. One hour later, the patient begins having contractions lasting longer than 2 minutes. The fetal heart rate falls to the 70s. Which of the following is the most appropriate next step in management?

a)Administer general anesthesia
b)Administer terbutaline
c)Perform amnioinfusion
d)Start oxytocin
e) Perform cesarean delivery
______
27. A 25-year-old primigravid woman comes to the physician for her first prenatal visit. Her last menstrual period was 7 weeks ago. She has had some nausea and vomiting but otherwise has no complaints. Past medical and surgical history are unremarkable. Her family history is significant for cystic fibrosis with an affected aunt. Her husband has an affected cousin. Physical examination is unremarkable. Given her family history, she is concerned about the risks of having a child with cystic fibrosis. She inquires about cystic fibrosis screening. Which of the following is the appropriate response?

a)Screening is available
b)Screening is inappropriate in her case
c)Screening is mandatory
d)Screening is not available
e)Screening is unnecessary: she has a 1 in 4 chance of having an affected child
______

28. A 52-year-old woman comes to the physician because of hot flashes. Her last menstrual period was 1 year ago. Over the past year, she has noted a persistence of her hot flashes, which come several times each day and are associated with a feeling of heat and flushing. They also awaken her at night and interfere with her sleep. She has no medical problems, takes no medications, and has no known drug allergies. She has a family history of cardiovascular disease and she does not smoke. Physical examination is unremarkable. She is started on estrogen and medroxyprogesterone acetate (Provera). The addition of a progestin is most likely to decrease her risk of which of the following?

a)Breast cancer
b)Breast pain
c)Endometrial cancer
d)Mood changes
e)Weight gain
______

29.A 21-year-old woman comes to the physician because of "bumps" on her vulva that she has just recently noticed. These bumps do not cause her symptoms, but she wants to know what they are and wants them removed. She has no medical problems, takes no medications, and has no allergies to medications. She smokes one-half pack of cigarettes per day. She is sexually active with 3 partners. Examination shows 3 cauliflower-like lesions on the right labia majora. Which of the following is the most appropriate next step in management?

a)Acyclovir
b)Penicillin
c)Cone biopsy
d)Cryotherapy
e)Vulvectomy
______

30.A 29-year-old patient comes to the physician for an annual examination. She has normal menstrual periods every 30 days. She was 15 years old when she first began having intercourse. She uses condoms for contraception. Her past medical history is significant for multiple sclerosis. This condition has required her to use a wheelchair for the past 4 years, which makes pelvic examination somewhat difficult for her. She smokes one pack of cigarettes per day. Given her difficulty with the pelvic examination, she inquires as to how often she needs to have a Pap smear performed. Which of the following is the correct answer?

a)A Pap smear should be performed every year
b)A Pap smear should be performed every 3 years
c) A Pap smear should be performed every 5 years
d)A Pap smear should be performed only if there are symptoms
e) A Pap smear is not necessary
______
31.A 33-year-old woman comes to the physician for her first prenatal visit. Her last menstrual period was 7 weeks ago. She has had no bleeding or abdominal pain. She has no medical problems and takes no medications. She has no family history of congenital anomalies. Her husband is 55 years old. He is in good health and also has no family history of birth defects. The patient is concerned that her husband's age may place their fetus at increased risk of a chromosomal anomaly. She wishes to know the paternal age above which amniocentesis or chorionic villus sampling should be considered. Which of the following is the correct response?

a) Above age 30
b)Above age 35
c)Above age 40
d) Above age 45
e)There is no age cutoff for paternal risk
______
32.A 14-year-old girl comes to the physician for an annual examination. She has no complaints. She became sexually active during the past year and uses condoms occasionally for contraception. She has asthma, for which she occasionally takes an albuterol inhaler. She had an appendectomy at age 9. Physical examination is unremarkable including a normal pelvic examination. When should this patient begin having Pap testing?

a)Immediately
b)Age 16
c) Age 18
d) Age 20
e) Age 21
______

33.A 25-year-old nulliparous woman at 35 weeks' gestation comes to the labor and delivery ward complaining of contractions, a headache, and flashes of light in front of her eyes. Her pregnancy has been uncomplicated except for an episode of first trimester bleeding that completely resolved. She has no medical problems.
Her temperature is 37 C (98.6 F),
blood pressure is 160/110 mm Hg,
pulse is 88/minute,
and respirations are 12/minute. Examination shows that her cervix is 2 centimeters dilated and 75% effaced, and that she is contracting every 2 minutes.
The fetal heart tracing is in the 140s and reactive.
Urinalysis shows 3+ proteinuria.
Laboratory values are as follows:
leukocytes 9,400/mm3,
hematocrit 35%,
platelets 101,000/mm3. Aspartate aminotransferase (AST) is 200 U/L,
and ALT 300 U/L. Which of the following is the most appropriate next step in management?

a)Administer oxytocin
b)Discharge the patient
c)Encourage ambulation
d)Start magnesium sulfate
e)Start terbutaline
______
34.A 33-year-old primigravid woman at 18 weeks' gestation comes to the physician for a prenatal visit. Her prenatal course has been uncomplicated thus far. She has no complaints. She has had no loss of fluid, bleeding, or contractions. She has hypothyroidism, for which she takes thyroid hormone replacement. The patient states that a friend of hers recently had a preterm delivery. The patient is quite concerned about preterm delivery and wants to know whether home uterine activity monitoring (HUAM) is recommended. Which of the following is the most appropriate response?

a) HUAM has been proven to cause preterm birth
b)HUAM has been proven to prevent preterm birth
c)HUAM has not been proven to prevent preterm birth
d)HUAM should be started immediately
e) HUAM should be started at 35 weeks
______
35. A 32-year-old nulliparous woman at 38 weeks' gestation comes to the labor and delivery ward with regular painful contractions after a gush of fluid two hours ago. Her temperature is 98.6 F (37 C). She is found to have gross rupture of membranes and to have a cervix that is 6 centimeters dilated. The fetus is in breech position. The patient is then brought to the operating room for cesarean delivery. Which of the following represents the correct procedure for antibiotic administration?

a) Administer intravenous antibiotics 30 minutes prior to the procedure
b)Administer intravenous antibiotics after the cord is clamped
c) Administer intravenous antibiotics immediately after the procedure
d)Administer intravenous antibiotics for 24 hours after the procedure
e)Administer oral antibiotics for 1 week following the procedure.
______
36. A previously healthy 21-year-old woman has a profuse, malodorous vaginal discharge. Examination shows a greenish gray "frothy" discharge with a "fishy" odor and petechial lesions on the cervix. There is no cervical motion tenderness. Her temperature is 37.5 C (99.4 F), blood pressure is 120/80 mm Hg, pulse is 60/min, and respirations are 16/min. Microscopic evaluation of the discharge is most likely to show which of the following?

a) "Clue cells"
b)Gram-negative diplococci
c)Gram-positive diplococci
d)Motile, flagellated organisms
e)Pseudohyphae or hyphae
______
37.A 21-year-old primigravid woman at 39 weeks' gestation comes to the labor and delivery ward with painful contractions every three minutes. Her prenatal course was unremarkable. Examination shows her cervix to be 3 centimeters dilated and 90% effaced. The fetal heart rate tracing is in the 150s and reactive. 5 hours later cervical examination reveals that the patient is 9 centimeters dilated and at -1 station. The fetal heart rate tracing shows moderate variable decelerations with each contraction and decreased variability. Fetal scalp sampling is performed that yields fetal scalp pHs of 7.04, 7.05, and 7.06. Which of the following is the most appropriate next step in management?

a)Expectant management
b)Episiotomy
c)Forceps-assisted vaginal delivery
d)Vacuum-assisted vaginal delivery
e) Cesarean delivery
______
38.A 31-year-old, HIV-positive woman, gravida 3, para 2, at 32-weeks' gestation comes to the physician for a prenatal visit. Her prenatal course is significant for the fact that she has taken zidovudine throughout the pregnancy. Otherwise, her prenatal course has been unremarkable. She has no history of mental illness. She states that she has been weighing the benefits and risks of cesarean delivery in preventing transmission of the virus to her baby. After much deliberation, she has decided that she does not want a cesarean delivery and would like to attempt a vaginal delivery. Which of the following is the most appropriate next step in management?

a)Contact psychiatry to evaluate the patient
b)Contact the hospital lawyers to get a court order for cesarean delivery
c)Perform cesarean delivery at 38 weeks
d) Perform cesarean delivery once the patient is in labor
e) Respect the patient's decision and perform the vaginal delivery
______
39. A 26-year-old nulligravid woman comes to the emergency department because of severe right lower quadrant pain. She states that the pain started last night. This morning she was awakened from sleep with severe pain in the same area. During the episode of pain she also had nausea, vomiting, and diaphoresis. On admission to the emergency department she required 5 mg of morphine to control her pain. Examination is significant for right lower quadrant tenderness and a tender right adnexal mass on pelvic examination. Urine hCG is negative. Urinalysis is negative. Transvaginal ultrasound reveals an 8 cm right ovarian mass. Which of the following is the most likely diagnosis?

a)Appendicitis
b)Ectopic pregnancy
c)Nephrolithiasis
d)Ovarian torsion
e)Pelvic inflammatory disease
______
40.An 18-year-old woman comes to the physician for advice regarding birth control. She has been sexually active since the age of 15 and has had numerous sexual partners since that time. She has tried the oral contraceptive pill twice, for approximately two cycles each time, but stopped because of irregular bleeding. She has had gonorrhea once and Chlamydia twice. She does not smoke. Physical examination is unremarkable. Which of the following forms of birth control should be recommended for this patient?

a)Condoms
b)Diaphragm
c)Intrauterine device
d)Oral contraceptive pill
e)Tubal ligation
______
41. A 44-year-old woman, gravida 4, para 3, at 8 weeks' gestation comes to the physician for her first prenatal visit. She has mild nausea and vomiting but no other complaints. Her obstetric history is significant for three full-term, normal vaginal deliveries of normal infants. She has no medical or surgical history and takes no medications. Physical examination reveals an 8-week-sized uterus, but is otherwise unremarkable. She wishes to have chromosomal testing of the fetus and wants to have chorionic villus sampling performed, as she did with her last pregnancy. Compared with amniocentesis, chorionic villus sampling may place the patient at greater risk for which of the following?

a)Fetal Down syndrome
b)Fetal limb defects
c)Fetal neural tube defects
d)Maternal sepsis
e)Mid-second-trimester abortion
______
42.A pharmaceutical company sponsors a physician lecture concerning thrombotic complications of the oral contraceptive pill (OCP). At the start of the presentation, the company's representative makes a short presentation regarding their particular brand of OCP. He then proceeds to announce that his company would like to award a gift to the physician in the group who gives the largest number of prescriptions for this pill. Which of the following is the most appropriate action?

a) Acceptance of the gift
b)Attempt to get colleagues to prescribe the medication
c)Promise to prescribe more of the medication
d)Refusal of the gift
e) Request for money rather than a gift
______
43. A 24-year old woman comes to the physician because of burning with urination. She states that every time she urinates there is pain and that she has a feeling that she constantly needs to urinate even though only a little comes out. She has never had any similar symptoms before. She has no medical problems and no known drug allergies. Examination is unremarkable. Urinalysis demonstrates that the urine is positive for leukocyte esterase and nitrites. Which of the following is the most appropriate pharmacotherapy?

a)Intramuscular ceftriaxone
b)Intravenous levofloxacin
c)Oral levofloxacin for 7 days
d)Oral trimethoprim-sulfamethoxazole for 3 days
e) Wait for the culture results to institute therapy
______
44. A 21-year-old woman comes to the physician because of abdominal pain. She states that the pain is in her right lower quadrant and has been getting worse over the past 3 months. She has no other symptoms and a normal appetite. Examination demonstrates mild right lower quadrant abdominal tenderness. Pelvic examination reveals mild right adnexal enlargement and tenderness. Urine human chorionic gonadotropin (hCG) is negative. A pelvic ultrasound is obtained that shows a 4-centimeter, heterogeneous hyperechoic lesion in the right adnexa with cystic areas. On transvaginal ultrasound, hair and calcifications are demonstrated within the cystic areas. Which of the following is the most likely diagnosis?

a)Appendicitis
b)Benign cystic teratoma (dermoid)
c)Corpus luteum cyst
d)Ectopic pregnancy
e)Tubo-ovarian abscess
______
45.A 65-year-old woman comes to the physician because of bleeding from the vagina. She states that her last menstrual period was at age 50 and that she has had no bleeding since. She has no medical problems and takes no medications. She is not sexually active. Examination is unremarkable, including a normal pelvic examination. After informed consent is obtained, an endometrial biopsy is performed. The patient complains of discomfort during and after the procedure but feels well enough to go home. Later that night, with her abdominal pain worsening, the patient comes to the emergency department. An ultrasound is performed that shows a normal uterus and adnexae but a complex fluid collection posterior to the uterus. Which of the following is the most likely diagnosis?

a) Bowel perforation
b)Endometritis
c)Endometrial cancer
d)Tuboovarian abscess
e)Uterine perforation
______
46.A 23-year-old female comes to the physician because of a swelling in her vagina. She states that the swelling started about 3 days ago and has been growing larger since. The swelling is not painful, but it is uncomfortable when she jogs. She has asthma for which she uses an albuterol inhaler, but no other medical problems. Examination shows a cystic mass 4 cm in diameter near the hymen by the patient's left labia minora. The mass is nontender and there is no associated erythema. The mass is freely mobile. The rest of the pelvic examination is unremarkable. Which of the following is the most likely diagnosis?

a)Bartholin's cyst
b)Condyloma lata
c)Granuloma inguinale
d)Hematocolpos
e)Vulvar cancer
______
47. A 37-year-old woman, gravida 3, para 2, comes to her physician for follow-up on her ectopic pregnancy. She was diagnosed with an ectopic pregnancy 7 days ago and given methotrexate. She now presents with abdominal pain that started this morning. Examination is significant for moderate left lower quadrant tenderness. Laboratory analysis shows that her beta-hCG value has doubled over the past week. Transvaginal ultrasound shows that the ectopic pregnancy is roughly the same size but there is an increased amount of fluid in the pelvis. Which of the following is the most appropriate next step in management?

a)Expectant management
b)Repeat methotrexate
c)Laparoscopy
d)Oophorectomy
e)Hysterectomy
______
48. A 26-year-old woman comes to the physician because of a lump in her vagina. The lump is nontender but is uncomfortable when she walks. She states that for the last 6 years this lump has appeared about once a year. When it occurs she goes to the doctor who puts a catheter into it, which is taken out in a few weeks. She has no other medical problems. She is sexually active with two partners. Examination shows a cystic mass approximately 4 cm in diameter on the right side of the vagina near the hymeneal ring. The mass feels like a discrete cyst. The rest of the pelvic examination is unremarkable. Which of the following is the most appropriate next step in management?
a)Expectant management
b)Oral antibiotics
c)Intravenous antibiotics
d)Incision and drainage
e) Bartholin's cyst marsupialization
______
49.A 25-year-old woman, gravida 2, para 2 is 4 days status post cesarean section and develops a temperature to 100.7 F (38.2 C). She had her cesarean section when she went into unstoppable preterm labor with a breech fetus. She had an uncomplicated postoperative course until this temperature elevation. Her pulse is 100/min, blood pressure is 110/70 mm Hg, and respirations are 16/min. There is discoloration and cyanosis around the incision. The area around the incision is completely numb. There is no uterine tenderness on bimanual exam. Which of the following is of the most concern in this patient?