Gyneco (378)

100 Questions | By Chhunviseth | Last updated: Mar 20, 2022 | Total Attempts: 256

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1.

A 20-year-old female presents to your office for routine well-woman examination. She has a history of acne, for which she takes minocycline and isotretinoin on a daily basis. She also has a history of epilepsy that is well controlled on valproic acid. She also takes a combined oral contracep- tive birth control pill containing norethindrone acetate and ethinyl estra- diol. She is a nonsmoker but drinks alcohol on a daily basis. She is concerned about the effectiveness of her birth control pill, given all the medications that she takes. She is particularly worried about the effects of her medications on a developing fetus in the event of an unintended preg- nancy. Which of the following drugs has the lowest potential to cause birth defects?
- A.
  
  A. Alcohol
- B.
  
  B. Isotretinoin (Accutane)
- C.
  
  C. Tetracyclines
- D.
  
  D. Progesterone
- E.
  
  E. Valproic acid (Depakote)
2.

A patient presents for prenatal care in the second trimester. She was born outside the United States and has never had any routine vaccinations. Which of the following vaccines is contraindicated in pregnancy?
- A.
  
  A. Hepatitis A
- B.
  
  B. Tetanus
- C.
  
  C. Typhoid
- D.
  
  D. Hepatitis B
- E.
  
  E. Measles
3.

Your 25-year-old patient is pregnant at 36 weeks gestation. She has an acute urinary tract infection (UTI). Which of the following medications is contraindicated in the treatment of the UTI in this patient?
- A.
  
  A. Ampicillin
- B.
  
  B. Nitrofurantoin
- C.
  
  C. Trimethoprim/sulfamethoxazole
- D.
  
  D. Cephalexin
- E.
  
  E. Amoxicillin/clavulanate
4.

You diagnose a 21-year-old woman at 12 weeks gestation with gonorrhea cervicitis. Which of the following is the most appropriate treatment for her infection?
- A.
  
  A. Doxycycline
- B.
  
  B. Chloramphenicol
- C.
  
  C. Tetracycline
- D.
  
  D. Minocycline
- E.
  
  E. Ceftriaxone
5.

A 36-year-old G0 who has been epileptic for many years is contem- plating pregnancy. She wants to go off her phenytoin because she is con- cerned about the adverse effects that this medication may have on her unborn fetus. She has not had a seizure in the past 5 years. Which of the following is the most appropriate statement to make to the patient?
- A.
  
  A. Babies born to epileptic mothers have an increased risk of structural anomalies even in the absence of anticonvulsant medications.
- B.
  
  B. She should see her neurologist to change from phenytoin to valproic acid because valproic acid is not associated with fetal anomalies.
- C.
  
  C. She should discontinue her phenytoin because it is associated with a 1% to 2 % risk of spina bifida.
- D.
  
  D. Vitamin C supplementation reduces the risk of congenital anomalies in fetuses of epileptic women taking anticonvulsants.
- E.
  
  E. The most frequently reported congenital anomalies in fetuses of epileptic women are limb defects.
6.

At 1 year of age, a child has six deciduous teeth, which are discolored and have hypoplasia of the enamel. Match the appropriate scenario with the antibiotic most likely responsible for the clinical findings presented.
- A.
  
  A. Tetracycline
- B.
  
  B. Streptomycin
- C.
  
  C. Nitrofurantoin
- D.
  
  D. Chloramphenicol
- E.
  
  E. Sulfonamides
7.

During routine auditory testing of a 2-day-old baby, the baby failed to respond to high-pitched tones. Match the appropriate scenario with the antibiotic most likely responsible for the clinical findings presented.
- A.
  
  A. Tetracycline
- B.
  
  B. Streptomycin
- C.
  
  C. Nitrofurantoin
- D.
  
  D. Chloramphenicol
- E.
  
  E. Sulfonamides
8.

A 24-year-old primigravida with twins presents for routine ultra- sonography at 20 weeks gestation. Based on the ultrasound findings, the patient is diagnosed with dizygotic twins. Which of the following is true regarding the membranes and placentas of dizygotic twins?
- A.
  
  A. They are dichorionic and monoamniotic only if the fetuses are of the same sex.
- B.
  
  B. They are dichorionic and monoamniotic regardless of the sex of the fetuses.
- C.
  
  C. They are monochorionic and monoamniotic if they are conjoined twins.
- D.
  
  D. They are dichorionic and diamniotic regardless of the sex of the twins.
- E.
  
  E. They are monochorionic and diamniotic if they are of the same sex.
9.

After delivery of a term infant with Apgar scores of 2 at 1 minute and 7 at 5 minutes, you ask that umbilical cord blood be collected for pH. The umbilical arteries carry which of the following?
- A.
  
  A. Oxygenated blood to the placenta
- B.
  
  B. Oxygenated blood from the placenta
- C.
  
  C. Deoxygenated blood to the placenta
- D.
  
  D. Deoxygenated blood from the placenta
10.

During the routine examination of the umbilical cord and placenta after a spontaneous vaginal delivery, you notice that the baby had only one umbilical artery. Which of the following is true regarding the finding of a single umbilical artery?
- A.
  
  A. It is a very common finding and is insignificant.
- B.
  
  B. It is a rare finding in singleton pregnancies and is therefore not significant.
- C.
  
  C. It is an indicator of an increased incidence of congenital anomalies of the fetus.
- D.
  
  D. It is equally common in newborns of diabetic and nondiabetic mothers.
- E.
  
  E. It is present in 5% of all births.
11.

A 22-year-old G1P0 at 28 weeks gestation by LMP presents to labor and delivery complaining of decreased fetal movement. She has had no pre- natal care. On the fetal monitor there are no contractions. The fetal heart rate is 150 beats per minute and reactive. There are no decelerations in the fetal heart tracing. An ultrasound is performed in the radiology department and shows a 28-week fetus with normal-appearing anatomy and size con- sistent with dates. The placenta is implanted on the posterior uterine wall and its margin is well away from the cervix. A succenturiate lobe of the pla- centa is seen implanted low on the anterior wall of the uterus. Doppler flow studies indicate a blood vessel is traversing the cervix connecting the two lobes. This patient is most at risk for which of the following?
- A.
  
  A. Premature rupture of the membranes
- B.
  
  B. Fetal exsanguination after rupture of the membranes
- C.
  
  C. Torsion of the umbilical cord caused by velamentous insertion of the umbilical cord
- D.
  
  D. Amniotic fluid embolism
- E.
  
  E. Placenta accreta
12.

Healthy 34-year-old G1P0 patient comes to see you in your office for a routine OB visit at 12 weeks gestational age. She tells you that she has stopped taking her prenatal vitamins with iron supplements because they make her sick and she has trouble remembering to take a pill every day. A review of her prenatal labs reveals that her hematocrit is 39%. Which of the following statements is the best way to counsel this patient?
- A.
  
  A. Tell the patient that she does not need to take her iron supplements because her prenatal labs indicate that she is not anemic and therefore she will not absorb the iron supplied in prenatal vitamins
- B.
  
  B. Tell the patient that if she consumes a diet rich in iron, she does not need to take any iron supplements
- C.
  
  C. Tell the patient that if she fails to take her iron supplements, her fetus will be anemic
- D.
  
  D. Tell the patient that she needs to take the iron supplements even though she is not anemic in order to meet the demands of pregnancy
- E.
  
  E. Tell the patient that she needs to start retaking her iron supplements when her hemoglobin falls below 11 g/dL
13.

A pregnant patient of yours goes to the emergency room at 20 weeks gestational age with complaints of hematuria and back pain. The emer- gency room physician orders an intravenous pyelogram (IVP) as part of a workup for a possible kidney stone. The radiologist indicates the absence of nephrolithiasis but reports the presence of bilateral hydronephrosis and hydroureter, which is greater on the right side than on the left. Which of the following statements is true regarding this IVP finding?
- A.
  
  A. The bilateral hydronephrosis is of concern, and renal function tests, including BUN and creatinine, should be run and closely monitored.
- B.
  
  B. These findings are consistent with normal pregnancy and are not of concern.
- C.
  
  C. The bilateral hydronephrosis is of concern, and a renal sonogram should be ordered emergently.
- D.
  
  D. The findings indicate that a urology consult is needed to obtain recommendations for further workup and evaluation.
- E.
  
  E. The findings are consistent with ureteral obstruction, and the patient should be referred for stent placement.
14.

During a routine return OB visit, an 18-year-old G1P0 patient at 23 weeks gestational age undergoes a urinalysis. The dipstick done by the nurse indicates the presence of trace glucosuria. All other parameters of the urine test are normal. Which of the following is the most likely etiology of the increased sugar detected in the urine?
- A.
  
  A. The patient has diabetes.
- B.
  
  B. The patient has a urine infection.
- C.
  
  C. The patient’s urinalysis is consistent with normal pregnancy.
- D.
  
  D. The patient’s urine sample is contaminated.
- E.
  
  E. The patient has kidney disease.
15.

A 33-year-old G2P1 is undergoing an elective repeat cesarean section at term. The infant is delivered without any difficulties, but the placenta cannot be removed easily because a clear plane between the placenta and uterine wall cannot be identified. The placenta is removed in pieces. This is followed by uterine atony and hemorrhage. Match the descriptions with the appropriate placenta type.
- A.
  
  A. Succenturiate placenta
- B.
  
  B. Vasa previa
- C.
  
  C. Placenta previa
- D.
  
  D. Membranaceous placenta
- E.
  
  E. Placenta accreta
16.

The shortest distance between the sacral promontory and the symphysis pubis is called which of the following?
- A.
  
  A. Interspinous diameter
- B.
  
  B. True conjugate
- C.
  
  C. Diagonal conjugate
- D.
  
  D. Obstetric (OB) conjugate
- E.
  
  E. Biparietal diameter
17.

A patient presents in labor at term. Clinical pelvimetry is performed. She has an oval-shaped pelvis with the anteroposterior diameter at the pelvic inlet greater than the transverse diameter. The baby is occiput posterior. The patient most likely has what kind of pelvis?
- A.
  
  A. A gynecoid pelvis
- B.
  
  B. An android pelvis
- C.
  
  C. An anthropoid pelvis
- D.
  
  D. A platypelloid pelvis
- E.
  
  E. An androgenous pelvis
18.

On pelvic examination of a patient in labor at 34 weeks, the patient is noted to be 6 cm dilated, completely effaced with the fetal nose and mouth palpable. The chin is pointing toward the maternal left hip. This is an example of which of the following?
- A.
  
  A. Transverse lie
- B.
  
  B. Mentum transverse position
- C.
  
  C. Occiput transverse position
- D.
  
  D. Brow presentation
- E.
  
  E. Vertex presentation
19.

A patient comes to your office with her last menstrual period 4 weeks ago. She denies any symptoms such as nausea, fatigue, urinary frequency, or breast tenderness. She thinks that she may be pregnant because she has not had her period yet. She is very anxious to find out because she has a history of a previous ectopic pregnancy and wants to be sure to get early prenatal care. Which of the following actions is most appropriate at this time?
- A.
  
  A. No action is needed because the patient is asymptomatic, has not missed her period, and cannot be pregnant.
- B.
  
  B. Order a serum quantitative pregnancy test.
- C.
  
  C. Listen for fetal heart tones by Doppler equipment.
- D.
  
  D. Perform an abdominal ultrasound.
- E.
  
  E. Perform a bimanual pelvic examination to assess uterine size
20.

A patient presents for her first initial OB visit after performing a home pregnancy test and gives a last menstrual period of about 8 weeks ago. She says she is not entirely sure of her dates, however, because she has a long history of irregular menses. Which of the following is the most accurate way of dating the pregnancy?
- A.
  
  A. Determination of uterine size on pelvic examination
- B.
  
  B. Quantitative serum human chorionic gonadotropin (HCG) level
- C.
  
  C. Crown-rump length on abdominal or vaginal ultrasound
- D.
  
  D. Determination of progesterone level along with serum HCG level
- E.
  
  E. Quantification of a serum estradiol level
21.

A healthy 31-year-old G3P2002 patient presents to the obstetrician’s office at 34 weeks gestational age for a routine return visit. She has had an uneventful pregnancy to date. Her baseline blood pressures were 100 to 110/60 to70, and she has gained a total of 20 lb so far. During the visit, the patient complains of bilateral pedal edema that sometimes causes her feet to ache at the end of the day. Her urine dip indicates trace protein, and her blood pressure in the office is currently 115/75. She denies any other symptoms or complaints. On physical examination, there is pitting edema of both legs without any calf tenderness. Which of the following is the most appropriate response to the patient’s concern?
- A.
  
  A. Prescribe Lasix to relieve the painful swelling.
- B.
  
  B. Immediately send the patient to the radiology department to have venous. Doppler studies done to rule out deep vein thromboses.
- C.
  
  C. Admit the patient to L and D to rule out preeclampsia.
- D.
  
  D. Reassure the patient that this is a normal finding of pregnancy and no treatment is needed.
- E.
  
  E. Tell the patient that her leg swelling is caused by too much salt intake and instruct her to go on a low-sodium diet.
22.

A 28-year-old G1P0 presents to your office at 18 weeks gestational age for an unscheduled visit secondary to right-sided groin pain. She describes the pain as sharp and occurring with movement and exercise. She denies any change in urinary or bowel habits. She also denies any fever or chills. The application of a heating pad helps alleviate the discomfort. As her obstetrician, what should you tell this patient is the most likely etiology of this pain?
- A.
  
  A. Round ligament pain
- B.
  
  B. Appendicitis
- C.
  
  C. Preterm labor
- D.
  
  D. Kidney stone
- E.
  
  E. Urinary tract infection
23.

A 19-year-old G1P0 presents to her obstetrician’s office for a routine OB visit at 32 weeks gestation. Her pregnancy has been complicated by gestational diabetes requiring insulin for control. She has been noncompli- ant with diet and insulin therapy. She has had two prior normal ultra- sounds at 20 and 28 weeks gestation. She has no other significant past medical or surgical history. During the visit, her fundal height measures 38 cm. Which of the following is the most likely explanation for the discrepancy between the fundal height and the gestational age?
- A.
  
  A. Fetal hydrocephaly
- B.
  
  B. Uterine fibroids
- C.
  
  C. Polyhydramnios
- D.
  
  D. Breech presentation
- E.
  
  E. Undiagnosed twin gestation
24.

A 30-year-old G2P1001 patient comes to see you in the office at 37 weeks gestational age for her routine OB visit. Her first pregnancy resulted in a vagi- nal delivery of a 9-lb 8-oz baby boy after 30 minutes of pushing. On doing Leopold maneuvers during this office visit, you determine that the fetus is breech. Vaginal examination demonstrates that the cervix is 50% effaced and 1 to 2 cm dilated. The presenting breech is high out of the pelvis. The esti- mated fetal weight is about 7 lb. The patient denies having any contractions. You send the patient for a sonogram, which confirms a fetus with a double footling breech presentation. There is a normal amount of amniotic fluid present and the head is hyperextended in the “stargazer” position. Which of the following is the best next step in the management of this patient?
- A.
  
  A. Allow the patient to undergo a vaginal breech delivery whenever she goes into labor.
- B.
  
  B. Send the patient to labor and delivery immediately for an emergent cesarean section.
- C.
  
  C. Schedule a cesarean section at or after 41 weeks gestational age.
- D.
  
  D. Schedule an external cephalic version in the next few days.
- E.
  
  E. Allow the patient to go into labor and do an external cephalic version at that time if the fetus is still in the double footling breech presentation.
25.

A 29-year-old G1P0 presents to the obstetrician’s office at 41 weeks gestation. On physical examination, her cervix is 1 centimeter dilated, 0% effaced, firm, and posterior in position. The vertex is presenting at –3 station. Which of the following is the best next step in the management of this patient?
- A.
  
  A. Send the patient to the hospital for induction of labor since she has a favorable Bishop score.
- B.
  
  B. Teach the patient to measure fetal kick counts and deliver her if at any time there are less than 20 perceived fetal movements in 3 hours.
- C.
  
  C. Order BPP testing for the same or next day.
- D.
  
  D. Schedule the patient for induction of labor at 43 weeks gestation.
- E.
  
  E. Schedule cesarean delivery for the following day since it is unlikely that the patient will go into labor.