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EOR 119 exam Women's health
A 40 year-old female presents with a 1.5 cm well-circumscribed mass noted on mammography in the right upper, outer quadrant. Which of the following procedures is most appropriate and should be done next? A. Fine needle aspiration B. BRCA 1 and BRCA 2 genetic testing C. Serum CA- D. Radiation therapy - ✔ ✔ (c) A. Fine needle aspiration is fairly accurate, easily performed, and has minimal morbidity. (u) B. Although BRCA 1 and BRCA 2 genetic tests are used in the risk assessment for possible breast and ovarian cancer, it would not replace the need to perform a more definitive evaluation of an identified breast mass. (u) C. Serum CA-125 is a tumor marker for ovarian, not breast, cancer. (u) D. Radiation therapy is only indicated after a diagnosis of breast cancer is proven and may be used as adjunctive therapy. A 40 year-old female presents with a Pap smear abnormality revealing atypical glandular cells (AGUS). What is the most appropriate intervention? A. HPV DNA testing B. Colposcopy with endometrial curretage(ECC) C. Repeat Pap smear in 3 months
D. Colposcopy and endometrial sampling - ✔ ✔ (u) A. HPV DNA testing is recommended to further evaluate patients with Pap smears with dysplasia. (u) B. Colposcopy with ECC would be recommended in patients with ASCUS, LGSIL, HGSIL, or squamous cell findings on a Pap smear. (u) C. Repeat Pap smear would be recommended in patients with ASCUS, not AGUS, results on a Pap smear. (c) D. Colposcopy and endometrial sampling are important to perform in patients with AGUS Pap results because glandular cells are associated with squamous and glandular precursor lesions and carcinoma.
. A 21 year-old obese woman complains of menstrual irregularity since menarche at age 17. She is 5'5" and weighs 180 pounds. Exam of her face reveals excessive hair growth as well as acne. Her abdomen shows midline hair growth and truncal obesity. A previous pelvic ultrasound shows many small fluid filled ovarian cysts bilaterally. Which of the following is the most appropriate diagnostic study to make the initial diagnosis in this patient? A. Prolactin level B. Endometrial biopsy C. Free testosterone D. Thyroid stimulating hormone - ✔ ✔ (u) A. Prolactin level will not be elevated in a patient with polycystic ovarian syndrome. (u) B. Endometrial hyperplasia occurs secondary to anovulation, endometrial biopsy is mandatory for follow-up
Colposcopic examination of the cervix of a 38 year-old woman with a high- grade lesion on Papanicolaou (Pap) smear yields a positive endocervical canal curettage (ECC) as its only abnormality. Which of the following is the most appropriate next step in this patient? A. Repeat the Pap smear in 3 months B. Perform a conization of the cervix C. Repeat the colposcopic examination in 3 months D. No follow-up is required - ✔ ✔ B. A conization of the cervix is recommended in this case because there is a substantial discrepancy between the screening Pap test and the histologic data from biopsy and ECC. Additionally the ECC is positive for disease in this case. Dysmenorrhea would most likely occur in which of the following patients? A. A young teenager who just started having her menses B. A woman on birth control pills C. A marathon runner with one menses per year D. A 35 year-old woman with regular cycles - ✔ ✔ (u) A. Young teenagers who have just started their menses are unlikely to have dysmenorrhea, because they usually are anovulatory for up to one year. (u) B. Women on birth control pills do not have dysmenorrhea because they do not ovulate on oral contraceptives and OCPs are used to treat dysmenorrhea.
(u) C. Marathon runners are often amenorrheic or have oligoamenorrhea. They do not have dysmenorrhea because dysmenorrhea is a function of ovulatory cycles. CORRECT: D. Women with regular menstrual cycles are most likely to have dysmenorrhea. Dysmenorrhea is caused by a excess of prostaglandin F 2 alpha. Prostaglandin production increases under the influence of progesterone, reaching a peak at, or soon after, the start of menstruation.
. A 29 year-old female has been diagnosed with infertility due to anovulation. Her provider suggests using a medication that will block the feedback inhibition of estradiol on the hypothalamus and pituitary leading to an increase in FSH. 3+ proteinuria. Fetal heart tones are 150. What is your next step in the care of this patient? A. Admit to hospital and prepare for delivery B. Admit to hospital with antepartum fetal surveillance and close monitoring of maternal conditions C. Order bed rest at home with daily fetal movement counts and twice weekly antepartum care D. Order bed rest at home with administration of prophylactic magnesium sulfate - ✔ ✔ (c) A. Severe preeclampsia mandates hospitalization. Delivery is indicated if gestational age is 34 weeks or greater. (u) B. Antepartum fetal surveillance and close monitoring in hospital is appropriate for pregnant female with
(c) C. This patient most likely has primary dysmenorrhea supported by onset of pain within 1-2 years after onset of menarche and characteristic symptoms of low, mid-abdominal, spasmodic cramping pain that radiates to the back or inner thighs beginning on the first or second day of menstruation. Pelvic examination fails to reveal any pathological findings. (u) D. Premenstrual syndrome is seen primarily in females that are 25-40 years old. Associated physical and emotional symptoms appear 7-14 days before the onset of menses and resolve once menstruation begins. A 16 year-old female G1P0Ab0 is 30 weeks pregnant. Her last two monthly prenatal exams have shown a trace to 1 plus proteinuria. The patient denies any previous history of hypertension, seizures, headache, visual disturbances or spotting. On examination, blood pressure is 150/98. The fundal height is 32 cm, the uterus is soft and nontender and fetal heart tones are 160 bpm. DTRs are 4 plus out of 4 plus in the upper and lower extremities, and there is moderate pedal edema bilaterally. The skin examination is unremarkable. Based upon these findings what is the most likely diagnosis? A. Eclampsia B. Pre-eclampsia C. Gestational hypertension D. HELLP Syndrome - ✔ ✔ (u) A. Eclampsia is the occurrence of seizures in a pre-eclamptic patient.
CORRECT: B. Pre-eclampsia is the hypertension associated with proteinuria. This occurs in greater frequency in nulliparous, adolescent and black women. (u) C. Gestational hypertension is hypertension that continues after pre- eclampsia for 12 weeks post-partum then returns to normal. If hypertension continues after 12 weeks then the patient is said to have chronic hypertension and is often predictive of later development of essential hypertension. (u) D. HELLP syndrome is a subcategory of pre-eclampsia in which the patient develops hemolytic anemia, elevated liver enzymes and low platelets. A 16 year-old G0P0 patient presents complaining of lower pelvic pain that alternates from right to left side of her pelvis. She states that it is related to her cycle and occurs most commonly midcycle. She denies sexual activity. She reports that she has taken ibuprofen at the time of the discomfort with some relief. Her pelvic examination is unremarkable. Which of the following is the most likely diagnosis? A. Endometriosis B. Mittelschmerz C. Functional ovarian cyst D. Pelvic inflammatory disease - ✔ ✔ Explanations (u) A. With endometriosis, the uterus is often fixed and retroflexed in the pelvis. The palpable mass is an
self-breast exams and any family history of breast or gynecologic cancers. On palpation of her left breast, a solitary 1 cm rubbery, firm, well-circumscribed, non-tender breast mass is noted. In review of her records, similar findings were noted on last year's examination. Which of the following is the most likely diagnosis? A. fibroadenoma B. breast fat necrosis C. fibrocystic changes D. intraductal papilloma - ✔ ✔ CORRECT: A. Fibroadenoma of the breast most commonly is seen in young females. Typical characteristics include a solitary 1-3 cm firm, painless, freely movable mass that does not change with the menstrual cycle and are slow growing. Most are found as an incidental finding on physical examination or during self- breast examination. (u) B. Fat necrosis of the breast is rare. It is thought to result from trauma to the breast and occasionally is accompanied by ecchymosis. If left untreated, the mass eventually disappears. (u) C. Fibrocystic changes in the breast are most common in females between 30-50 years of age. The disorder is characterized by painful, often multiple and usually bilateral masses that are associated with increased pain and size of breast mass premenstrually. (u) D. Intraductal papillomas are usually non-palpable. The patient presents with complaints of spontaneous onset of
bloody, serous, or cloudy nipple discharge. A 22 year-old G1P0 female presents at 12 weeks gestation with 24 hours of vaginal bleeding. She complains of continued cramping and bleeding requiring pad change every two hours. Vital signs are normal. Vaginal examination shows bleeding with a dilated cervix. Which of the following is the most likely diagnosis? A. Threatened abortion B. Inevitable abortion C. Incomplete abortion D. Complete abortion - ✔ ✔ (u) A. Threatened abortion (AB) implies the cervix remains closed with only slight bleeding. (c) B. Abortion is inevitable when cervical effacement, dilatation and rupture of membranes is noted. (u) C. Incomplete AB implies the products of conception have partially passed causing continued bleeding, more common after 10 weeks. (u) D. Complete AB is identified by passage of the entire conceptus A 23 year-old female is in active labor and has progressed from 3 cm to 6 cm in the last six hours. Fetal monitoring demonstrates mild repetitive late decelerations. Which of the following is the most likely cause of this finding? A. Fetal hypoxia B. Head compression C. Cord compression
will reduce the duration of viral shedding and shorten the duration of symptoms. (u) B. Metronidazole is the treatment of choice for Trichomonas vaginitis. (u) C. Ceftriaxone is one of the options to treat uncomplicated gonorrhea or is used as part of the treatment regimen for pelvic inflammatory disease. (u) D. Benzathine penicillin G is the treatment of choice for a patient with syphilis. A 24 year-old sexually active woman presents to the clinic complaining of dysmenorrhea, dyspareunia and backache that occurs premenstrually. Pelvic examination shows pain upon uterine motion and uterosacral nodularity in the posterior vaginal fornix. The definitive diagnosis for this patient requires which of the following? A. Pelvic ultrasound B. CT of the abdomen C. Laparoscopy with biopsy D. CA-125 test - ✔ ✔ (u) A. Pelvic ultrasound has little value in diagnosing endometriosis. (u) B. CT of the abdomen has little value in diagnosing endometriosis. (c) C. Diagnosis of endometriosis must be made by direct visualization. Laparoscopy with biopsy is the most appropriate diagnostic study in this patient. (u) D. CA-125 may be elevated in endometriosis, but it is not diagnostic A 25 year-old female presents for a routine gynecological examination. You palpate a 2 cm breast mass in her right
breast. Her menstrual period was last week. She has no family history of breast cancer. What is the modality of choice to further evaluate her breast mass? A. Magnetic resonance imaging (MRI) B. Excisional biopsy C. Ultrasound D. Mammography - ✔ ✔ (u) A. MRI's of the breast are done in patients with prior breast cancer or who have BRCA 1 or 2 positivity. (u) B. Excisional biopsy is not indicated without differentiation of lesion by ultrasound. CORRECT: C. In a 25 year-old an ultrasound is the best choice because of the density of the breast tissue in young women. (u) D. Mammographies are not recommended in women prior to the age of 35 without family history of breast cancer or BRCA positive. A 25 year-old female presents with constant premenstrual pelvic pain. She also notes dysmenorrhea and dyspareunia. Which of the following is the most likely diagnosis? A. Uterine leiomyoma B. Endometrial polyps C. Ovarian cysts D. Endometriosis - ✔ ✔ (u) A. Leiomyomas of the uterus may present with abnormal uterine bleeding, but typically do not present with any symptoms.
are found. Which of the following is the most likely diagnosis? A. Threatened abortion B. Inevitable abortion C. Incomplete abortion D. Complete abortion - ✔ ✔ (u) A. Threatened abortion is characterized by bleeding in the first trimester without loss of fluid or tissue. CORRECT: B. Inevitable abortion is the gross rupture of membranes in the presence of cervical dilation. (u) C. Incomplete abortion is when the cervical os is open and allows passage of blood. The products of conception may remain in utero or may partially extrude through the open os. (u) D. Complete abortion refers to a documented pregnancy that spontaneously passes all of the products of conception. A 25 year-old G2P2 married female presents to the clinic for birth control counseling. Her past history includes deep vein thrombosis with her last pregnancy. She does not want another pregnancy for at least 4 years. The birth control method that would be best for this patient is which of the following? A. Vaginal ring B. Transdermal patch C. Combined oral contraceptive pill D. Levonorgestrel releasing IUD - ✔ ✔ u) A. The risk of venous thromboembolism with combined hormone in ring is similar to the oral contraceptive pill
(OCP).
(u) B. The risk of venous thromboembolism with combined hormone in patch is similar to OCP. (u) C. The use of oral OCPs triples a user's risk of venous thromboembolism. (c) D. IUD releases potent progestin only; is not a combination contraceptive. A 25 year-old presents with pelvic pain and uterine bleeding. Her Beta-HCG was 1200 mIU/L six days ago. Her current Beta-HCG is 1600 mIU/L. What is the next best test in the evaluation of this patient? A. Laparoscopy B. Culdocentesis C. Dilation and curettage D. Transvaginal ultrasound - ✔ ✔ (u) A. The use of laparoscopy in the diagnosis of an ectopic pregnancy has decreased, but is still useful when a definitive diagnosis is difficult. (u) B. Culdocentesis is used in the diagnosis of intraperitoneal bleeding, which may or may not be present in an ectopic pregnancy. (u) C. Dilation and curettage may confirm or exclude intrauterine pregnancy but is not the next best test in the evaluation of ectopic pregnancy. (c) D. Transvaginal ultrasound is the best test to separate ectopic from intrauterine pregnancy. A 26 year-old gravida 0 sexually active female presents to the emergency room complaining of colicky pain in her lower abdomen for the past 12 hours. She passed out earlier in the day while trying to have a bowel movement. Her
evaluations are unremarkable. Which of the following is the most appropriate diagnostic test to order at this time? A. VDRL B. amniocentesis C. maternal serum alpha-fetoprotein D. 1-hour post-Glucola blood glucose - ✔ ✔ (u) A. A serological test for syphilis, usually the VDRL, is part of the routine obstetrical tests ordered at a patient's initial prenatal visit. (u) B. Genetic testing should be offered routinely to patients over the age of 35. Amniocentesis is usually performed routinely at 16-18 weeks gestation if indicated. (u) C. Maternal serum alpha-fetoprotein testing is routinely done between 15- 18 weeks gestation to screen for neural tube defects. CORRECT D. Glucose screening, usually with a 1-hour Glucola, is routinely performed between 24-28 weeks gestation to evaluate for glucose intolerance. A 30 year-old female presents to the emergency department with a syncopal episode. She has a history of irregular menstrual cycles and infertility. She has scanty, persistent vaginal bleeding and sharp pelvic pain. A left adnexal mass is palpated. The most likely diagnosis is A. placenta abruptio. B. ectopic pregnancy. C. pelvic inflammatory disease.
D. ruptured ovarian cyst. - ✔ ✔ (u) A. This is primarily a third trimester cause of vaginal bleeding. (c) B. Infertility increases the risk of developing ectopic pregnancy. The onset of vaginal bleeding, pelvic pain, and formation of an adnexal mass makes this the most likely diagnosis. (u) C. Pelvic inflammatory disease typically presents with fever, abdominal pain, purulent vaginal discharge, and cervical motion tenderness. (u) D. Acute pelvic pain may occur secondary to bleeding from the rupture of a hemorrhagic ovarian cyst, but no adnexal mass would be palpable on pelvic examination. A 30 year-old female presents to the emergency room having passed out at home 30 minutes prior to arrival. Her last menstrual period was 6 weeks ago and pregnancy test was reported positive 5 days ago. She started having vaginal bleeding last night. Vital signs are BP 70/40 mmHg, P 140 bpm, R 22. She is pale and diaphoretic. The next step in the evaluation of this patient's condition should be which of the following? A. Abdominal ultrasound B. Culdocentesis C. Laparotomy D. Magnetic resonance imaging - ✔ ✔ (u) A. Abdominal ultrasound is not the test of choice in this patient. (u) B. Culdocentesis has been replaced by transvaginal ultrasound as diagnostic procedure for suspected ectopic pregnancy.
