Obstetrics and Gynecology Test

Question 1

A 57-year-old woman comes to the physician 1 week after noticing a mass in her left breast during breast self-examination.
Menopause occurred 6 months ago.
She was receiving estrogen therapy but discontinued it 6 weeks ago; she has had no menopausal symptoms.
There is no family history of breast cancer.
Examination shows a 2-cm, palpable, nontender, mobile mass in the upper outer quadrant of the left breast; no nipple discharge can be expressed.
Examination of the right breast shows no abnormalities.
Which of the following is the most appropriate next step in management?

Accepted Answer

Mammography

Answer

Reexamination in 3 months

Answer

CT scan of the chest

Answer

Ductal lavage

Answer

Mastectomy

Question 2

A 27-year-old nulligravid woman has had severe pain with menses that has caused her to miss at least 2 days of work during each menstrual cycle for the past year. She has occasional pain during sexual intercourse. She weighs 50 kg (110 lb) and is 160 cm (5 ft 3 in) tall; BMI is 20 kg/m2. Pelvic examination shows a normal-appearing vulva and vagina. The cervix is pink with minimal endocervical gland eversion. The uterus is normal in size. The left ovary is 2 × 3 cm; the right is 4 × 6 cm. Which of the following is the most likely cause of her condition?

Accepted Answer

Endometriosis

Answer

Chronic appendiciti

Answer

Pelvic congestion syndrome

Answer

Polycystic ovarian syndrome

Answer

Premenstrual syndrome

Question 3

A 22-year-old woman comes to the physician because of a 2-day history of pain with urination, intense vaginal itching, and a thick discharge. She has no history of serious illness. She is sexually active and uses an oral contraceptive. Her temperature is 37°C (98.6°F). Abdominal examination shows no abnormalities. Genitourinary examination shows erythema of the vulva and vagina with an odorless curd-like discharge. The cervix appears normal. Bimanual examination shows no abnormalities. The pH of the vaginal discharge is 4. Wet mount preparations of the discharge with saline and with KOH are obtained. The saline slide shows mature squamous epithelial cells, and the KOH slide shows multiple budding yeasts with pseudohyphae. Which of the following is the most likely diagnosis?

Accepted Answer

Candidiasis

Answer

Bacterial vaginosis

Answer

Chlamydia trachomatis infection

Answer

Lichen sclerosus

Answer

Scabies

Answer

Trichomoniasis

Question 4

A 27-year-old nulligravid woman and her husband have been unable to conceive for 12 months. She has never used contraception. Menses occur at 28-day intervals, and her last menstrual period was 2 weeks ago. She had a single episode of pelvic inflammatory disease 4 years ago and was treated with oral antibiotics. Vaginal examination shows no abnormalities. Cervical cultures are normal. Which of the following is the most appropriate next step in diagnosis?

Accepted Answer

Hysterosalpingography

Answer

Reevaluation in 6 months

Answer

Ultrasonography of the abdomen

Answer

Sperm penetration assay

Answer

Endometrial biopsy

Question 5

A 30-year-old woman, gravida 2, para 1, comes for her first prenatal visit at 26 weeks’ gestation. Uterine size is greater than expected for dates. Ultrasonography shows fetal hydrops. Which of the following is the most appropriate next step in diagnosis?

Accepted Answer

Maternal Rh status with antibody screening

Answer

Maternal HIV antibody test

Answer

Cervical and urine cultures for group B streptococcus

Answer

MRI of the fetus

Answer

Amniocentesis for measurement of α-fetoprotein concentration

Question 6

A 42-year-old woman, gravida 2, para 2, comes to the physician because of increasingly frequent loss of urine during the past year. She has loss of urine when she coughs, sneezes, exercises, or plays with her children. Her incontinence is never preceded by a sudden urge to void, and she does not have loss of urine at night. Her children were born after uncomplicated vaginal deliveries. She has no history of other hospital admissions or serious illness. She takes no medications. Abdominal examination shows no abnormalities. The external genitalia, vagina, and cervix appear normal. The uterus and adnexa are normal to palpation. There is loss of a small amount of urine with Valsalva maneuver. Her postvoid residual volume is 50 mL. Urinalysis shows no abnormalities. Which of the following is the most likely diagnosis?

Accepted Answer

Stress incontinence

Answer

Overactive bladder with incontinence

Answer

Overflow incontinence

Answer

Urinary tract infection

Answer

Vesicovaginal fistula

Question 7

During a routine examination, a 25-year-old woman expresses concern about her risk for ovarian cancer because her mother died of the disease. Which of the following is the most appropriate course of action?

Accepted Answer

Obtain a more detailed family history of cancer

Answer

Reassure her that ovarian cancer is not hereditary

Answer

Recommend a diet high in beta-carotene

Answer

Annual CT scans of the abdomen

Answer

Prophylactic oophorectomy

Question 8

At her 6-week postpartum visit, an 18-year-old woman, gravida 1, para 1, tells her physician that she has a pinkish vaginal discharge that has persisted since her delivery, although it is decreasing in amount. On physical examination, the uterus is fully involuted and there are no adnexal masses. Which of the following is the most appropriate next step in management?

Accepted Answer

Reassurance that this is normal

Answer

Measurement of serum prolactin concentration

Answer

Quantitative β-hCG test

Answer

Administration of ampicillin

Answer

Dilatation and curettage

Question 9

A 32-year-old nulligravid woman comes to the physician because of a 6-week history of persistent foul-smelling vaginal discharge and vaginal itching. Her symptoms have not improved despite 2 weeks of treatment with over-the-counter antifungal medications and fluconazole. She has been sexually active and monogamous with her boyfriend during the past year, and they use condoms consistently. Examination shows excoriated labia and erythematous vaginal mucosa. There is a frothy, watery-gray discharge in the posterior vaginal vault. A wet mount preparation of the discharge shows numerous multi-flagellated organisms the size of erythrocytes. Which of the following is the most likely causal organism?

Accepted Answer

Trichomonas vaginalis

Answer

Haemophilus ducreyi

Answer

Neisseria gonorrhoeae

Answer

Pseudomonas aeruginosa

Answer

Treponema pallidum

Question 10

An asymptomatic 24-year-old primigravid woman at 36 weeks’ gestation comes for a routine prenatal visit. A grade 2/6, systolic ejection murmur is heard at the upper left sternal border. The S2 varies with inspiration, and the pulmonic component is soft; diastole is clear. Which of the following is the most likely diagnosis?

Accepted Answer

Flow murmur

Answer

Anomalous pulmonary venous return

Answer

Atrial septal defect

Answer

Patent ductus arteriosus

Answer

Pulmonary valve stenosis