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Flashcards in Quiz 6 Deck (59)
1

An 18 year old at 35 weeks gestation has been feeling well, although she has occasional "tightening" of her abdomen and had noticed some vaginal spotting this morning. Speculum exam reveals that her cervix is visually dilated to 2 cm. Monitoring for 1 hour reveals one contraction. The fetal heart status is reassuring. The next step in managing this patient should be...

discharge to home with counseling on the signs and symptoms of labor

2

A 25-year-old patient is being treated for preterm labor with nifedipine. Which of the following is a possible complication?

Decrease in uteroplacental blood flow

3

A 34-year-old at 25 weeks gestation felt "feverish" last evening. She denies contractions, abdominal pain, or vaginal bleeding. Her past medical history is unremarkable. She is afebrile now. Her lungs are clear to auscultation. Her abdomen is mildly tender to palpation. There is no rebound or guarding. Urinalysis is normal. Her WBC is 15,000. The source of the leukocytosis of greatest concern is...

chorioamnionitis

4

What is the most appropriate technique to evaluate cervical length?

Ultrasound

5

Which of the following is the most serious consequence of preterm premature rupture of membranes?

Preterm delivery

6

A 22-year-old patient at 23 weeks of gestation describes a sudden gush of fluid from the vagina. Which of the following can cause a false-negative Nitrazine test?

Rupture of the membranes with no residual fluid

7

A 30-year-old primigravid patient at 41 weeks and 3 days of gestation has a normal NST and AFI. Estimated fetal weight is 5,600 g. She weighs 320 lbs and has been managed with diet for an abnormal 3-hour glucose test since 28 weeks. The cervix is closed and posterior. What is the most appropriate management?

Cesarean delivery within 24 hours

8

A 32-year-old woman is at 41 weeks of gestation. Her cervix is found to be unfavorable. She asks her physician about the next step of management and is told that she should...

have a nonstress test and an amniotic fluid index

9

A 20-year old white female G0 comes to see you about contraception. She is in college and plans to go to grad school, so she wants something that is 100% effective in preventing pregnancy. You explain to her that the method failure rate and the typical use rate can be very different depending on the method chosen.

The "method failure rate" reflects the rate of failure when the method is...

used correctly 100% of the time

10

A 45-year-old G2P2 has been seeing you for heavy periods lasting 7 to 10 days with clots and cramping. She is a 1 pack per day smoker and plans on quitting. She has 2 to 3 drinks per weekend. Her family history is remarkable for breast cancer in her mother and older sister after menopause. Her blood pressure is 138/78. She weighs 220 pounds. Your exam is unremarkable but her uterus is difficult to assess due to her habitus. An ultrasound revealed a normal size uterus with no fibroids. An endometrial biopsy was benign.

A sound next step would be...

Levonorgestrel IUD

11

The overall risk of ectopic pregnancy in users of IUDs is

unchanged

12

Removal of an IUD in the first trimester of a pregnancy is associated with a decreased spontaneous abortion rate of...

30%

13

In most cases, successful reversal of female sterilization done by tubal ligation is possible in approximately what percent of cases?

25-50%

14

Antibodies against the sperm are found in about what proportion of men who have undergone vasectomy?

50%

15

Bilateral tubal ligation has the additional benefit of reducing the likelihood of...

Ovarian cancer

16

A 28 year old G3P3 presents to the emergency room early in the morning in severe pain after a tubal ligation performed yesterday. She claims she was told the procedure went well but the pain developed shortly after getting home yesterday afternoon. She took her pain medicine as prescribed but has not been able to control her pain

What is the most likely method of sterilization used?

Falope ring

17

What female sterilization method is most likely to result in future ectopic pregnancy?

Electrocautery

18

A 34-year-old G2P2 tells you she wants her copper IUD removed because her periods have become heavier and crampy so her husband is getting a vasectomy.

You advise her to...

Wait until 10 weeks after the vasectomy

19

Postoperative complications of vasectomy such as bleeding, hematoma formation, and local skin infection occur in about what percent of cases?

5-10%

20

When counseling a woman on sexual desire, one common flaw in the traditional model of female sexual response is its failure to account for the frequent overlap of desire and...

arousal

21

The sexual dysfunction that is most likely to occur in a patient who was in an abusive relationship is...

hypoactive sexual desire disorder

22

A 23 year old woman comes to the office for evaluation of painful intercourse and pain when inserting tampons. These symptoms began approximately 5 months ago as mild vulvar irritation. She was diagnosed by another health care provider as having a "vaginal infection" for which she has received multiple cycles of various medications with no benefit and progressively worsening symptoms. She is now unable to have intercourse and can insert only the smallest tampon, though she can wear them comfortable once they are in place. She weighs 63 kg and is 160 cm tall. Vital signs are temperature 37.0 C, pulse 78/min, respirations 16/min, and blood pressure 118/54 mmHg. The general physical examination is normal. The test or procedure most likely to establish the diagnosis for this patient is...

inspection and palpations of the vulva

23

Among female genital tract malignancies, endometrial carcinoma ranks where in frequency?

First

24

In 1994, the World Health Organization sought to standardize the classification system of endometrial hyperplasia. The major categories central to this classification are...

cytologic atypia and glandular/stromal architecture

25

Complex hyperplasia is characterized histologically by...

increased gland-to-stroma ratio giving a "crowded" or "back-to-back" appearance

26

A healthy, thin, 70-year-old woman presents to your office complaining of one episode of vaginal spotting. She has no medical problems and only takes a daily multivitamin. You perform an endometrial biopsy and obtain scant amounts of tissue. The final pathology reads "insufficient tissue for diagnosis." What is the recommended follow-up for this patient?

Ultrasound to evaluate endometrial stripe

27

On morning rounds, you look up Ms. Jones' final pathology from her recent total abdominal hysterectomy and staging for endometrial cancer. You report that the pathologist found "tumor limited to the uterus invading greter than 50% of the myometrium with cervical stromal involvement." The senior resident asks you to characterize her stage. Your (correct) response should be...

IIB

28

On morning rounds, you look up Ms. Jones' final pathology report from her recent total abdominal hysterectomy and staging for endometrial cancer. You report that the pathologist found "tumor was carcinoma in situ with one focus of adenosquamous carcinoma (2 mm wide x 4 mm deep in size) limited to the upper one-third of the vagina." The senior resident asks you to characterize her stage. Your (correct) response should be...

IIIB

29

A 62-year-old woman presents with postmenopausal bleeding, pelvic pain, and a rapidly enlarging uterus. She is not taking hormone replacement therapy. These findings present a strong index of suspicion for...

uterine sarcoma

30

Malignant ovarian epithelial cell tumors spread primarily by...

direct extension within the peritoneal cavity

31

In autopsy data, breast cancer metastatic to the ovary is found in what proportion of cases?

25%

32

Of the new cases of ovarian cancer yearly, what percent will die within 5 years?

60%

33

A 22 year old patient asks about the risks of prematurity at her initial prenatal visit. She can be informed that babies born prematurely in the United States account for what percent of all perinatal mortality?

75%

34

A 25 YEAR OLD PATIENT AT 20 weeks of gestation is concerned about loss of amniotic fluid associated with coitus last night. What is associated with a false-positive Nitrazine test?

Semen

35

A 29 year old woman presents at 28 weeks of gestation with a complaint of leaking of fluid from her vagina. Her prenatal course has been uncomplicated. Her vital signs are normal. A speculum examination reveals pooling of amniotic fluid and is positive for ferning and Nitrazine. Sonogram reveals a normally grown fetus with oligohydramnios. Her uterus is nontender. What is the most appropriate next step?

Expectant management

36

A 30 year old patient inquires about the likelihood that she will deliver after her due date. She can be informed that postterm pregnancy occurs in what percent of pregnancies?

10%

37

A 30 year old primigravid patient at 41 weeks and 3 days of gestation has a normal NST and AFI. Estimated fetal weight is 5,000g. She weighs 320lbs and has been managed with diet for an abnormal 3-hour glucose test since 28 weeks. The cervix is closed and posterior. What is the most appropriate management?

Cesarean delivery within 24 hours

38

The spontaneous expulsion rate of IUDs in he first year following insertion is up to...

5%

39

What percent of patients will spontaneously abort if they become pregnant while using an IUD?

40-50%

40

What is the primary mechanism of action of contraceptive foam?

Imposes a spermicidal barrier between the sperm and the egg

41

What is the 10 year failure rate in tubal ligation done by bipolar conjugation?

2%

42

Which sterilization technique has the longest delay until sterilization is achieved?

Hysteroscopic micro-insert

43

Which of the following female sterilization methods is most likely to be successfully reversed?

Hulka clip

44

A 28 year old G2P2 surgical resident on birth control pills consults you about permanent sterilization. She desires no more children and a recent pregnancy scare made her realize she wants something permanent. Her husband will not get a vasectomy. She cannot take any time off and wants to be as discrete as possible.

The permanent sterilization procedure with the briefest recovery is...

hysteroscopic implant inserion

45

A 25 year old patient has undergone reversal of a tubal ligation and then exhibits signs and symptoms of pregnancy. She should initially be presumed to have...

an ectopic pregnancy

46

A 22 year old patient asks about the risks of prematurity at her initial prenatal visit. She can be informed that babies born prematurely in the United States account for what percent of all perinatal mortality?

75%

47

A 25 YEAR OLD PATIENT AT 20 weeks of gestation is concerned about loss of amniotic fluid associated with coitus last night. What is associated with a false-positive Nitrazine test?

Semen

48

A 29 year old woman presents at 28 weeks of gestation with a complaint of leaking of fluid from her vagina. Her prenatal course has been uncomplicated. Her vital signs are normal. A speculum examination reveals pooling of amniotic fluid and is positive for ferning and Nitrazine. Sonogram reveals a normally grown fetus with oligohydramnios. Her uterus is nontender. What is the most appropriate next step?

Expectant management

49

A 30 year old patient inquires about the likelihood that she will deliver after her due date. She can be informed that postterm pregnancy occurs in what percent of pregnancies?

10%

50

A 30 year old primigravid patient at 41 weeks and 3 days of gestation has a normal NST and AFI. Estimated fetal weight is 5,000g. She weighs 320lbs and has been managed with diet for an abnormal 3-hour glucose test since 28 weeks. The cervix is closed and posterior. What is the most appropriate management?

Cesarean delivery within 24 hours

51

The spontaneous expulsion rate of IUDs in he first year following insertion is up to...

5%

52

What percent of patients will spontaneously abort if they become pregnant while using an IUD?

40-50%

53

What is the primary mechanism of action of contraceptive foam?

Imposes a spermicidal barrier between the sperm and the egg

54

What is the 10 year failure rate in tubal ligation done by bipolar conjugation?

2%

55

Which sterilization technique has the longest delay until sterilization is achieved?

Hysteroscopic micro-insert

56

Which of the following female sterilization methods is most likely to be successfully reversed?

Hulka clip

57

A 28 year old G2P2 surgical resident on birth control pills consults you about permanent sterilization. She desires no more children and a recent pregnancy scare made her realize she wants something permanent. Her husband will not get a vasectomy. She cannot take any time off and wants to be as discrete as possible.

The permanent sterilization procedure with the briefest recovery is...

hysteroscopic implant inserion

58

A 25 year old patient has undergone reversal of a tubal ligation and then exhibits signs and symptoms of pregnancy. She should initially be presumed to have...

an ectopic pregnancy

59

What is the most common ovarian cancer in women under the age of 20 years?

Germ cell tumor