Obstetrics and Gynecology

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DIRECTIONS: Each of the numbered items or incomplete statements in this section is followed by answers or by completion of the statements. Select the one lettered answer or completion that is best in each case.

452. A 23-year-old woman presents with fever and bilateral lower quadrant abdominal pain for two days. She complains of the onset of a mucopurulent vaginal discharge with her menses, which she states is yellowish in color. She has a new sexual partner and uses a nonbar-rier method of contraception. Her temperature is 103.2°F She has bilateral lower quadrant tenderness with palpation, and pelvic examination reveals cervical and adnexal motion tenderness. A mass is palpable in the left adnexa. Which of the following is the most likely diagnosis?

a. Fitz-Hugh-Curtis syndrome b. Pelvic inflammatory disease c. Perihepatitis d. Acute inflammation of Bartholin's gland e. Chancroid

453. A 37-year-old woman in her 32nd wk of gestation (G2P1) presents with a seizure. She has been healthy and does not smoke cigarettes, drink alcohol, or use illicit drugs. She has been poorly compliant in receiving her prenatal care. Physical examination reveals a blood pressure of 150/95 mm Hg. The patient's face and hands appear edematous. Other than the patient being postictal (confused and disoriented after the seizure), the neurologic examination is normal. The urinalysis reveals proteinuria. The rest of the patient's laboratory data is normal. Which of the following is the most likely diagnosis?

a. HELLP syndrome b. Preeclampsia c. Eclampsia d. Essential hypertension e. Primary seizure disorder

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454. A 20-year-old woman presents with the sudden onset of severe lower abdominal pain that radiates to her left shoulder. She has some vaginal bleeding now, but her last menstrual period was 6 wk ago. She has no history of sexually transmitted diseases and has never been pregnant. She uses condoms inconsistently about 50% of the time with her partner of 18 mo. She denies dysuria or frequency. On physical examination, blood pressure is 100/70 mm Hg, heart rate is 100/min, and temperature is normal. Abdominal exam reveals tenderness and rebound in the left lower quadrant. Adler sign is positive. Pelvic examination reveals a boggy and poorly delineated mass in the left adnexa. The patient's abdominal pain worsens upon slight movement of the cervix. Which of the following is the most likely diagnosis?

a. Pelvic inflammatory disease b. Pyelonephritis c. Appendicitis d. Ectopic pregnancy e. Ruptured corpus luteum cyst

455. Which of the following best describes irregular, prolonged, and heavy menstrual bleeding?

a. Menorrhagia b. Metrorrhagia c. Menometrorrhagia d. Polymenorrhea e. Oligomenorrhea

456. A 24-year-old woman, gravida 3, para 2, presents with the chief complaint of some lower abdominal pain accompanied by a small amount of vaginal bleeding. She is 16 wk pregnant and has been healthy throughout the pregnancy. She does not smoke cigarettes, drink alcohol, or use illicit drugs. Abdominal examination is normal. Pelvic examination reveals that the internal cervical os is closed. Which of the following is the most likely diagnosis?

a. Complete abortion b. Incomplete abortion c. Threatened abortion d. Inevitable abortion e. Missed abortion

457. A 42-year-old woman, G2, P2, presents with the chief complaint of severe bilateral breast pain that seems to be worse around the time of menses. Physical examination reveals bilateral breast tenderness with palpation. Multiple lumps are palpated in both breasts. Mammogram reveals dense bilateral breast tissue. Which of the following is the most likely diagnosis in this patient?

a. Fibroadenoma b. Fibrocystic disease c. Paget's disease d. Mastitis e. Mammary duct ectasia

458. A 32-year-old woman in her third trimester presents with painless and profuse bright red vaginal bleeding. Pelvic examination is deferred. Transvaginal ultrasonogra-phy reveals an abnormally positioned placenta. Which of the following is the most likely diagnosis?

a. Placenta accreta b. Placenta previa c. Abruptio placentae d. Bloody show e. Vasa previa

459. A 52-year-old woman complains of recurrent episodes in which she becomes extremely hot and diaphoretic. During these episodes, she becomes anxious and feels like her heart is racing. Each episode lasts approximately 5 min. The episodes are so intense that she must put on the air conditioner or open a window until the episode resolves. Hot weather and stress often precipitate the symptoms. The episodes seem to be worse at night. The patient further states that she has been amenorrheic for 12 mo and has recently begun experiencing vaginal dryness and dyspareunia. Physical examination is normal. Which of the following is the most likely diagnosis?

a. Depression b. Menopause c. Hypothyroidism d. Somatization e. Personality disorder

460. A 30-year-old woman in her 36th week of gestation (G1, P0) presents with a platelet count of 85,000/pL. She has no complaints of easy bruisability or mucosal bleeding and feels healthy. She has no past illnesses and takes no medications. She has no family history of bleeding problems. Laboratory data reveals a normal complete blood count, prothrombin time, and partial thromboplastin time. Liver enzymes and urinalysis are normal. Peripheral blood smear reveals normal morphology of red blood cells and platelets. Which of the following is the most likely diagnosis?

a. Idiopathic thrombocytopenic purpura b. Pseudothrombocytopenia c. Gestational thrombocytopenia d. HELLP syndrome e. Thrombotic thrombocytopenic purpura (TTP)

f. Hemolytic-uremic syndrome (HUS)

461. As you are performing the external portion of a pelvic examination, you palpate a warm, fluctuant mass that is unilateral in the posterolateral portion of the labia majora. The patient states that palpation is painful. The surrounding tissue is inflamed and edematous. Which of the following is the most likely diagnosis?

a. Bartholin's cyst b. Bartholin's abscess c. Rectocele d. Cystocele e. Genital herpes

462. A 64-year-old woman presents with vaginal bleeding similar to "spotting" that has occurred daily for 1 mo. Her last menses was at age 50 and she has been healthy her entire life. She denies fever, weight loss, or abdominal pain. Physical examination is normal. Which of the following is the most likely diagnosis?

a. Atrophic vaginitis b. Endometriosis c. Uterine leiomyoma d. Endometrial carcinoma e. Polycystic ovarian syndrome

463. A 29-year-old woman in her first trimester presents with painless profuse vaginal bleeding. Her blood pressure is 130/90 mm Hg. She has facial and hand edema. Pelvic examination reveals a 24-wk-sized uterus. Urinalysis reveals proteinuria. Which of the following is the most likely diagnosis?

a. Placenta previa b. Abruptio placenta c. Hydatidiform mole d. Normal pregnancy e. Multiple-gestation pregnancy

464. A 23-year-old woman presents to your office for a prenatal visit. She has not received any previous prenatal care and does not know the date of her last menstrual period. On physical examination, the fundal height is palpated to be at the level of the umbilicus. Which of the following is the estimated number of weeks of gestation?

DIRECTIONS: Each set of matching items in this section consists of a list of lettered options followed by several numbered items. For each numbered item, select the appropriate lettered option(s). Each lettered option may be selected once, more than once, or not at all. Each item will state the number of options to select. Choose exactly this number. Items 465-467

For each patient with a vaginal finding, choose the most likely causative organism.

a. Trichomonas vaginalis b. Neisseria gonorrhoeae c. Gardnerella vaginalis d. Candida albicans e. Chlamydia trachomatis f. Enterobius vermicularis

467. A 31-year-old woman presents with vaginal burning and a white, cheeselike vaginal discharge. Pseudohyphae are visible with a KOH preparation. (SELECT 1 ORGANISM) Items 468-472

For each patient with a breast finding, select the most likely diagnosis.

465. A 19-year-old woman presents with a malodorous, watery, gray-colored vaginal discharge. Clue cells are visible on wet mount preparation and there is a fishy odor to the discharge when mixed with KOH. (SELECT 1 ORGANISM)

466. A 35-year-old woman presents with vaginal itching. Examination reveals strawberry patches or petechiae on the cervix and vaginal mucosa and a frothy green-colored discharge. A pear-shaped organism is visible on wet mount preparation.


a. Breast cancer b. Paget's disease of the breast c. Inflammatory breast carcinoma d. Intraductal papilloma e. Fibroadenoma

468. A 25-year-old woman presents with a palpable breast mass that has well-defined margins and is movable. (SELECT 1 DIAGNOSIS)

469. A 50-year-old woman presents with a hard, circumscribed, fixed, edematous breast mass. The overlying skin has a peau d'orange appearance. (SELECT 1 DIAGNOSIS)

470. A 52-year-old woman presents with bloody discharge from her right nipple. She has no palpable breast mass. (SELECT 1 DIAGNOSIS)

471. A 36-year-old woman has erythema and a visible erysipeloid margin of her left breast. The involved area is warm and tender to palpation. (SELECT 1 DIAGNOSIS)

472. A 39-year-old woman presents with eczematoid changes of her left breast, which occasionally itches, burns, oozes an exudate, and bleeds. (SELECT 1 DIAGNOSIS)

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