A 16-year-old girl presents with lower abdominal pain and fever

A 16-year-old girl presents with lower abdominal pain and fever. On physical examination, a tender adnexal mass is felt. Further questioning in private reveals the following: she has a new sexual partner; her periods are irregular; she has a vaginal discharge. Which of the following is the most likely diagnosis?

1. Appendiceal abscess
2. Tuboovarian abscess
3. Ovarian cyst
4. Renal cyst
5. Ectopic pregnancy

the answer is below…

A 29-year-old G3P0 presents to your office for preconception counseling

A 29-year-old G3P0 presents to your office for preconception counseling. All of her pregnancies were lost in the first trimester. She has no significant past medical or past surgical history. She should be counseled that without evaluation and treatment her chance of having a live birth is which of the following?

1. <20%
2. 20 to 35%
3. 40 to 50%
4. 70 to 85%
5. >85%

the answer is below…

A 24-year-old woman has had three first-trimester spontaneous abortions

A 24-year-old woman has had three first-trimester spontaneous abortions. Which of the following statements concerning chromosomal aberrations in abortions is true?

1. 45,X is more prevalent in chromosomally abnormal term babies than in abortus products
2. Approximately 20% of first-trimester spontaneous abortions have chromosomal abnormalities
3. Trisomy 21 is the most common trisomy in abortuses
4. Despite the relatively high frequency of Down syndrome at term, most Down fetuses abort spontaneously
5. Stillbirths have twice the incidence of chromosomal abnormalities as live births

the answer is below…

Your patient is concerned about the possibility of a spontaneous loss

After an initial pregnancy resulted in a spontaneous loss in the first trimester, your patient is concerned about the possibility of this recurring. Which of the following is an appropriate answer regarding the chance of recurrence?

1. It depends on the genetic makeup of the prior abortus
2. It is no different than it was prior to the miscarriage
3. It is increased to approximately 50%
4. It is increased most likely to greater than 50%
5. It depends on the sex of the prior abortus

the answer is below…

A 21-year-old G1 at 40 weeks, severe preeclampsia, delivered a 3900-g male infant via vaginal delivery

A 21-year-old G1 at 40 weeks, who underwent induction of labor for severe preeclampsia, delivered a 3900-g male infant via vaginal delivery after pushing for 21/2 hours. A second-degree midline laceration and sidewall laceration were repaired in the usual fashion under local analgesia. The estimated blood loss was 450 cc. Magnesium sulfate is continued postpartum for the seizure prophylaxis. Six hours after the delivery the patient has difficulty voiding. Which is the most likely cause of her problem?

a. Preeclampsia

b. Infusion of magnesium sulfate

c. Vulvar hematoma

d. Ureteral injury

e. Use of local analgesia for repair

the answer is below…

A 32-year-old G1P0 routine OB visit at 14 weeks gestational age have a platelet count of 60,000

A 32-year-old G1P0 reports to your office for a routine OB visit at 14 weeks gestational age. Labs drawn at her first prenatal visit 4 weeks ago reveal a platelet count of 60,000. All her other labs were within normal limits. During the present visit, the patient has a blood pressure of 120/70. Her urine dip reveals the presence of trace protein. The patient denies any complaints. The only medication she is currently taking is a prenatal vitamin. On taking a more in-depth history you learn that, prior to pregnancy, your patient had a history of occasional nose and gum bleeds, but no serious bleeding episodes. She has considered herself to be a person who just bruises easily. Which of the following is the most likely diagnosis?

a. Alloimmune thrombocytopenia

b. Gestational thrombocytopenia

c. Immune thrombocytopenic purpura

d. HELLP syndrome

e. Pregnancy-induced hypertension

the answer is below…

A 39-year-old G1P0 at 39 weeks has a blood pressure 150/100

A 39-year-old G1P0 at 39 weeks gestational age is sent to labor and delivery from her obstetrician’s office because of a blood pressure reading of 150/100 obtained during a routine OB visit. Her baseline blood pressures during the pregnancy were 100–120/60-70. On arrival to labor and delivery, the patient denies any headache, visual changes, nausea, vomiting, or abdominal pain. The heart rate strip is reactive and the tocodynamometer indicates irregular uterine contractions. The patient’s cervix is 3 cm dilated. Her repeat BP is 160/90. Hematocrit is 34.0, platelets are 160,000, SGOT is 22, SGPT is 15, and urinalysis is negative for protein. Which of the following is the most likely diagnosis?

a. Preeclampsia

b. Chronic hypertension

c. Chronic hypertension with superimposed preeclampsia

d. Eclampsia

e. Pregnancy-induced hypertension (gestational hypertension)

the answer is below…

A mother brings her daughter, 17 years old and has not started her period

A mother brings her daughter in to see you for consultation. The daughter is 17 years old and has not started her period. She is 4 ft 10 in. tall. She has no breast budding. On pelvic examination, she has no pubic hair. By digital examination the patient has a cervix and uterus (emang boleh ya?). The ovaries are not palpable. As part of the workup, serum FSH and LH levels are drawn and both are high. Which of the following is the most likely reason for delayed puberty and sexual infantilism in this patient?

a. Adrenogenital syndrome (testicular feminization)

b. McCune-Albright syndrome

c. Kallman syndrome

d. Gonadal dysgenesis

e. Müllerian agenesis

the answer is below…

A 28-year-old nulligravid patient complains of bleeding between her periods and increasingly heavy menses

A 28-year-old nulligravid patient complains of bleeding between her periods and increasingly heavy menses. Over the past 9 months she has had two dilation and curettages (D&Cs), which have failed to resolve her symptoms, and oral contraceptives and antiprostaglandins have not decreased the abnormal bleeding. Which of the following options is most appropriate at this time?

a. Perform a hysterectomy

b. Perform hysteroscopy

c. Perform endometrial ablation

d. Treat with a GnRH agonist

e. Start the patient on a high-dose progestational agent

the answer is below…

During the evaluation of secondary amenorrhea in a 24-year-old woman, hyperprolactinemia is diagnosed

During the evaluation of secondary amenorrhea in a 24-year-old woman, hyperprolactinemia is diagnosed. Which of the following conditions could cause increased circulating prolactin concentration and amenorrhea in this patient?

a. Stress

b. Primary hyperthyroidism

c. Anorexia nervosa

d. Congenital adrenal hyperplasia

e. Polycystic ovarian disease

the answer is below…