p.1
Vaginal Bleeding in Pregnancy
What is the most likely diagnosis for a 34-week pregnant woman with labor pains and a cervix dilated to 4 cm?
Uteroplacental insufficiency.
p.14
Cervical Incompetence
What is the recommended frequency for Pap smear screening for a sexually active 40-year-old woman?
Yearly screening recommended.
p.20
Complications of Multiple Pregnancies
What is the most appropriate management for a 30-year-old woman in labor with a dilated cervix and ruptured membranes?
Augmentation with oxytocin.
p.4
Complications of Multiple Pregnancies
What is the indication for administering RhoGAM?
A. Mother is Rh- and the baby is Rh+
p.16
Endometriosis and Infertility
What is the most likely diagnosis for a 27-year-old woman with oligomenorrhea and signs of hyperandrogenism?
Polycystic Ovary Syndrome.
p.13
Endometriosis and Infertility
What is the significance of adenomatous hyperplasia in the context of endometrial health?
It can lead to an increased risk of endometrial cancer.
What is the likely diagnosis for a 24-year-old woman with severe abdominal pain, vaginal bleeding, and a tense abdomen?
Ruptured ectopic pregnancy
p.15
Endometriosis and Infertility
What is the most appropriate initial step in evaluation for a 27-year-old nulliparous woman concerned about infertility?
Referral to a reproductive specialist.
p.3
Management of Asthma in Pregnancy
What medication regimen is most appropriate for a 28-year-old woman with worsening asthma at 24 weeks' gestation?
Inhaled glucocorticoids and long-acting bronchodilators.
p.20
Endometriosis and Infertility
What hormone is primarily responsible for stimulating follicle development?
Follicle-stimulating hormone.
p.5
Pelvic Inflammatory Disease
What is the most appropriate management for a 15-year-old girl with menstrual pain and normal exams?
Non-steroidal anti-inflammatory medication.
p.18
Pelvic Inflammatory Disease
What is the most appropriate next step in management for a 33-year-old woman with severe lower abdominal pain and suspected bilateral tubo-ovarian abscesses?
Intravenous antibiotic therapy.
p.18
Gestational Hypertension and Preeclampsia
What is the most likely diagnosis for a 39-year-old primigravida with elevated blood pressure but negative urinalysis for protein?
Gestational hypertension.
p.6
Endometriosis and Infertility
What is the most likely finding in the 30-year-old woman with irregular vaginal bleeding and enlarged ovaries?
A Follicle Stimulating Hormone to Luteinizing Hormone ratio of 1:3.
p.17
Endometriosis and Infertility
What is the most likely diagnosis for a 16-year-old with primary amenorrhea and elevated testosterone levels?
Complete androgen insensitivity syndrome.
p.11
Complications of Multiple Pregnancies
What is the next step in management for a 28-year-old woman at 37 weeks' gestation with spontaneous rupture of membranes and fever?
Intravenous intrapartum antibiotics.
What is the most likely predisposing factor for an ectopic pregnancy in a 28-year-old woman?
Previous tubal pregnancy.
p.8
Gestational Hypertension and Preeclampsia
What risk is increased during pregnancy for a woman with hypertension taking labetalol?
Intrauterine growth restriction.
p.14
Postpartum Care and Complications
What is the most appropriate management for a pregnant woman stabilized on paroxetine for severe depression?
Continue paroxetine and monitor for depression.
p.2
Complications of Multiple Pregnancies
What describes the membranes and placenta of dizygotic twins?
Dichorionic and diamniotic regardless of the sex of the foetuses.
p.20
Postpartum Care and Complications
What preventive measure is appropriate for a 37-year-old woman with a history of recurrent postpartum hemorrhage?
Deliver the patient in the operating room.
p.2
Complications of Multiple Pregnancies
What physical findings were noted in the 28-year-old woman's examination?
Pale nail beds, palpable cervical lymph nodes, and crepitations over the upper left lobe.
p.13
Endometriosis and Infertility
What is the most likely cause of irregular vaginal bleeding in a 42-year-old obese woman with adenomatous hyperplasia?
Peripheral conversion of precursors to estrogen.
p.11
Gestational Hypertension and Preeclampsia
What is the most likely diagnosis for a 32-year-old woman at 16 weeks pregnant with a 'snowstorm-like' ultrasound appearance?
Complete hydatidiform mole.
p.9
Gestational Hypertension and Preeclampsia
What is the most important intervention for a patient with fetal heart tones dropping to 80 beats per minute after prostaglandin gel application?
Prepare for an urgent cesarean section.
p.18
Vaginal Bleeding in Pregnancy
What symptom did the 25-year-old woman G5 P2022 present with during her hospital admission?
Painless vaginal bleeding.
p.6
Endometriosis and Infertility
What symptoms did the 20-year-old woman present with at the Maternal Health Clinic?
Severe facial acne, irregular menstrual bleeding, and fine hair growth.
p.10
Complications of Multiple Pregnancies
What is the most appropriate method for labor induction in a 32-year-old multiparous woman at 41 weeks and 2 days gestation?
D. Cervical ripening agent.
p.6
Endometriosis and Infertility
What additional laboratory values should be obtained for the 20-year-old woman?
Glucose tolerance and lipid profile.
p.10
Vaginal Bleeding in Pregnancy
What is the next best step in management after spontaneous rupture of membranes in a patient with a history of recurrent vaginal herpes simplex?
A. Pelvic speculum examination.
p.13
Endometriosis and Infertility
What hormonal imbalance is indicated by elevated follicle-stimulating hormone (FSH) levels in a patient with polycystic ovary syndrome?
Increased FSH levels indicate ovarian dysfunction.
p.15
Pelvic Inflammatory Disease
What is the first step in management for a 14-year-old girl with colicky lower abdominal pain associated with menses?
Nonsteroidal anti-inflammatory drugs.
p.18
Complications of Multiple Pregnancies
What is the most appropriate next step in management for a 25-year-old woman in labor with a cervix dilated to 6 cm?
Monitor partographic progress.
p.14
Endometriosis and Infertility
What is the best-evidenced treatment for a woman with recurrent symptoms of severe premenstrual syndrome?
Selective serotonin uptake inhibitors.
p.19
Fetal Monitoring and Diagnosis
What examination is most likely to confirm the diagnosis of leaking liquor in a 29-year-old woman at 30 weeks' gestation?
Sterile speculum examination.
What is the most appropriate management for a patient diagnosed with cervical incompetence at 8 weeks' gestation?
Insert cervical suture at 14-16 weeks.
p.7
Gestational Hypertension and Preeclampsia
What significant medical history does the 35-year-old nulliparous woman have at 24 weeks' gestation?
Insulin-dependent diabetes class F with nephritis and chronic hypertension.
p.19
Gestational Hypertension and Preeclampsia
What is the most important purpose of the first antenatal visit for a 28-year-old woman at 10 weeks' gestation?
Confirm the gestational dating.
p.9
Postpartum Care and Complications
When is the optimal time to administer intravenous antibiotics for a patient undergoing a cesarean section?
During pre-operative preparation.
p.2
Complications of Multiple Pregnancies
What symptoms did the 28-year-old immigrant woman present with at 20 weeks' gestation?
Cough, night chills, and thick sputum.
p.20
Fetal Monitoring and Labor Management
What is the most appropriate management for a 30-year-old woman in labor with a dilated cervix of 5 cm and ruptured membranes?
A) Augmentation with oxytocin
B) Prostaglandin E1 analogue
C) Continue observation
D) Dinoprostone
E) Cesarean section
A) Augmentation with oxytocin
Explanation: In this scenario, the cervix is dilated but labor is not progressing adequately. Augmentation with oxytocin is the most appropriate management to enhance contractions and facilitate labor progression.
p.13
Endometriosis and Infertility
What risk is increased for a 43-year-old woman with a history of oligomenorrhea due to polycystic ovary syndrome who discontinued progesterone?
A) Hip fracture
B) Cervical dysplasia
C) Ectopic pregnancy
D) Endometrial carcinoma
E) Ovarian cancer
D) Endometrial carcinoma
Explanation: Discontinuing progesterone therapy in a patient with polycystic ovary syndrome increases the risk of endometrial carcinoma due to unopposed estrogen exposure.
p.17
Endometriosis and Infertility
What is the most likely diagnosis for a 16-year-old with primary amenorrhea, normal adult-size breasts, and elevated testosterone levels?
A) Mayer-Rokitansky-Kuster-Hauser syndrome
B) Complete androgen insensitivity syndrome
C) Asherman's syndrome
D) Turner syndrome
E) Polycystic ovary syndrome
B) Complete androgen insensitivity syndrome
Explanation: The presence of normal breast development and elevated testosterone levels in a 16-year-old with primary amenorrhea suggests complete androgen insensitivity syndrome, where the body cannot respond to androgens.
p.16
Endometriosis and Infertility
What diagnostic procedure would most likely help in diagnosing the 25-year-old woman with pelvic pain and nodularity on the uterosacral ligaments?
A) Ultrasound
B) Laparoscopy
C) Hysteroscopy
D) Hysterosalpingogram
E) MRI
B) Laparoscopy
Explanation: Laparoscopy is the most definitive diagnostic tool for conditions like endometriosis, which is suspected in this case due to the pelvic pain and physical exam findings.
p.16
Endometriosis and Infertility
What is the most likely diagnosis for the 27-year-old woman with oligomenorrhea and signs of hyperandrogenism?
A) Polycystic ovary syndrome
B) Hyperprolactinemia
C) Hypothyroidism
D) Hypopituitarism
E) Endometriosis
A) Polycystic ovary syndrome
Explanation: The combination of oligomenorrhea, facial hair, and inflammatory acne suggests polycystic ovary syndrome (PCOS), which is characterized by hormonal imbalances.
p.2
Complications of Multiple Pregnancies
What is the best management for a 33-year-old pregnant woman presenting with dizziness and light-headedness at 38 weeks' gestation?
A) Blood transfusion
B) Refer to a neurologist
C) Avoid sleeping on the back
D) ECG and echocardiography
E) Increase fluid intake
C) Avoid sleeping on the back
Explanation: The symptoms of dizziness and light-headedness in late pregnancy can be associated with supine hypotensive syndrome, which occurs when the weight of the uterus compresses the inferior vena cava when the woman lies on her back. Avoiding this position can alleviate symptoms.
p.11
Diagnosis and Management of Ovarian Torsion
What is the most appropriate method of treatment for a 30-year-old woman with a 9x9 cm heterogeneous mass in the lower right quadrant?
A) Watchful waiting
B) Dilation and curettage
C) Operative laparoscopy
D) Methotrexate administration
E) Antibiotic therapy
C) Operative laparoscopy
Explanation: Given the presence of a large mass and the symptoms of progressive pain and heavy bleeding, operative laparoscopy is the most appropriate treatment to evaluate and manage the mass effectively.
p.5
Postpartum Care and Complications
What is the most appropriate management for a 15-year-old girl with pain during menstruation and normal physical exams?
A) Non-steroidal anti-inflammatory medication
B) Estrogen-progestin oral contraceptive
C) Cervical dilation
D) Danazol
E) Hormonal therapy
A) Non-steroidal anti-inflammatory medication
Explanation: Non-steroidal anti-inflammatory medications are typically the first-line treatment for dysmenorrhea in adolescents.
p.17
Complications of Multiple Pregnancies
What is the most appropriate diagnosis for a 20-year-old pregnant woman with loss of fetal movements, decreased urinary output, and lab results indicating low hemoglobin and platelets?
A) Acute glomerulonephritis
B) Acute amniotic embolism
C) Disseminated intravascular coagulation
D) Autoimmune thrombocytopenic purpura
E) Eclampsia
B) Acute amniotic embolism
Explanation: The symptoms of loss of fetal movements, decreased urinary output, and lab results suggest acute amniotic embolism, which can lead to severe complications during pregnancy.
p.17
Endometriosis and Infertility
Which radiological assessment is most appropriate for a 26-year-old woman with secondary amenorrhea, breast tenderness, and elevated serum prolactin levels?
A) Lumbar spine
B) Sella-turcica
C) Kidneys
D) Pelvis
E) Chest
B) Sella-turcica
Explanation: Elevated serum prolactin levels and secondary amenorrhea warrant an assessment of the sella turcica to check for a prolactinoma or other pituitary abnormalities.
What is the first step in management for a 14-year-old girl with colicky lower abdominal pain associated with menses?
A) Nonsteroidal anti-inflammatory drugs
B) Oral contraceptive pills
C) Acetaminophen
D) Clomiphene
E) Hysterectomy
A) Nonsteroidal anti-inflammatory drugs
Explanation: The first step in managing menstrual-related pain in adolescents is typically the use of nonsteroidal anti-inflammatory drugs (NSAIDs) to alleviate pain and discomfort.
p.20
Fetal Monitoring and Labor Management
What is the most appropriate immediate management for a 22-year-old primigravida with a loop of umbilical cord below the fetal head?
A) Vacuum extraction
B) Cesarean section
C) Forceps delivery
D) Fetal monitoring
E) Induction of labor
B) Cesarean section
Explanation: The presence of a loop of umbilical cord below the fetal head indicates a risk of cord compression, making a cesarean section the most appropriate immediate management to ensure fetal safety.
p.13
Endometriosis and Infertility
What is the most likely cause of adenomatous hyperplasia in a 42-year-old nulligravid patient with polycystic ovary syndrome?
A) Human papillomavirus
B) Unopposed estrogen
C) Cellular apoptosis
D) Chronic inflammation
E) Genetic predisposition
B) Unopposed estrogen
Explanation: Adenomatous hyperplasia is often caused by unopposed estrogen stimulation, particularly in patients with conditions like polycystic ovary syndrome.
What is the most appropriate management for a patient diagnosed with cervical incompetence at 8 weeks' gestation?
A) Insertion of cervical suture the same week
B) Confirm the diagnosis by Hegar dilator
C) Insert cervical suture at 14-16 weeks
D) Begin beta mimetic drugs
E) Monitor until delivery
C) Insert cervical suture at 14-16 weeks
Explanation: The appropriate management for cervical incompetence is to place a cervical suture (cerclage) at 14-16 weeks of gestation to help prevent miscarriage.
p.5
Vaginal Bleeding in Pregnancy
When should a 31-year-old woman with negative HPV and Pap tests for the past year repeat these tests?
A) 6 months
B) 1 year
C) 2 years
D) 3 years
E) 5 years
D) 3 years
Explanation: Current guidelines recommend that women with negative HPV and Pap tests repeat these tests every 3 years.
p.3
Diagnosis of Ectopic Pregnancy
What is the next best step in obtaining a definitive diagnosis for a patient with a positive interferon-gamma release assay?
A) Chest X-ray
B) Sputum culture
C) Tuberculin skin test
D) Sputum smear cytology
E) Complete blood count
B) Sputum culture
Explanation: A sputum culture is the most appropriate next step for confirming a diagnosis of tuberculosis in a patient with a positive interferon-gamma release assay, as it allows for the identification of Mycobacterium tuberculosis.
p.4
Endometriosis and Infertility
What is the most likely factor contributing to infertility in a 24-year-old woman with irregular periods and multiple small cysts on ultrasound?
A) Tubal factor
B) Cervical factor
C) Ovulatory factor
D) Endometrial factor
E) Uterine factor
C) Ovulatory factor
Explanation: The presence of multiple small cysts lining the ovarian periphery, known as 'pearl necklace appearance', along with irregular menstrual cycles, indicates polycystic ovary syndrome (PCOS), which is a common ovulatory factor in infertility.
p.5
Diagnosis of Ectopic Pregnancy
What is the most likely diagnosis for a patient with a heart rate of 120/min, respiratory rate of 20/min, and temperature of 36.8 °C?
A) Threatened abortion
B) Ectopic pregnancy
C) Complete abortion
D) Anovulatory cycle
E) Normal pregnancy
B) Ectopic pregnancy
Explanation: The elevated heart rate and respiratory rate can indicate a stress response, which is commonly associated with ectopic pregnancy, making it the most likely diagnosis in this scenario.
p.20
Postpartum Care and Complications
What is the most appropriate management for a 14-year-old girl with painless vaginal bleeding and normal lab results?
A) Follicle stimulating hormone and prolactin
B) Oral contraceptive pills
C) Metformin
D) Reassure
E) Surgical intervention
D) Reassure
Explanation: Given the normal lab results and the nature of the bleeding, reassurance is the most appropriate management for this adolescent, as it may be a normal variant of menstrual cycles.
p.10
Complications of Multiple Pregnancies
What additional clinical finding would be associated with intrauterine growth restriction in a pregnant woman?
A) Elevated maternal liver enzymes
B) Gestational diabetes
C) Oligohydramnios
D) Polyhydramnios
E) Normal fetal heart rate
C) Oligohydramnios
Explanation: Oligohydramnios, or low amniotic fluid levels, is often associated with intrauterine growth restriction, indicating potential fetal distress or compromised growth.
p.10
Fetal Monitoring and Labor Management
Which method would be most appropriate for labor induction in a woman who is 41 weeks and 2 days gestation?
A) Artificial rupture of membranes
B) Intravenous oxytocin infusion
C) Indwelling catheter insertion
D) Cervical ripening agent
E) Expectant management
D) Cervical ripening agent
Explanation: Given the cervix is only 2 cm dilated and 50% effaced, using a cervical ripening agent is appropriate to prepare the cervix for labor induction.
p.10
Diagnosis of Ectopic Pregnancy
What is the next best step in management for a woman with a history of recurrent vaginal herpes simplex after spontaneous rupture of membranes?
A) Pelvic speculum examination
B) Prepare for instrumental delivery
C) Proceed to caesarean section delivery
D) Intravenous acyclovir administration
E) Monitor fetal heart rate
A) Pelvic speculum examination
Explanation: A pelvic speculum examination is necessary to assess the status of the membranes and the cervix, especially in the context of a herpes simplex history.
p.10
Postpartum Care and Complications
Which vaccine is recommended for a pregnant woman concerned about an outbreak of illness in her child's school at 16 weeks of gestation?
A) Rubella
B) Varicella
C) Smallpox
D) Influenza
E) Tetanus
D) Influenza
Explanation: The influenza vaccine is recommended during pregnancy to protect both the mother and fetus from potential complications associated with the flu.
p.18
Endometriosis and Infertility
What is the most appropriate investigation for the 45-year-old woman with amenorrhea and a desire to become pregnant?
A) LH and FSH levels
B) Endometrial biopsy
C) Hysterosalpingogram
D) Thyroid function tests
E) Pelvic ultrasound
A) LH and FSH levels
Explanation: In a woman with amenorrhea and a desire to conceive, measuring LH and FSH levels is the most appropriate initial investigation to assess ovarian function.
p.14
Vaginal Bleeding in Pregnancy
What is the most likely diagnosis for a 32-year-old pregnant woman with uterine tenderness, reduced fetal movement, and dark red vaginal bleeding after a fall?
A) Placenta previa
B) Uterine rupture
C) Placental abruption
D) Latent phase of labor
E) Ectopic pregnancy
C) Placental abruption
Explanation: The symptoms of uterine tenderness, reduced fetal movement, and dark red vaginal bleeding after trauma suggest placental abruption, which is a serious condition requiring immediate attention.
p.12
Complications of Multiple Pregnancies
What is the most appropriate management for a young primigravida with significant edema and high blood pressure?
A) Diuretics
B) Low-salt diet
C) Oral labetalol
D) Continued evaluation
E) Immediate delivery
D) Continued evaluation
Explanation: In cases of significant edema and elevated blood pressure, continued evaluation is crucial to monitor for potential complications such as preeclampsia before initiating treatment.
p.13
Endometriosis and Infertility
What is the most likely diagnosis for a patient with elevated prolactin levels and irregular menstrual cycles?
A) Hypothyroidism
B) Hypopituitarism
C) Hyperprolactinemia
D) Polycystic Ovary Syndrome
E) Endometrial carcinoma
C) Hyperprolactinemia
Explanation: The elevated prolactin levels suggest hyperprolactinemia, which can lead to irregular menstrual cycles and other hormonal imbalances.
p.13
Endometriosis and Infertility
What is the most likely cause of adenomatous hyperplasia in a 42-year-old obese woman with irregular vaginal bleeding?
A) Adrenal hyperplasia
B) Hepatic dysfunction
C) Local genetic mutation of the endometrium
D) Peripheral conversion of precursors to estrogen
E) Human papillomavirus infection
D) Peripheral conversion of precursors to estrogen
Explanation: In obese women, excess adipose tissue can lead to increased peripheral conversion of androgens to estrogen, contributing to adenomatous hyperplasia.
p.19
Vaginal Bleeding in Pregnancy
What is the most likely diagnosis for a patient with mild pain, normal vital signs, and trickling blood through the cervix with an open os?
A) Inevitable abortion
B) Incomplete abortion
C) Threatened abortion
D) Septic incomplete abortion
E) Ectopic pregnancy
B) Incomplete abortion
Explanation: The presence of trickling blood through the cervix and an open os suggests that the abortion process has started but is not complete, indicating an incomplete abortion.
p.19
Endometriosis and Infertility
In a 28-year-old woman with a history of infertility for over 2 years and a monophasic basal body temperature pattern, what is the most probable cause of infertility?
A) Pelvic inflammatory disease
B) The coital factor
C) Vaginal factor
D) Anovulation
E) Endometriosis
D) Anovulation
Explanation: The monophasic pattern of basal body temperature suggests that ovulation is not occurring, making anovulation the most likely cause of infertility in this case.
p.19
Fetal Monitoring and Labor Management
What is the most likely method to confirm the diagnosis of leaking liquor in a 29-year-old woman at 30 weeks' gestation?
A) Chemical examination of liquor
B) Bimanual vaginal examination
C) Sterile speculum examination
D) Ultrasound examination
E) Fetal heart monitoring
C) Sterile speculum examination
Explanation: A sterile speculum examination is the most direct method to assess for leaking amniotic fluid and confirm the diagnosis of ruptured membranes.
p.19
Postpartum Care and Complications
What is the most important purpose of the first antenatal visit for a woman who is 10 weeks' gestation?
A) Identify the risk factors
B) Confirm viable pregnancy
C) Confirm the gestational dating
D) Estimate the hemoglobin level
E) Assess fetal heart rate
C) Confirm the gestational dating
Explanation: Confirming the gestational dating is crucial during the first antenatal visit to ensure appropriate monitoring and care throughout the pregnancy.
p.8
Management of Asthma in Pregnancy
What is the primary reason for administering magnesium sulfate to a pregnant woman with proteinuria and elevated blood pressure?
A) Prevent pulmonary congestion
B) Control vascular vasospasms
C) Reduce blood pressure
D) Prevent seizures
E) Improve fetal heart rate
D) Prevent seizures
Explanation: Magnesium sulfate is primarily administered to prevent seizures in women with severe hypertension or pre-eclampsia.
p.18
Vaginal Bleeding in Pregnancy
What is the likely complication for the 25-year-old woman G5 P2022 who presented with painless vaginal bleeding at 10 weeks of gestation?
A) Ectopic pregnancy
B) Placenta previa
C) Molar pregnancy
D) Threatened abortion
E) Cervical incompetence
B) Placenta previa
Explanation: Painless vaginal bleeding in early pregnancy raises suspicion for placenta previa, especially in a woman with multiple pregnancies.
p.6
Endometriosis and Infertility
What is the most likely laboratory finding for the 30-year-old woman with irregular vaginal bleeding and bilaterally enlarged ovaries?
A) Normal testosterone levels
B) Decreased free androgen index
C) Increased thyroid hormones
D) A Follicle Stimulating Hormone to Luteinizing Hormone ratio of 1:3
E) Elevated prolactin levels
D) A Follicle Stimulating Hormone to Luteinizing Hormone ratio of 1:3
Explanation: The presence of irregular cycles and enlarged ovaries suggests polycystic ovary syndrome (PCOS), which is often associated with an elevated LH relative to FSH.
What is the first step in management for a 48-year-old woman with heavy vaginal bleeding and slight dizziness?
A) Non-steroidal anti-inflammatory agents
B) Medroxyprogesterone
C) Conjugated estrogen
D) Blood transfusion
E) Hysterectomy
C) Conjugated estrogen
Explanation: In cases of heavy vaginal bleeding, especially with signs of potential hypovolemia, the administration of conjugated estrogen is often the first step to stabilize the patient and manage bleeding.
p.5
Endometriosis and Infertility
What is the best action for a 23-year-old nulligravida patient who has been trying to conceive for 3 months with regular periods and no prior reproductive problems?
A) Sperm count
B) Continue trying
C) Genetic testing
D) Tubal patency test
E) IVF consultation
B) Continue trying
Explanation: Given that the patient is young and has no reproductive issues, the best course of action is to continue trying for a while longer before pursuing further testing.
p.9
Fetal Monitoring and Labor Management
Which fetal presentation is favorable for vaginal delivery in a twin gestation?
A) Transverse-cephalic
B) Cephalic-cephalic
C) Breech-breech
D) Breech-cephalic
E) Cephalic-breech
B) Cephalic-cephalic
Explanation: The cephalic-cephalic presentation is the most favorable for vaginal delivery in a twin gestation, as both fetuses are in the optimal position for birth.
p.9
Diagnosis and Management of Ovarian Torsion
What is the most likely diagnosis for a 30-year-old woman with severe right-sided abdominal pain and a confirmed 6 cm mass?
A) Ectopic pregnancy
B) Ovarian torsion
C) Ruptured cyst
D) Appendicitis
E) Ovarian cancer
B) Ovarian torsion
Explanation: The presentation of sudden severe pain, nausea, and the presence of a mass on ultrasound strongly suggests ovarian torsion, which is a surgical emergency.
p.9
Postpartum Care and Complications
When is the optimal time to administer intravenous antibiotics for a patient undergoing a cesarean section?
A) During pre-operative preparation
B) Upon closure of the skin wound
C) After the umbilical cord is clamped
D) Postoperative
E) Before anesthesia induction
A) During pre-operative preparation
Explanation: Administering intravenous antibiotics during pre-operative preparation is crucial to reduce the risk of postoperative infections during a cesarean section.
p.9
Complications of Multiple Pregnancies
What is the most important intervention for a nulliparous woman at 42 weeks' gestation with fetal heart tones dropping to 80 beats per minute?
A) Administer oxygen at 10 L/min by facemask
B) Prepare for an urgent cesarean section
C) Administer subcutaneous terbutaline
D) Increase fluid intake
E) Monitor fetal heart rate continuously
B) Prepare for an urgent cesarean section
Explanation: The significant drop in fetal heart tones indicates fetal distress, necessitating urgent intervention, likely a cesarean section, to ensure the safety of the fetus.
p.19
Endometriosis and Infertility
A 33-year-old woman with a history of amenorrhea for a year following dilation and curettage has normal serum FSH levels and no response to withdrawal tests. What is the most likely diagnosis?
A) Kallman syndrome
B) Sheehan syndrome
C) Asherman syndrome
D) Polycystic ovarian syndrome
E) Turner syndrome
C) Asherman syndrome
Explanation: The history of dilation and curettage, along with the lack of response to hormonal withdrawal tests, suggests intrauterine adhesions characteristic of Asherman syndrome.
p.2
Complications of Multiple Pregnancies
What best describes the membranes and placenta of dizygotic twins?
A) Monochorionic and monoamniotic for conjoined twins
B) Monochorionic and diamniotic for the fetuses of the same sex
C) Dichorionic and monoamniotic for the fetuses of the same sex
D) Dichorionic and diamniotic regardless of the sex of the fetuses
E) Monochorionic and monoamniotic regardless of the sex of the fetuses
D) Dichorionic and diamniotic regardless of the sex of the fetuses
Explanation: Dizygotic twins are always dichorionic and diamniotic, meaning they each have their own placenta and amniotic sac, regardless of their sex.
p.12
Endometriosis and Infertility
What is the most likely diagnosis for a 30-year-old woman with severe dysmenorrhea unrelieved by naproxen?
A) Endometriosis
B) Leiomyomata
C) Endometrial hyperplasia
D) Pelvic congestion
E) Ovarian cysts
A) Endometriosis
Explanation: Severe dysmenorrhea that is unresponsive to NSAIDs like naproxen is highly suggestive of endometriosis, which is characterized by painful menstruation.
p.11
Management of Asthma in Pregnancy
What is the next step in management for a 28-year-old woman at 37 weeks' gestation with spontaneous rupture of membranes and fever?
A) Provide spinal analgesia
B) Intravenous intrapartum antibiotics
C) Urgent delivery by caesarean section
D) Administer intramuscular dexamethasone
E) Monitor fetal heart rate only
B) Intravenous intrapartum antibiotics
Explanation: Given the patient's fever and the risk of infection following rupture of membranes, the most appropriate next step is to administer intravenous antibiotics to prevent potential complications such as chorioamnionitis.
p.11
Diagnosis of Ectopic Pregnancy
What is the most likely diagnosis for a 32-year-old woman at 16 weeks pregnant with a 'snowstorm-like' ultrasound appearance?
A) Complete hydatidiform mole
B) Chorioadenoma destruens
C) Partial hydatidiform mole
D) Choriocarcinoma
E) Ectopic pregnancy
A) Complete hydatidiform mole
Explanation: The 'snowstorm-like' appearance on ultrasound and elevated levels of human chorionic gonadotropin are characteristic of a complete hydatidiform mole, indicating abnormal placental development.
p.1
Fetal Monitoring and Labor Management
What is the most likely diagnosis for a 35-year-old woman at 34 weeks of gestation presenting with labor pains and a cervix dilated to 4 cm?
A) Placenta previa
B) Head compression
C) Umbilical cord compression
D) Uteroplacental insufficiency
D) Uteroplacental insufficiency
Explanation: Given the patient's gestational age and the presence of labor pains with a dilated cervix, uteroplacental insufficiency is the most likely diagnosis, as it can lead to fetal distress and complications during labor.
p.1
Diagnosis and Management of Ovarian Torsion
What is the most likely diagnosis for a 21-year-old woman with severe lower abdominal pain, tenderness in the right iliac fossa, and a negative pregnancy test?
A) Acute cysts
B) Ovarian torsion
C) Acute appendicitis
D) Ectopic pregnancy
B) Ovarian torsion
Explanation: The symptoms of severe lower abdominal pain, tenderness, and guarding, particularly on the right side, along with a negative pregnancy test, suggest ovarian torsion as the most likely diagnosis.
p.1
Diagnosis of Ectopic Pregnancy
Which of the following is the most likely predisposing factor for an ectopic pregnancy in a 28-year-old woman?
A) Induction of ovulation
B) Previous tubal pregnancy
C) Pelvic inflammatory disease
D) Use of an intrauterine contraceptive device
B) Previous tubal pregnancy
Explanation: A previous tubal pregnancy is a significant risk factor for future ectopic pregnancies, making it the most likely predisposing factor in this scenario.
p.18
Vaginal Bleeding in Pregnancy
What is the most likely diagnosis for the 39-year-old primigravida with elevated blood pressure but negative urinalysis for protein?
A) Eclampsia
B) Chronic hypertension
C) Gestational hypertension
D) Superimposed preeclampsia
E) Pre-existing hypertension
C) Gestational hypertension
Explanation: The patient presents with elevated blood pressure at 39 weeks of gestation without proteinuria, indicating a diagnosis of gestational hypertension.
p.10
Fetal Monitoring and Labor Management
Which significant medical history indicates beneficial use of forceps during delivery?
A) Herpes
B) Asthma
C) Hypertension
D) Prolonged rupture of membranes (PROM)
E) Mitral valve stenosis
D) Prolonged rupture of membranes (PROM)
Explanation: Prolonged rupture of membranes can increase the risk of infection, making the use of forceps beneficial to expedite delivery and reduce potential complications.
p.6
Fetal Monitoring and Labor Management
What is the most accurate Apgar score for the neonate described?
A) 6
B) 7
C) 8
D) 9
E) 10
C) 8
Explanation: The Apgar score is calculated based on five criteria: heart rate, breathing, reflex irritability, activity, and appearance. The neonate's scores are: Heart rate (2), Breathing (1), Reflex irritability (2), Activity (1), Appearance (2), totaling 8.
p.6
Postpartum Care and Complications
Which vaccine is most appropriate to administer to the gravida 2 para 0 woman who is afraid of having another stillbirth?
A) Rubella
B) Measles
C) Influenza
D) Tdap
E) Varicella
C) Influenza
Explanation: The influenza vaccine is recommended during pregnancy to protect both the mother and the fetus from severe illness, especially since the patient is currently pregnant.
What is the most appropriate initial step in the evaluation of a 27-year-old nulliparous woman concerned about infertility?
A) Referral to a reproductive specialist
B) Basal body temperature charting
C) Hysterosalpingogram
D) Semen analysis
E) Ovulation induction
A) Referral to a reproductive specialist
Explanation: Given the patient's concern about infertility after one year of unprotected intercourse, the most appropriate initial step is to refer her to a reproductive specialist for a comprehensive evaluation.
p.1
Vaginal Bleeding in Pregnancy
What is the most likely cause of vaginal bleeding in a 28-year-old woman with a history of cervical incompetence?
A) Luteal phase defect
B) Asherman's syndrome
C) Cervical incompetence
D) Chromosomal abnormality
D) Chromosomal abnormality
Explanation: In this case, the woman's history of cervical incompetence and previous second-trimester abortions suggests that chromosomal abnormalities are a likely cause of her current vaginal bleeding, especially given the context of early pregnancy.
p.8
Complications of Multiple Pregnancies
What complication is most likely to occur with a uterine fundus measuring 25 cm above the symphysis and fetal heart tones at 160 beats per minute?
A) Stillbirth
B) Pre-eclampsia
C) Shoulder dystocia
D) Large for gestational age infant
E) Placental abruption
B) Pre-eclampsia
Explanation: The elevated fundal height and fetal heart rate can indicate increased risk factors, including pre-eclampsia, especially in a multiparous woman.
p.18
Fetal Monitoring and Labor Management
What is the most appropriate next step in management for the 25-year-old woman in labor with a cervix dilated to 6 cm?
A) Advise CT pelvimetry
B) Emergency caesarean section
C) Augment labor with oxytocin
D) Monitor partographic progress
E) Perform an epidural anesthesia
D) Monitor partographic progress
Explanation: In this scenario, the appropriate next step is to monitor the partographic progress of labor, as the patient is already in active labor with significant cervical dilation.
p.18
Complications of Multiple Pregnancies
For the 33-year-old woman with severe lower abdominal pain and suspected bilateral tubo-ovarian abscesses, what is the most appropriate next step in management?
A) Exploratory laparotomy
B) Intravenous antibiotic therapy
C) Emergent laparoscopic drainage
D) CT-guided percutaneous drainage
E) Observation and follow-up
B) Intravenous antibiotic therapy
Explanation: The most appropriate initial management for suspected tubo-ovarian abscesses is intravenous antibiotic therapy to address the infection before considering surgical options.
p.2
Complications of Multiple Pregnancies
What condition is associated with the finding of a single artery in the umbilical cord?
A) African race
B) Maternal diabetes
C) Low fetal mortality
D) Major fetal malformation in 80%
E) Maternal hypertension
B) Maternal diabetes
Explanation: The presence of a single umbilical artery is often associated with maternal diabetes, which can lead to various fetal anomalies and complications.
p.16
Endometriosis and Infertility
What is the most likely diagnosis for the 19-year-old woman with crampy lower abdominal pain during menses?
A) Secondary dysmenorrhea
B) Premenstrual syndrome
C) Primary dysmenorrhea
D) Endometriosis
E) Ovarian cysts
C) Primary dysmenorrhea
Explanation: The symptoms of crampy abdominal pain that begins with menses and radiates, without pain between menses, are characteristic of primary dysmenorrhea.
p.12
Management of Asthma in Pregnancy
What is the greatest risk to the unborn child of a 25-year-old woman who smoked one pack of cigarettes per day?
A) Macrosomia
B) Low birth weight
C) Transient tachypnea
D) Neonatal hypoglycemia
E) Preterm labor
B) Low birth weight
Explanation: Smoking during pregnancy is strongly associated with low birth weight, making it the greatest risk to the unborn child in this scenario.
p.12
Diagnosis of Ectopic Pregnancy
What is the most appropriate next investigation for a 40-year-old woman with post-coital bleeding and a cervical mass?
A) Pap smear
B) Cone biopsy
C) RNA analysis
D) Directed biopsy
E) Colposcopy
D) Directed biopsy
Explanation: A directed biopsy of the cervical mass is the most appropriate next step to obtain tissue for diagnosis, especially in the context of post-coital bleeding.
In a patient with dysfunctional uterine bleeding, what is the first step in management?
A) Dilation and curettage
B) Oral contraceptive pill
C) Endometrial ablation
D) Hysterectomy
E) Blood transfusion
B) Oral contraceptive pill
Explanation: The first step in managing dysfunctional uterine bleeding is often the use of oral contraceptive pills to help regulate the menstrual cycle and reduce bleeding.
p.17
Vaginal Bleeding in Pregnancy
What is the most likely site of hymeneal tear suggestive of penile penetration in a 14-year-old child who presented with anogenital erythema and mild vaginal bleeding?
A) 2 o'clock
B) 4 o'clock
C) 6 o'clock
D) 8 o'clock
E) 10 o'clock
C) 6 o'clock
Explanation: The 6 o'clock position is commonly associated with tears resulting from penile penetration, making it the most likely site of hymeneal tear in this case.
p.11
Diagnosis and Management of Ovarian Torsion
What is the most appropriate treatment for a hemodynamically stable woman with a 2.5 x 3 cm tubal ectopic pregnancy?
A) Laparoscopy
B) Observation
C) Laparotomy
D) Medical management
E) Expectant management
A) Laparoscopy
Explanation: For a stable patient with a confirmed ectopic pregnancy, laparoscopic surgery is often the preferred treatment to remove the ectopic tissue and prevent complications.
p.4
Diagnosis of Ectopic Pregnancy
Which structure remains fully sensitive despite a pudendal nerve block?
A) Urogenital diaphragm
B) Perineal body
C) Rectum
D) Vulva
E) Ischial spine
C) Rectum
Explanation: The pudendal nerve block primarily affects the sensory innervation of the perineum and external genitalia, but the rectum remains fully sensitive as it is innervated by the pelvic splanchnic nerves.
p.4
Complications of Multiple Pregnancies
What is the most likely diagnosis for a 37-year-old primigravida with amenorrhea, hyperemesis gravidarum, and a uterus size equivalent to 16 weeks' gestation?
A) Choriocarcinoma
B) Hydatidiform mole
C) Toxemia of pregnancy
D) Placental site trophoblastic tumor
E) Ectopic pregnancy
B) Hydatidiform mole
Explanation: The symptoms of hyperemesis gravidarum and elevated hCG levels, along with a uterus larger than expected for gestational age, suggest a hydatidiform mole, which is characterized by abnormal placental growth.
p.4
Use of RhoGAM in Pregnancy
What is the indication for administering RhoGAM?
A) Mother is Rh- and the baby is Rh+
B) Father is Rh+ and the baby is Rh-
C) Mother is Rh+ and the baby is Rh-
D) Father is Rh- and the baby is Rh+
E) Mother is Rh- and the father is Rh-
A) Mother is Rh- and the baby is Rh+
Explanation: RhoGAM is given to Rh-negative mothers to prevent the development of antibodies against Rh-positive blood cells, particularly when the baby is Rh-positive.
p.14
Vaginal Bleeding in Pregnancy
What is the most appropriate initial management for a 34-week pregnant woman in labor with heavy vaginal bleeding and a retroplacental sonolucent area?
A) Administration of a tocolytic agent
B) Oxytocin augmentation
C) Caesarean section
D) Amniotomy
E) Bed rest
C) Caesarean section
Explanation: Given the heavy vaginal bleeding and the presence of a retroplacental sonolucent area, a Caesarean section is the most appropriate initial management to ensure the safety of both the mother and the fetus.
p.14
Diagnosis and Management of Ovarian Torsion
What is the best advice regarding Pap smear screening for a 40-year-old sexually active patient with a regular menstrual cycle?
A) Yearly screening recommended
B) Every 5 years is recommended
C) No routine screening recommended
D) Three negative results and no further screening
E) Screening only if symptomatic
A) Yearly screening recommended
Explanation: For sexually active women, yearly Pap smear screening is recommended to detect cervical cancer early, especially in the context of regular menstrual cycles.
p.12
Diagnosis and Management of Ovarian Torsion
What is the next step in management for a 48-year-old obese woman with nausea and a dusky cervix?
A) Progesterone challenge
B) Pelvic ultrasound
C) Beta-hCG test
D) Huhner's test
E) Endometrial biopsy
C) Beta-hCG test
Explanation: Given the patient's symptoms and the possibility of pregnancy despite using barrier methods, a Beta-hCG test is the most appropriate next step to confirm or rule out pregnancy.
p.9
Diagnosis of Ectopic Pregnancy
What is the most appropriate next step for a 34-year-old woman with rising B-human chorionic gonadotropin levels after methotrexate treatment?
A) Exploratory laparoscopy
B) Repeat methotrexate
C) Salpingectomy
D) Salpingostomy
E) Observation
A) Exploratory laparoscopy
Explanation: Given the rising B-human chorionic gonadotropin levels and the patient's symptoms, exploratory laparoscopy is warranted to assess for potential complications such as a ruptured ectopic pregnancy.
p.20
Postpartum Care and Complications
What preventive measure should be taken for a 37-year-old woman with a history of recurrent postpartum hemorrhage at delivery?
A) Deliver the patient in the operating room
B) Administer oxytocin prophylactically
C) Perform a cesarean section
D) Monitor vital signs closely
E) Provide iron supplements
A) Deliver the patient in the operating room
Explanation: Given her history of recurrent postpartum hemorrhage, delivering in the operating room allows for immediate access to surgical intervention if needed, making it a prudent preventive measure.
p.8
Management of Asthma in Pregnancy
Why is a caesarean section necessary for a woman with twins, where Twin A is breech and Twin B is cephalic?
A) Ruptured membranes
B) Previous caesarean
C) Fetal presentation
D) Fetal age
E) Maternal request
B) Previous caesarean
Explanation: The history of a previous caesarean section increases the likelihood of requiring another caesarean, especially with the current breech presentation of Twin A.
p.8
Use of RhoGAM in Pregnancy
What is the next best step in management for a pregnant woman who has never had chickenpox and has a negative serum antibody test?
A) Avoid exposure
B) Varicella vaccination
C) Prophylactic acyclovir
D) Zoster immunoglobulin
E) Immediate delivery
A) Avoid exposure
Explanation: The best immediate management for a woman without immunity to chickenpox is to avoid exposure to the virus.
p.8
Complications of Multiple Pregnancies
In a 34-year-old woman with hypertension taking labetalol, which risk is increased during her pregnancy?
A) Intrauterine growth restriction
B) Abnormal fetal presentation
C) Adherent placenta
D) Uterine rupture
E) Preterm labor
A) Intrauterine growth restriction
Explanation: Hypertension during pregnancy is associated with an increased risk of intrauterine growth restriction due to compromised placental blood flow.
p.2
Fetal Monitoring and Labor Management
What is the advantage of a mediolateral episiotomy during the second stage of labor?
A) Easy repair
B) Less infection
C) Tighter introitus
D) Less anal extension
E) Faster delivery
D) Less anal extension
Explanation: A mediolateral episiotomy is designed to reduce the risk of anal extension during delivery, which can occur with a midline episiotomy.
p.3
Postpartum Care and Complications
In a patient with recurrent bleeding after intercourse, what is the likely source of her bleeding?
A) Uterine cervix
B) Uterine body
C) Vagina
D) Vulva
E) Ovaries
A) Uterine cervix
Explanation: In cases of recurrent bleeding after intercourse, the uterine cervix is often the source, especially in patients with a history of genital warts, which can lead to cervical changes.
p.14
Endometriosis and Infertility
Which treatment is best evidenced for a woman with recurrent symptoms of severe depression linked to her menstrual cycle?
A) Selective serotonin uptake inhibitors
B) Oral medroxyprogesterone acetate
C) Progesterone vaginal suppositories
D) Transdermal estrogen patches
E) Cognitive behavioral therapy
A) Selective serotonin uptake inhibitors
Explanation: Selective serotonin uptake inhibitors (SSRIs) are well-supported by evidence for treating premenstrual dysphoric disorder (PMDD), which aligns with the patient's symptoms.
p.16
Endometriosis and Infertility
What is the most likely diagnosis for the 24-year-old woman with cyclic pelvic pain and heavy menstrual flow?
A) Pelvic inflammatory disease
B) Uterine fibroids
C) Endometriosis
D) Adenomyosis
E) Ovarian cysts
C) Endometriosis
Explanation: The cyclic nature of the pelvic pain, heavy menstrual flow, and physical exam findings are indicative of endometriosis.
p.3
Management of Asthma in Pregnancy
What is the most appropriate medication regimen for a 28-year-old woman with worsening asthma during pregnancy?
A) Short-acting bronchodilators and oral glucocorticoids
B) Inhaled glucocorticoids and short-acting bronchodilators
C) Inhaled glucocorticoids and long-acting bronchodilators
D) Long-acting beta2 agonist and inhaled glucocorticoids
E) Oral beta2 agonists
C) Inhaled glucocorticoids and long-acting bronchodilators
Explanation: For a pregnant woman with worsening asthma symptoms, the combination of inhaled glucocorticoids and long-acting bronchodilators is recommended to provide better control of asthma symptoms.
p.4
Diagnosis of Ectopic Pregnancy
What is the likely diagnosis for a 24-year-old woman with severe abdominal pain, vaginal bleeding, and a tense abdomen, with a history of LMP 8 weeks ago?
A) Ectopic pregnancy
B) Miscarriage
C) Ovarian torsion
D) Placental abruption
E) Uterine rupture
A) Ectopic pregnancy
Explanation: The combination of severe abdominal pain, vaginal bleeding, and hypotension suggests a ruptured ectopic pregnancy, which is a medical emergency requiring immediate attention.
p.6
Endometriosis and Infertility
Which additional laboratory values should be obtained for the 20-year-old woman with severe facial acne and irregular menstrual bleeding?
A) Thyroid stimulating hormone and free T3 and T4
B) Progesterone and thyroid stimulating hormone
C) Dehydroepiandrosterone and androstenolone
D) Glucose tolerance and lipid profile
E) Serum electrolytes and creatinine
D) Glucose tolerance and lipid profile
Explanation: Given the patient's symptoms and body mass index, assessing glucose tolerance and lipid profile is important to evaluate for potential metabolic syndrome or insulin resistance.
p.16
Endometriosis and Infertility
For a couple trying to conceive for 6 months, what is the most appropriate investigation?
A) Serum TSH
B) Serum prolactin
C) Urinary FSH/LH
D) Day 21 progesterone
E) Semen analysis
D) Day 21 progesterone
Explanation: Day 21 progesterone testing is used to assess ovulation, which is crucial for understanding fertility issues in couples trying to conceive.
p.3
Management of Asthma in Pregnancy
Which initial test is most appropriate for a 34-year-old woman presenting with coughing and difficulty breathing during pregnancy?
A) Spirometry
B) Chest X-ray
C) Arterial blood gas levels
D) Hemoglobin estimation
E) Peak flow measurement
A) Spirometry
Explanation: Spirometry is the most appropriate initial test to assess lung function in a patient with respiratory symptoms, especially in the context of asthma exacerbation during pregnancy.
p.2
Postpartum Care and Complications
What condition is suggested by a 28-year-old pregnant woman presenting with a productive cough, night chills, and crepitations over the upper left lobe?
A) Asthma
B) Tuberculosis
C) Pneumonia
D) Bronchitis
E) Allergic reaction
B) Tuberculosis
Explanation: The symptoms of a productive cough, night chills, and crepitations, along with the patient's history of receiving a BCG vaccine, suggest a possible case of tuberculosis, especially in an immigrant population.
p.12
Endometriosis and Infertility
What is the likely cause of infertility in a 30-year-old woman with irregular menstrual cycles and elevated TSH levels?
A) Polycystic ovary syndrome
B) Thyroid dysfunction
C) Uterine fibroids
D) Endometriosis
E) Ovarian insufficiency
B) Thyroid dysfunction
Explanation: The elevated TSH level indicates hypothyroidism, which can lead to irregular menstrual cycles and infertility, making it a likely cause in this scenario.
p.19
Diagnosis of Ectopic Pregnancy
What is the most probable diagnosis for a 25-year-old woman with a positive pregnancy test, no intrauterine pregnancy seen on ultrasound, and lower abdominal pain?
A) Ruptured corpus luteum
B) Ectopic pregnancy
C) Molar pregnancy
D) Missed abortion
E) Ovarian torsion
B) Ectopic pregnancy
Explanation: The combination of a positive pregnancy test, absence of an intrauterine pregnancy on ultrasound, and lower abdominal pain suggests an ectopic pregnancy, which is a medical emergency.
p.14
Management of Asthma in Pregnancy
What is the most appropriate management for a pregnant woman with a history of severe depression stabilized on paroxetine?
A) Discontinue paroxetine to avoid prematurity
B) Continue paroxetine and monitor for depression
C) Discontinue paroxetine to avoid fetal damage
D) Continue paroxetine and add lithium
E) Switch to a different antidepressant
B) Continue paroxetine and monitor for depression
Explanation: Continuing paroxetine while monitoring for depression is appropriate, as the benefits of managing the mother's mental health outweigh the risks of medication during pregnancy.
