Prenatal Care
A 25yo multiparous patient at 12+0 GA has a Ucx performed at her initial OB visit. She denies dysuria, increased frequency, suprapubic pain during this pregnancy. She has NKDA. The urine culture grow 10,000 cfu/mL of group B streptococcus. The most appropriate management related to the above Ucx result is:
A) antimicrobial treatment based on retrovaginal sampling at 36-37 wk GA
b)antimicrobial treatment now
C) intrapartum antimicrobial treatment
D) monthly urien cultures
E) third-trimester antimicrobial treatment
What is intrapartum antimicrobial use? (68)
A 42yo divorced woman presents for an annual. She works as a nurse and is an avid traveler. No pertinent history. Received her annual flu shot, up to date for travel/work vaccines. The most appropriate immunization for this patient today is:
A) hep B B) HPV C) Pneumococcal D) Tdap E) Varicella
What is HPV?
The most common cause of vaginal discharge in a a sexually active 19 year old is
What is bacterial vaginosis?
A 33yo P1001 presents for contraception counseling. H/o breast cancer 3 years ago currently on tamoxifen. Eventually desires future children, but wants effective contraception method at this time. The most appropriate contraception for this patient is ...
What is Copper IUD?
A 68yo with h/o HTN presents with vaginal pain with intercourse. She recently initiated sexual activity with a new partner. She hasn't been sexually active since her husband died 10 years ago. The pain is both insertional and deep. Denies dysuria, vasomotor symptoms. Physical exam remarkable for moderate vaginal atrophy. In addition to use of lubrication/vaginal moisturizer the most effective treatment is....
a) estrogen b) flibanserin c ) ospemifene d) prasterone e) testosterone
What is estrogen?
A 34yo women presents at 6wk GA based on LMP. She is experiencing some spotting. reports having an US one week ago showing sac in her uterus. On exam scant dark vaginal bleeding with closed cervix. Repeat TVUS demonstrates an intrauterine GS w/ mean diameter 27mm without a yolk sac or fetal pole. No adnexal masses. BHCG 1700. The finding that confirms a diagnosis of non-viable pregnancy in this patient is:
A) abscence of an embryo 1 week after documented GS
B) BHCG > 1500 without a yolk sac
C) mean sac diameter > 25mm without an embryo
D) Positive pregnancy test with vaginal bleeding
E) pregnancy at 6wk GA by LMP without an embryo
What is mean sac diameter > 25mm without an embryo? (102)
An 80yo presents for a routine annual visit, reporting complaints of fatigue and resistant constipation. History notable for HTN controlled on Lisinopril. She is not taking any additional medications denies significant PMH/Surg Hx. She is frail, dependent on caretakers for daily activities of living. Physical exam unremarkable. Labs ordered by her geriatrician notable for TSH of 11mIU/L, TSH/free T3 wnl. Serum antithyroid peroxidase antibody levels elevated. The best next step is:
A) Request thyroid US
B) Retest thyroid hormone in 6mo
C) Start levothyroxine
D) test for antithyroglobulin antibody titer
What is retest thyroid hormone in 6 months?
A) bone age assessment B) follow up 1 year C) lab evaluation D) pelvic sonogram
What is follow up in one year?
A 28yo P0 presents for contraception counseling. She has been happy with amenorrhea while on depot medroxyprogesterone acetate (DMPA) for contraception for the previous 2 years. She is concerned about the risk of bone dentity loss. She is a non-smoker, BMI 24, does not desire pregnancy. She's tried IUD, Nexplanon and OCP in past which all induced irregular bleeding. The most appropriate birth control for this patient is....
What is DMPA?
A 65yo patient returns for a follow up visit. She was seen in the office 6mo ago for several days of period-like bleeding. TVUS showed anteverted homogeneous-appearing uterus with 3mm endometrial stripe, normal appearing ovaries. No h/o abnormal paps. When asked about vaginal bleeding today she reports intermittent spotting every few weeks. On exam slightly atrophic vaginal epithelium without trauma, normal appearing cervix. STI testing negative. The most appropriate next test to perform is: A) colposcopy B) CT AP C) endometrial sampling D) saline infusion ultrasonography E) transvaginal sonogram
what is endometrial sampling? (64)
A) 1-2% B) 2-5% C) 6-7% D) 8-9% E) 10-12%
What is 2-5%?
A) grand multiparity B) family history C) BMI D) Tobacco use
A 28yo woman presents to the office for an annual exam.She reports increasing distress in current relationship due to lack of interest in sexual activity with her partner over the past year. She was not sexually active prior to this relationship. She denies feeling pain during intercourse, but also denies pleasure or arousal. No other pertinent history. Which treatment should patient start?
A) Flibanserin B) Low dose vaginal estrogen therapy C) Ospemifene D) Sildenafil citrate E) Systemic dehydroepiandrosterone
A) CDC B) state legistlatures C) state medical boards D) U.S Congress
What is state legislatures (67)
A 52yo patient presents to clinic to discuss her menopausal symptoms. She hasn't had a period in 8months and is experiencing frequent hot flashes and night seats. She takes lisinopril for HTN. Her anxiety disorder is well controlled on paroxetine therapy, lifestyle modifications and gabapentin but shays her "symptoms are so bad" and she needs something else. VS: HR 76 BP 154/96 BMI 41. PE unremarkable. She wants to avoid hormonal therapy. In addition to lifestyle modifications, the most appropriate option is:
A) add black cohosh B) add clonidine C) add phytoestrogen D) discontinue lisinopril
What is add clonidine? (70)
A 30yo G2P1 presents for routine PNC at 30wk GA. She has a 3year h/o opioid use disorder and has been on methadone therapy for past 2 years. She has been on the same dose of methadone the entire pregnancy. In the past 2 weeks she has been waking up with chills and a racing heart in the middle of the night. She has been craving additional opioids and has taken a few pills from her mother's house. The best next step in managing her opioid disorder is to:
A) add naloxone
B) increase methadone dose
C) initiate gradual methadone taper
D) switch to buprenorphine
E) switch to naltrexone
What is increase methadone dose? (110)
A 52yo woman presents for her annual exam. PMH notable for hypothyroidism for which she takes levothyroxine. Denies other comorbidities. Physical exam and labs are normal. Recently entered a new relationship after her divorce. She is up to date with her influenza and COVID-19 vaccines. She reports having all her childhood vaccines and received her TDAP 7 years ago. The vaccine recommended for her at this time is:
A) human papillomavirus
B) MMR
C) pneumococcal
D) recombinant zoster
E) Tdap
What is recombinant zoster? (105)
A 43yo multiparous patient presents with a 4mo h/o abdominal fullness. Menses q 45-60 days for past 2 years. Denies significant PMH, maternal aunt had breast cancer age 60. On pelvic exam provider notes a fixed nodular 6cm mass in right adnexa. US confirms a 6.2cm cystic mass with 2mm thick septation. CA 125 50. The finding that most indicates she should be referred to a gynecologist oncologist is:
A) CA 125 concentration B) family history C) mass separation D) physical exam findings E) size of mass of US
What are physical exam findings?
A 26yo P0 with an IUD in situ presents for an annual exam. She has been happy with the device and indicates no complaints. The result of her pap indicates that she has Actinomyces as seen on cytology. How should this be managed?
A) Remove IUD, prescribe doxycycline
B) Prescribe doxycycline
C) Remove IUD, prescribe ceftriaxone
D) Prescribe ceftriaxone
E) No intervention
What is no intervention?
A 62yo presents to clinic with vaginal dryness and irritation due to vaginal atrophy. Her PMH includes hysterectomy with bilateral salpingoophorectomy 6 months ago for endometrial adenocarcinoma. Which of the following is the most appropriate first step in medical management of her symptoms?
A) estradiol oral tablets
B) estradiol vaginal cream
C) Progesterone vaginal suppository
D) Vaginal Dilator
E) Vaginal Moisturizer
What is vaginal moisturizer?
A 42yo P0120 at 11wk3d GA undergoes chorionic villus sampling. She is known to be Rh negative. Which is the correct dose range of anti-D immune globulin in this patient?
A) 10-40 mcg B) 50-120 mcg C) 125-300mcg D) 260-310 mcg E) 300-350 mcg
What is 50-120mcg?
< 12wk 50-120
>12wk 300mcg
300mcg protects against sensitization from up to 30mL fetal whole blood.
A 77yo women presents to the office for her annual well-woman visit. She recently moved into assisted living because of dementia and difficulty performing her daily activities of living. Her last mammogram was 2 years ago and all her previous mammography results were normal. The recommended breast surveillance strategy for this patient is:
A) Breast ultrasonography
B) clinical breast examination
C) mammography
D) no additional screening
What is no additional screening? (115)
A 17yo adolescent comes to your office reporting heavy menstrual bleeding for past 10 months. Menarche age 11, regular menses until recently. PMH notable for depression (management with fluoxetine), moderate asthma (takes fluticasone and Vitamin D daily) and dysmenorrhea (managed with naproxen). Without clinical consultation she began taking St John's wort to improve her mood. VSS. PE unremarkable. The medication she is taking currently that is most likely causing her heavy menstrual bleeding is:
A) Fluoxetine B) Fluticasone C) Naproxen D) St Johns Wort E) Vitamin D
What is Fluoxetine? (90)
A patient presents to the office for contraceptive counseling. She does not wish to try for childbearing for at least 4 years and is interested in the IUD. Her only concern is the risk of pelvic inflammatory disease with the IUD as she read an article online implying IUDs cause PID. The physician informs the patient that the risk of PID with an IUD is approximately:
A) Not possible
B) <1%
C) 2-5%
D) 6-10%
E: 11-15%
What is <1%?
A 57yo presents to the office complaining of "hot flashes" and she is interested in non-hormonal treatment of her symptoms. Which of the following medications is approved by the FDA for treatment of vasomotor symptoms?
A) Clonidine B) Gabapentin C) Methyldopa D) Paroxetine E) Venlafaxine