Like mother, like daughter
A 42 yo woman, G2P2, with an unremarkable PMH recently received a diagnosis of a BRCA 1 mutation. She is in good health and has a BMI of 28. Her mother received a diagnosis of stage IIIC ovarian cancer at age 56 years. The best option to reduce her future risk of breast and ovarian cancer is:
A) combined OCP use until age 50
B) prophylactic mastectomy and BSO
C) biannual TVUS, breast MRI, and mammography
D) bilateral tubal ligation
B) prophylactic mastectomy and BSO
Q#127
A 69 yo woman comes to your office and reports increasing urinary incontinence over the last year. The episodes have occurred with coughing or when she has been unable to make it to the bathroom in time. She has been menopausal for 12 years and has no chronic medical problems. The answers on the 3IQ assessment tool suggest she may have mixed incontinence. In addition to this screening questionnaire, a complete history, PE, UA, and urine culture, the next step in this patient's management should be:
A) voiding diary
B) anticholinergic therapy
C) urodynamic testing
D) Kegel exercises
E) pessary
A) voiding diary
Q#20
A 38 yo G0 woman comes to your office with lower abdominal cramping for the past 2 years. The pain is worse during menses, which are regular in frequency, duration, and amount. Her LMP was 3 weeks ago. She reports bloating and rectal pressure that is partially relieved by defecation, occasional diarrhea, and passage of mucus for two years. She has experienced occasional pain with urination for 2 months. UA results are negative for WBCs and LE. Pelvic examination reveals a 5cm left pelvic mass.
A) laparoscopy
B) CT scan
C) colonscopy
D) ultrasound
E) MRI
D) ultrasound
Q#29
A 67yo women comes to your office with dyspareunia and vaginal dryness. She has been sexually abstinant for the past 10 years because of her late husband's chronic health concerns. Previously, she enjoyed sexual acitivities, including vaginal penetration. She is recently widowed, and has a new partner. However, she finds she is unable to tolerate vaginal penetration because of severe pain. Vulvar and vaginal exam reveals smooth, pale, epithelium. Microscopic exam shows scant, small, round immature parabasal cells. Vaginal pH is 5. You do not observe clue cells, candidiasis, or increased infamed cells. The most likely diagnosis is:
A) Vaginal atrophy
B) Lichen sclerosis
C) Lichen planus
D) Desquamative inflammatory vaginitis
E) Pemphigus vulgaris
A) Vaginal atrophy
Q#10
A) serum etonorgestrel level measurement
B) follow up in 6 months if not pregnant
C) incision and exploration
D) X-ray of the arm
D) X-ray of the arm
Q#19
For the clinical scenario below, what would be the appropriate cervical cancer screening?
A 72 yo postmenopausal woman with stress urinary incontinence and normal pap test history.
No further cervical cancer screening recommended
Q#138-142
Name that familial cancer syndrome:
A 48 year old woman with ovarian cancer has a family history of colon cancer in her father and brother
What is Lynch II syndrome
Q#147-149
A 29 yo woman presents to your office following treatment for a 4th UTI after sexual intercourse in the past year. She has a TOC that indicates that her last course of treatment was successful and she is asymptomatic today. You discuss with her a number of approaches to reduce the risk of such infections, including prophylactic antibiotics, daily ingestion of cranberry juice, voiding immediately after intercourse, postcoital douching, and daily ingestion of D-mannose. She would prefer to avoid antibiotics because antibiotic therapy for her UTIs has lead to monilial vaginitis on two occasions. You inform her that the method with the best evidence to support reduction of risk of recurrent UTIs is:
A) prophylactic antibiotics
B) daily cranberry juice
C) postcoital voiding
D) postcoital douching
E) daily D-mannose
A) prophylactic antibiotics
Q#115
55yo woman comes to the ED 2 weeks after an uncomplicated TLH/BSO. SHe has been experiencing fevers, chills, and pelvic pain but reports normal bowel and bladder function. Examination is remarkable for an intact vaginal cuff, with a 5cm fluctuant mass noted with mild, diffuse abdominal pain. Temp is 101F but otherwise stable vital signs. Labs are notable for an elevated WBC. CT demonstrates a 10x10x10cm pelvic fluid collection, consistent with a post-operative abscess, superior to the vaginal cuff. The next best step in management is:
A) oral abx
B) hospital observation
C) IV antibiotics
D) Drainage of the abscess
D) Drainage of the abscess
Q#66
A 62 yo G2P2 female is referred for recurrent PMB. She reports a history of light bleeding 6 months ago. At that time, her PCP ordered a pelvic USN that demonstrated a 4mm endometrial stripe. The patient tells you that she has had no further vaginal bleeding until 3 weeks ago. She reports that she has no other medical problems and is not taking any medications. Her last Pap was 1 year ago and was normal. No history of cervical dysplasia. Her BMI is 36. Pelvic exam is only notable for vaginal atrophy. You counsel her that the next best step is:
A) pelvic exam in 6 months
B) HSC with D&C
C) saline sonohysterography
D) endometrial biopsy
D) endometrial biopsy
Q#26
A 19 yo woman telephones your office to report that she had unprotected intercourse 4 days ago. Her LMP was 10 days ago and she is concerned she may become pregnant. You counsel her that the most effective emergency contraceptive is:
A) copper IUD
B) oral levonorgestrel
C) levonorgestrel IUD
D) oral mifepristone
E) oral ulipristal acetate
A) copper IUD
Q#11
A 33 yo G0 woman comes to your office with pap test results reported as atypical glandular cells, not otherwise specified. She has a history of irregular menses every 7-10 weeks. She has no medical problems and is not currently in a sexual relationship. Her last pap test 3 years ago yielded a normal result; neg HPV. Family history is significant for colon cancer (diagnosed in her father at age 51). The best next step in management is:
A) repeat Pap test with reflex HPV testing in 6 months
B) repeat HPV testing in 12 months
C) LEEP
D) colposcopy, ECC, endometrial biopsy
D) colposcopy, ECC, endometrial biopsy
Q#34
Cowden's disease is characterized by inherited breast and thyroid cancer and is caused by what mutation?
What is PTEN
Q#147-149
On POD#4 after placement of a suburethral sling for SUI, your patient has a PVR of 250mls. Before discharge from the hospital, the PVR was 300mls. The patient was discharged with an indwelling catheter. The surgery and PO course were uncomplicated. The next step in management is to:
A) release the sling
B) start antibiotics
C) replace the indwelling bladder catheter
D) start ISC
E) perform urethral dilation
D) start ISC
Q#3
34 yo woman, G3P3, comes to your office for a second opinion. She had three l/s procedures for endometriosis associated pelvic pain over the past 4 years. The procedure have not helped to decrease her symptoms of dysmenorrhea, dyspareunia, non-cyclic pelvic pain although all of the endometriotic tissue was removed each time. Her gynecologist has recommended a hysterectomy and BSO. She does not desire preservation of fertility. In the past year, she has been treated for 6 episodes of UTIs with symptoms of urgency, frequency and pain. Culture was performed during the last episode and was negative. She has no GI symptoms. Bimanual exam reveals severe, diffuse tenderness. The next step in management is:
A) hysterectomy and BSO
B) depot leuprolide
C) colonscopy
D) laparoscopy
E) cystoscopy
E) cystoscopy
Q#88
A 66 yo postmenopausal woman presents for follow up after bone density screening. Her T score is -0.9. She takes daily vitamin D and calcium. Her PMH is significant for a DVT after delivery of her second child 30 years ago. She currently reports treatment for GERD and osteoarthritis. She takes a daily antacid and acetaminophen as needed. She was treated with an oral steroid taper for 10 days because of an urticarial skin reaction. The best recommendation for her to maintain her BMD is:
A) oral estrogen and progesterone
B) selective estrogen receptor modulators
C) bisphophonates
D) calcium rich foods and strength building exercises
D) calcium rich foods and strength building exercises
Q#97
A 39 yo G2P2 female comes to the clinic and requests contraception. She has been in a monogamous relationship with a male sexual partner for the past 10 months and is not using any consistent contraceptive method. She reports a history of irregular menses that occur every 35-56 days without any intermenstrual spotting. Her BMI is 33. BP is 135/82. Urine pregnancy test and cultures for GC/CT are negative. You advise her that the best contraceptive for her is:
A) combination OCP
B) combination transdermal patch
C) progestin only contraceptive
D) levonorgestrel IUD
D) levonorgestrel IUD
Q#118
A 33 yo G3P3 woman comes to your office for her annual GYN exam. She is married and reports being in good health. She has a normal breast and pelvic exam. You perform a pap test and send the specimen for cytology and HPV co-testing. The pap result is normal, but the HPV test result is positive. The most appropriate next step is:
A) repeat the pap and HPV testing in 3 years
B) perform colposcopy
C) repeat the pap test in 1 year
D) perform HPV testing in 1 year
E) test for HPV 16 and 18 genotypes
E) test for HPV 16 and 18 genotypes
Q#71
A 35 yo woman, G2P2, comes to your office for her annual exam. Recently, she received the diagnosis of Lynch II syndrome. Her mother had uterine cancer at age 52, her maternal uncle had colon cancer at age 47, and her older sister had ovarian cancer at age 46. The best strategy to decrease this patient's risk of GI and GU cancer over the next 5 years is:
A) annual CT of the abdomen and pelvis
B) annual colonoscopy and TVUS w/ EMB
C) prophylactic colectomy with annual TVUS
D) prophylactic hysterectomy and BSO with annual colonoscopy
D) prophylactic hysterectomy and BSO with annual colonoscopy
Q#39
Two weeks after an uncomplicated TAH for uterine fibroids, a 48 year woman comes to your office and reports frequent urination. She reports that she has "leaking day and night," and that it is worse in the morning. The problem started 2 days ago. PE reveals clear fluid at the vaginal introitus. UA is significant for microscopic hematuria. The most likely diagnosis is:
A) post-op UTI
B) vesicovaginal fistula
C) SUI
D) OAB
B) vesicovaginal fistula
Q#108
A 16 yo patient comes to your office with a one week history of increased vaginal discharge and lower abdominal cramping. Her LMP was 2 weeks ago. She reports being sexually active, and says that she and her partner do not always use condom. No fever, vomiting, or diarrhea. She reports a possible mild reaction when given penicillin at age 4. Pelvic exam reveals mucopurulent discharge and uterine tenderness. Microscopy reveals an abundance of WBCs, but yields negative results for trichomonas, monilia, and BV. A urine pregnancy test is negative. The most appropriate antibiotic treatment for this patient is:
A) outpatient azithromycin and metronidazole
B) Outpatient ceftriaxone and doxycycline
C) Inpatient clindamycin and gentamicin
D) Inpatient levofloxacin and doxycycline
E) Outpatient levofloxacin and metronidazole
B) Outpatient ceftriaxone and doxycycline
Q #74
A 53 yo G2P2 woman informs you her LMP was 13 months ago and since that time she has had significant hot flushes and sleep disturbances. She states that she wakes up several times a night sweating. Her medical history is significant for breast cancer diagnosed 3 years ago, for which she takes tamoxifen citrate. The best initial treatment is:
A) black cohash
B) ginseng
C) venlafaxine
D) combined estrogen and progesterone therapy
E) gabapentin
E) gabapentin
Q#128
A 33 yo G1P1 woman recently stopped breastfeeding. She comes to your office to inquire about interval contraception. She had a normal SVD and gave birth to a healthy term infant 12 months ago. The pregnancy was c/b GDM and a seizure disorder. She is currently taking carbamazepine. Her PSH is notable for a l/s salpingostomy for ectopic pregnancy 5 years ago and malabsorptive gastric bypass surgery. In the past, she has used only condoms but wishes to avoid irregular anovulatory bleeding but does not want to use an injectable contraceptive method. You counsel her that her best choice for contraception is:
A) levonorgestrel IUD
B) cyclic combination OCPs
C) contraceptive rod
D) extended cycle OCPs
E) HSC tubal occlusion
A) levonorgestrel IUD
Q#7
27 yo primiparous woman consults you regarding management of the abnormal cervical cytology result. She had normal Pap test results 12 months ago when a pap test showed that she had LSIL. A colposcopic biopsy showed CIN1. Twelve months later, she received a +HPV test result. The next step in management is:
A) cryotherapy
B) LEEP
C) testing for HPV in 12 months
D) pap test in 6 months
E) colposcopy
E) colposcopy
Q#50
This inheritable cancer syndrome is characterized by soft tissue sarcomas breast cancer and is caused by a mutation in p53
What is Li-Fraumeni syndrome
Q#147-149
A 55 yo woman is evaluated for urinary incontinence. She underwent a TOT procedure 3 years ago for the clinical diagnosis of SUI. The patient reports some incontinence with activity and valsalva maneuvers but no urgency. Urodynamic testing is significant for a maximal urethral closing pressure of less that 40cm H2O. The most likely diagnosis for urinary incontinence in this patient is:
A) overactive bladder
B) vesicovaginal fistula
C) Intrinsic sphincter deficiency
D) Overflow incontinence
E) Recurrent stress incontinence
C) Intrinsic sphincter deficiency
Q#100
A 16yo patient comes to the ED with lower abdominal pain for 48 hours. She has no N/V/D or dysuria. She reports a normal appetite. Over the past year, she has had 3 sexual partners. She is not using any birth control. Her LMP was 5 weeks ago. PE shows a well-nourished young woman, in no acute distress. She has a mildly tender lower abdomen, left>right, purulent discharge per cervical os, and left adnexal tenderness. Temp 100.5. Lab tests reveal a WBC of 10,540 and a positive pregnancy test. US of the abdomen and pelvis is negative for appendicitis or fluid in the cul-de-sac. The contraindication to outpatient therapy is:
A) Pregnancy
B) Leukocyte count
C) Body temp
D) Age
E) Left adnexal tenderness
A) Pregnancy
Q#84
A 54 yo woman is seeking therapy for worsening menopausal symptoms. The patient reports hot flushes, night sweats, vaginal dryness, breast tenderness, joint stiffness, and general aches and pains. She has been postmenopausal for 2 years and states that her symptoms are starting to affect her performance at work and her relationships at home. She is in good health and is not taking any medications. Her family history is negative for breast cancer and clotting disorders. The patient is interested in starting hormone therapy. Of the symptoms described, HT is least likely to improve her:
A) joint stiffness
B) Vaginal dryness
C) breast tenderness
D) general aches and pains
E) night sweats
C) breast tenderness
Q#120
A 17 yo sexually active female comes to your office with her mother for contraceptive counseling. She has been using DMPA for birth control over the past 18 months. She wishes to continue with DMPA. She has no history of bone fractures and in in good health. Currently, she does not take any prescription medications, but in the past, she has had difficulty with remembering to take oral medications. Her mother read about the thinning of bones associated with DMPA and inquires about BMD testing. After discussion of her risk factors for bone loss, the best step in management is:
A) DXA scan
B) treat with bisphosphonates
C) continue with DMPA
D) switch to OCPs
E) check bone turnover metabolites
C) continue with DMPA
Q#33
A 52 yo woman comes to your office for her annual exam. She has not experienced spotting or vaginal bleeding since menopause 18 months ago. Her sister has a history of cervical cancer. Her pap test results are "satisfactory with no malignancy" with the notation of "endometrial cells present in a woman over 40 years." The next step in her evaluation is:
A) Endometrial assessment
B) HPV testing
C) repeat cytology in 6 months
D) colposcopy with ECC
A) Endometrial assessment
Q#1