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Question 1 During labor, a 25-year-old G6P2 woman is treated with mepiridine.

You do not have a complete prenatal history but the patient reports the use of marijuana to control nausea during her pregnancy. She quickly progresses from 4 cm to fully dilated in 1 hour and is now pushing. A limp unresponsive male infant is delivered. Heart rate is greater than 100 beats per minute. The infant has no respiratory effort. Which of the following is the most appropriate next step in the management of this patient?

Possible answers A. Give positive pressure ventilation and prepare to intubate B. Give positive pressure ventilation and prepare to give naloxone C. Give stimulation only and continue to monitor heart rate D. Suction thoroughly and check heart rate E. Suction thoroughly and give naloxone 8721 people answer this question Your score: 1

Correct

Your choice

People`s statistic 64% 17% 2% 7% 9%

Question 2 A 52 year-old nulliparous woman presents with long-standing vulvar and vaginal pain and burning. She has been unable to tolerate intercourse with her husband because of introital pain. She had difficulty sitting for prolonged periods of time or wearing restrictive clothing because of worsening vulvar pain. She recently noticed that her gums bleed more frequently. She avoids any topical over-the-counter therapies because they intensify her pain. Her physical examination is remarkable for inflamed gingiva and a whitish reticular skin change on her buccal mucosa. A fine papular rash is present around her wrists bilaterally. Pelvic examination reveals white plaques with intervening red erosions on the labia minora as shown in picture below. A speculum cannot be inserted into her vagina because of extensive adhesions. The cervix cannot be visualized. Which of the following is the most likely diagnosis in this patient?

Possible answers A. Squamous cell hyperplasia B. Lichen sclerosus C. Lichen planus D. Genital psoriasis E. Vulvar cancer 6637 people answer this question

Correct

Your choice

People`s statistic 4% 18% 53% 21% 4%

Your score: 1

Question 3 A 38 year-old G1P1 woman comes to the office for an annual exam. She has noticed some urinary frequency over the past month. She has no dysuria, hematuria, urgency or incontinence. She has normal cycles, no history of abnormal Pap smears or sexually transmitted infections and is sexually active, with 1 partner. She smokes a quarter of a pack of cigarettes daily, and drinks one glass of wine per day. Her mother had breast cancer at age 30. Her general examination is normal. On pelvic exam, she has normal external genitalia; vagina and cervix are without lesions. Her uterus is normal size, anteverted and nontender. Her left adnexa is normal, right adnexa has a mobile, slightly tender 4 cm mass. Laboratory results show a normal urinalysis, a negative urine pregnancy test and a normal Pap smear. What is the most appropriate next step in the management of this patient?

Possible answers A. Perform a transvaginal ultrasound B. Perform a diagnostic laparoscopy C. Recommend a CT-guided drainage of the mass D. Order a KUB plain film E. Perform an exploratory laparotomy 6668 people answer this question Your score: 0

Correct

Your choice

People`s statistic 85% 8% 2% 3% 3%

Question 4 A 23 year-old G1P1 delivered her first baby two days ago after an uncomplicated labor and vaginal delivery. She wants to breast feed and has been working with the lactation team. Prior to discharge, her temperature was 100.4F, 38C (other vitals were normal). She denies urinary frequency or dysuria and her lochia is mild without odor. On examination, her lungs are clear, cardiac exam normal, and abdomen and uterine fundus are nontender. Her breasts are firm and tender throughout, without erythema and nipples are intact. Which of the following is the most likely cause of her fever?

Possible answers A. Endomyometritis B. Septic pelvic thrombophlebitis C. Mastitis D. Breast engorgement E. Vaginitis 6773 people answer this question

Correct

Your choice

People`s statistic 6% 8% 12% 72% 2%

Your score: 1

Question 5 A 38 year-old G3P3 woman presents to the office because she has noted dark spots on her vulva. She states that the lesions have been present for at least two years and are occasionally itchy. She has a history of laser therapy for cervical intraepithelial neoplasia ten years ago, and has not had a pelvic exam since then. She has had multiple partners and uses condoms. Her menses are regular and she had a tubal ligation for birth control. She has smoked since age 14. She has a history of genital herpes, but has only one or two recurrences a year. On examination, multicentric brown-pigmented papules are noted on the perineum, perianal and labia minora. No induration or groin nodularity is noted. The vagina and cervix are normal in appearance. Which of the following is the most likely diagnosis?

Possible answers A. Hidradenitis suppurativa B. Molluscum contagiosum C. Vulvar intraepithelial neoplasia D. Melanoma E. Pagets disease 6722 people answer this question Your score: 1

Correct

Your choice

People`s statistic 7% 12% 52% 25% 4%

Question 6 A 22-year-old G2P1 presents for prenatal care at approximately 10 weeks gestation. Her first pregnancy was complicated by preterm premature rupture of the membranes at 28 weeks gestation. What is the recurrent risk of preterm premature rupture of the membranes during this pregnancy?

Possible answers A. 1% B. 5% C. 10% D. 30% E. 50% 7935 people answer this question Your score: 0

Correct

Your choice

People`s statistic 9% 17% 23% 44% 7%

Question 7 A 26-year-old G0 woman presents to the emergency room with 8 hours of severe right lower quadrant pain associated with nausea. She has a history of suspected endometriosis, which was diagnosed 2 years ago, based on severe dysmenorrhea. She has been using NSAIDs with her menses to control the pain. She is not sexually active. She is otherwise in good health. Her menstrual cycles are normal every 28 days and her last menstrual period was 3 weeks ago. She has no history of sexually transmitted infections. Her blood pressure is 145/70; pulse is 100; temperature is 99.2F. She appears uncomfortable. On abdominal exam, she has moderate tenderness to palpation in the right lower quadrant. On pelvic exam, she has no lesions or discharge. A complete bimanual exam was difficult to perform due to her discomfort. Labs: BHCG <5, hematocrit 29%. A pelvic ultrasound showed a 6cm right ovarian mass. The uterus and left ovary appeared normal. There was a moderate amount of free fluid in the pelvis. What is the most appropriate next step in the management of this patient?

Possible answers A. MRI of the pelvis B. Doppler pelvic ultrasound C. CAT scan of the pelvis D. Begin oral contraceptives E. Surgical exploration 7857 people answer this question Your score: 1

Correct

Your choice

People`s statistic 2% 14% 5% 8% 70%

Question 8 A 39 year-old G0 presents to the clinic reporting non-tender spots on her vulva for about a week. No pruritus or pain is present. She also notes a brownish rash on the palms of her hands. She admits to IV drug abuse. She was diagnosed as HIV-positive two years ago, but has not been compliant with suggested treatment. On examination, three elevated plaques with rolled edges are noted on the vulva. They are non-tender. A brown macular rash is noted on the palms of her hands and the soles of her feet. What is the most appropriate next step in the management of this patient?

Possible answers A. Obtain a treponemal-specific test B. Biopsy of the lesion C. Colposcopic evaluation of the vulvar lesions D. Culture the base of the lesion E. Perform a wet prep 10563 people answer this question

Correct

Your choice

People`s statistic 85% 8% 1% 4% 1%

Your score: 0

Question 9 A 33 year-old, G2P1 with a known twin gestation presents to your office at 24 weeks and notes that two days prior she had a nosebleed. She has not been seen in your office for the last 7 weeks. Ultrasound today shows a demise of one twin that has measurements consistent with 21 weeks gestation. What is the next step in the management of this patient?

Possible answers A. Immediate delivery of the surviving twin B. Continued management as a singleton pregnancy C. Maternal fibrinogen level D. Abdominal x-ray to assess for Spalding's sign E. Nonstress test of the surviving twin 7254 people answer this question Your score: 0

Correct

Your choice

People`s statistic 6% 12% 48% 1% 33%

Question 10 A 35 year-old G3P3 comes to the office to discuss tubal ligation as she desires permanent sterilization. What are the non-contraceptive health benefits of female sterilization?

Possible answers A. Reduced risk of endometriosis B. Reduced risk of ovarian cancer C. Protection against endometrial cancer D. Reduction in menstrual blood flow E. Reduced risk of sexually transmitted infections 8712 people answer this question Your score: 1

Correct

Your choice

People`s statistic 23% 55% 8% 11% 3%

Question 11

A 24 year-old G4P2 at 34 weeks gestation complains of a cough and whitish sputum for the last three days. She reports that everyone in the family has been sick. She reports a high fever last night up to 102F (38.9C). She denies chest pain. She smokes a half-pack of cigarettes per day. She has a history of asthma with no previous intubations. She uses an albuterol inhaler, although she has not used it this week. Pertinent physical examination findings: temperature 98.6F (37C), respiratory rate 16, pulse 94, blood pressure 114/78, peak expiratory flow rate 430 L/min (baseline documented in the outpatient chart = 425 L/min). Pharyngeal mucosa is erythematous and injected. Lungs are clear to auscultation. Pertinent laboratory studies: white blood cell count 8,700; arterial blood gases on room air (normal ranges in parentheses): pH 7.44 (7.36 7.44); PO2 103 mm Hg (>100), PCO2 26 mm Hg (28 32), HCO3 19 mm Hg (22 26). Chest x-ray is normal. What is the correct interpretation of this arterial blood gas?

Possible answers A. Acute metabolic acidosis B. Compensated respiratory alkalosis C. Compensated metabolic alkalosis D. Hypoventilation E. Hyperventilation 10292 people answer this question Your score: 1

Correct

Your choice

People`s statistic 2% 78% 9% 1% 10%

Question 12 You are counseling a 22 year-old, G1, who is at 38 weeks gestation. She has been pushing for 4 hours and you recommend a trial of forceps. She asks whether a vacuum-assisted delivery is associated with a lower incidence of maternal and fetal trauma. Which of the following is less likely to occur during a vacuum delivery?

Possible answers A. Maternal lacerations B. Fetal cephalohematoma C. Neonatal lateral rectus paralysis D. Neonatal hyperbilirubinemia E. Neonatal retinal hemorrhage 6900 people answer this question Your score: 1

Correct

Your choice

People`s statistic 70% 10% 12% 4% 5%

Question 13

A 21 year-old woman comes to the office because of acne, irregular menses and hirsutism. She initially was evaluated 6 months ago. At that time, she was diagnosed with idiopathic hirsutism. She was started on oral contraceptive pills to improve her symptoms. Menstrual periods now occur every month, but her hirsutism has not significantly improved. In addition to the oral contraceptives, which of the following would be an appropriate treatment for hirsutism?

Possible answers A. Spironolactone B. Lupron C. Danazol D. Depo-Provera E. Steroids 6592 people answer this question Your score: 1

Correct

Your choice

People`s statistic 85% 5% 7% 2% 1%

Question 14 A 29 year-old G1P1 had an uncomplicated vaginal delivery and breastfed immediately postpartum. She has a significant amount of abdominal soreness secondary to a tubal ligation on postpartum day 2. She is breast-feeding on her side with the baby lying on her side, well away from the abdomen to prevent pain at the incision site. She developed bleeding cracked nipples. Which of the following is the most likely cause?

Possible answers A. Feedings not frequent enough B. Poor positioning of infant C. Feedings too frequent D. Not enough milk production E. Irritation from the bra 8125 people answer this question Your score: 1

Correct

Your choice

People`s statistic 2% 78% 13% 4% 3%

Question 15 A 35-year-old G3P2 woman is at 18 weeks gestation. Her obstetrical history is significant for two previous low transverse cesarean sections. Her first one was performed secondary to arrest of dilation in the active phase. The patient reports that she only dilated to 7 centimeters. She delivered a healthy 3500-gram male infant. Her second cesarean section was an elective repeat. She delivered a healthy 3400-gram female

infant. The patient strongly desires to attempt a VBAC (vaginal birth after cesarean.) Which of the following statements is correct?

Possible answers A. If she attempts a VBAC, the risk of uterine rupture is approximately 10%. B. The likelihood of a successful VBAC is lower in patients with two previous Cesarean deliveries than in women with one prior Cesarean delivery. C. The likelihood of a successful VBAC does not appear to be affected by the indication of the previous Cesarean delivery. D. The success rate for having a successful VBAC after one previous low transverse Cesarean delivery is approximately 65%. E. She can safely undergo a prostaglandin induction of labor at term. 8385 people answer this question Your score: 0

Correct

Your choice

People`s statistic 10% 77%

4%

8%

2%

Question 16 A 22 year-old G4P1 woman at 26 weeks gestation presents with a postcoital musty odor and increased milky, gray-white discharge for the last week. This was an unplanned pregnancy. She had her first pregnancy at age 15. She reports that she has no new sex partners, but the father of the baby may not be monogamous. On examination, there is a profuse discharge in the vaginal vault, which covers the cervix. Pertinent labs: Wet mount: pH >4.5 and whiff test positive. Microscopic exam reveals clue cells, but no trichomonads or hyphae. Which of the following is the most appropriate next step in the management of this patient?

Possible answers A. Delay treatment until postpartum B. Treat her now and again during labor C. Treat her now D. Treat her and her partner E. No treatment necessary 9049 people answer this question Your score: 1

Correct

Your choice

People`s statistic 2% 4% 74% 19% 2%

Question 17 A 58 year-old G3P3 woman has been postmenopausal for 5 years and is concerned about osteoporosis. She has declined hormone therapy in the past. Her mother has a history of a hip fracture at age 82. A physical exam is unremarkable. In addition to weight bearing exercise and vitamin D supplementation, what optimal daily calcium intake should she take?

Possible answers A. 500 mg B. 750 mg C. 1000 mg D. 1200 mg E. 2000 mg 6599 people answer this question Your score: 1

Correct

Your choice

People`s statistic 4% 4% 25% 58% 8%

Question 18 A 36 year-old G1 with type I diabetes, is diagnosed with intrauterine growth restriction at 33 weeks gestation. What is the most appropriate next step in management?

Possible answers A. Amniocentesis B. Immediate delivery C. Weekly ultrasounds to assess fetal growth D. Antenatal testing of fetal well-being E. Observation 7025 people answer this question Your score: 1

Correct

Your choice

People`s statistic 3% 2% 27% 65% 3%

Question 19 A 28 year-old G1 presents for prenatal care. Her periods have been irregular and she does not recall when the last one occurred. She is healthy and denies any medical problems. The uterus is 10 weeks size and there are no adnexal masses. At this point in time, what is the best way to date the pregnancy?

Possible answers

Correct

Your choice

People`s statistic

A. Qualitative Serum hCG B. Quantitative Serum hCG C. Ultrasound measurement, gestational sac D. Ultrasound measurement, crown-rump length E. Fetal heart tones heard with Doppler 6941 people answer this question Your score: 1

0% 2% 12% 84% 1%

Question 20 A 25-year-old G2P1 woman at 38 weeks gestational age presents to labor and delivery with spontaneous onset of labor and spontaneous rupture of membranes. Cervical exam was 3 cm at presentation and 5 cm at last check, two hours ago. Presently, patient is very comfortable and notes mild contractions. You decide to place an intrauterine pressure catheter (IUPC). On placement, approximately 300 cc of frank blood and amniotic fluid flow out of the vagina. What is the most appropriate next step in the management of this patient?

Possible answers A. Emergent cesarean section B. Withdraw the IUPC, monitor fetus and then replace if tracing reassuring C. Begin amnioinfusion D. Begin Pitocin augmentation E. Keep IUPC in position and connect to tocometer 10563 people answer this question Your score: 0

Correct

Your choice

People`s statistic 17% 55% 2% 6% 19%

Question 21 A 19 year-old G1P0 woman at 18 weeks gestation presents with a 3-month history of palpitations and intermittent chest pain. Physical examination reveals a pulse of 96 and grade II/VI systolic ejection murmur with a click. The ECG shows normal rate and rhythm and an echocardiogram is ordered. Which of the following is the best treatment in the management of this patient?

Possible answers A. Anxiolytics B. -blockers

Correct

Your choice

People`s statistic 2% 55%

C. Calcium-channel blockers D. Digitalis E. No treatment needed at this time 9352 people answer this question Your score: 1

6% 1% 36%

Question 22 A 25 year-old G1P1 comes to the office due to left breast pain and fever. She is breast feeding her 2 1/2week old infant. The symptoms began earlier in the day and are not relieved by acetaminophen. Blood pressure 120/60; pulse 64; temperature 99.9 F, 37.7 C. On exam, she has erythema on the upper outer quadrant of the left breast, which is tender to touch; there are no palpable masses. In addition to starting oral antibiotics, what is the most appropriate next step in the management of this patient?

Possible answers A. Discontinue breastfeeding B. Add ibuprofen for pain relief C. Obtain a breast ultrasound D. Use a topical antifungal E. Admission to the hospital 7162 people answer this question Your score: 1

Correct

Your choice

People`s statistic 8% 79% 8% 3% 2%

Question 23 A 20 year-old G1P0 at 18 weeks gestation with a history of epilepsy has conceived while taking valproic acid. She is scheduled for an ultrasound. What is the most common anomaly associated with prenatal exposure to valproic acid?

Possible answers A. Cardiac defects B. Caudal regression syndrome C. Neural tube defects D. Cleft lip and palate E. Holoprosencephaly 9473 people answer this question

Correct

Your choice

People`s statistic 3% 1% 93% 2% 1%

Your score: 1

Question 24 A mother brings her 16 year-old daughter to the doctor because she has not begun menses and has not kept up in growth with her friends. She performs well in school and participates in extracurricular activities. On physical examination, she is 51 tall, 100 pounds and has Tanner stage 1 breast and pubic hair growth. Her breast nipples are widely spaced with a shield chest and neck is thickened. No genital tract abnormalities are noted on exam. Which of the following is the most likely cause of her delayed sexual maturation?

Possible answers A. Partial deletion of the long arm of the X chromosome B. Mullerian agenesis C. Down Syndrome D. Turner syndrome E. Rokitansky-Kuster-Hauser Syndrome 6924 people answer this question Your score: 1

Correct

Your choice

People`s statistic 1% 0% 0% 98% 1%

Question 25 An 81 year-old G3P3 woman presents to your office with a history of light vaginal spotting. She states this has occurred recently and in association with a thin yellow discharge. She never experienced any vaginal bleeding since menopause at the age of 52, and denies ever having been on hormone replacement therapy. She is otherwise reasonably healthy, except for osteoporosis, well-controlled hypertension, and diabetes. She is physically active and still drives to all her appointments. She is no longer sexually active since the death of her husband 2 years ago. On examination, she is noted to have severe atrophic changes affecting her vulva and vagina. A small Pederson speculum allows for visualization of a normal multiparous cervix, and the bimanual examination is notable for a small, mobile uterus. Rectovaginal exam confirms no suspicious adnexal masses or nodularity. Which of the following is the most appropriate management for this patient?

Possible answers A. Pelvic transvaginal ultrasound B. Office endometrial biopsy C. Reassurance and observation for further bleeding D. Vaginal estrogen therapy E. Dilation and curettage

Correct

Your choice

People`s statistic 6% 80% 5% 6% 3%

7029 people answer this question Your score: 1


Question 26 A 24 year-old G2P1 who underwent an elective termination two days ago presents to the emergency room with abdominal and pelvic pain. She has been feeling nauseated and reports a fever at home. On presentation, her blood pressure is 100/60; pulse 100; respiration 16; temperature 102F (38.9C). Physical examination reveals diffuse abdominal tenderness and, on pelvic examination, she has marked cervical motion tenderness. In addition to sending a CBC and cultures, which of the following is the most appropriate next step in the management of this patient?

Possible answers A. Obtain Beta-hCG level B. Proceed with a laparoscopy C. Proceed with a dilation and curettage D. Begin IV antibiotics E. Order a hysterosonogram 7782 people answer this question Your score: 0

Correct

Your choice

People`s statistic 15% 2% 7% 72% 3%

Question 27 A 72 year-old G3P2 postmenopausal woman is referred to your office by her internist after a work-up for abdominal bloating revealed a large pelvic mass on transvaginal ultrasound and an elevated CA-125. She has no significant medical history and only a prior appendectomy. The CT scan showed a large heterogenous pelvic mass measuring 20 x 13 x 10 cm. There was a moderate amount of ascites and likely omental caking. There was no significant pelvic or abdominal lymphadenopathy, and the chest x-ray showed only a small right pleural effusion. On pelvic examination, there is minimal cul-de-sac nodularity and the mass is readily palpable and somewhat mobile. There is an obvious fluid wave. Which of the following is the most appropriate next step in the management of this patient?

Possible answers A. Thoracentesis B. Exploratory laparotomy and tumor debulking C. Paracentesis D. Diagnostic laparoscopy and tissue biopsies E. Neoadjuvant chemotherapy 5651 people answer this question

Correct

Your choice

People`s statistic 2% 69% 6% 18% 5%

Your score: 1

Question 28 A 42 year-old G4P4 woman presents with a history of progressively worsening severe menstrual pain. Menses are regular, but she complains of very heavy flow requiring both a menstrual pad and tampon with frequent bleeds through this protection on heavy days. She takes Oxycodone that her husband used for back pain to relieve her dysmenorrhea. She had a tubal ligation four years ago. Pelvic examination shows an enlarged, soft, boggy uterus. No masses are palpated. Pregnancy test is negative, hemoglobin 9.8 and hematocrit 28.3%. What is the most likely diagnosis?

Possible answers A. Adenomyosis B. Endometrial carcinoma C. Endometriosis D. Primary dysmenorrhea E. Endometrial hyperplasia 6240 people answer this question Your score: 1

Correct

Your choice

People`s statistic 72% 2% 9% 3% 15%

Question 29 A 24 year-old woman comes to her physician for help with her premenstrual syndrome symptoms. She complains of not being herself for 3 to 4 days before her period and has episodes of crying and irritability. She denies depressive symptoms and notes she is a stay-at-home mother for her three children. After a complete history and physical examination, the patient is prescribed a selective serotonin reuptake inhibitor but, after three months, she returns as there is no change in her symptoms. Upon further discussion, the patient admits that her husband has a bad temper at times. Physical examination is normal with the exception of some bruising on the patients arms. She claims that she fell and that she is often clumsy. Which of the following is the most appropriate next step in the management of this patient?

Possible answers A. Report the injuries to the police B. Offer domestic violence resources to the patient C. Refer the patient for a psychiatric consultation D. Arrange for a home visit by a womens shelter counselor E. Arrange for security to escort her to a womens shelter 5083 people answer this question

Correct

Your choice

People`s statistic 9% 89% 1% 0% 1%

Your score: 1

Question 30 A 27 year-old G1P0 at 14 weeks gestation presents with a 2-month history of insomnia, feeling depressed, and unintentional weight loss. Symptoms began after the unexpected death of her father. She is not excited about this pregnancy and reports no suicidal ideation. Physical examination reveals a woman of stated age with a flat affect. Which of the following therapies is contraindicated in this patient?

Possible answers A. Paroxetine (Paxil) B. Sertraline (Zoloft) C. Fluoxetine (Prozac) D. Nortriptyline (Norpress) E. Bupropion (Wellbutrin) 9279 people answer this question Your score: 1

Correct

Your choice

People`s statistic 48% 6% 6% 17% 23%

Question 31 A 32 year-old G1 is seeing you in consultation at 35 weeks gestation. Ultrasound reveals limited fetal growth over the past 3 weeks. Biometry is consistent with 30-5/7, EFW 1900 g, less than 10th percentile. You counsel her about short and long-term complications for her baby. This fetus is at increased risk for all of the following adult disorders EXCEPT:

Possible answers A. Cardiovascular disease B. Chronic hypertension C. Chronic obstructive lung disease D. Diabetes E. Osteoporosis 7016 people answer this question Your score: 1

Correct

Your choice

People`s statistic 2% 7% 14% 24% 52%

Question 32

A 24 year-old G2P1 woman at 18 weeks with a history of asthma presents to the office with worsening symptoms, needing to use her inhaler more frequently. The symptoms began with the pregnancy and have gradually increased. She is using her albuterol inhaler as needed, recently 3 times a day. She denies any illness or fever. She has had asthma since she was a child. On exam, the patient appears comfortable. Her temperature is 100.2F (37.9C) and respiratory rate is 18. Auscultation of the lungs shows good air movement with mild scattered end expiratory wheezes. There are no rales or bronchial breath sounds. Which of the following is the most appropriate next step in the management of this patient?

Possible answers A. Oral theophylline B. Subcutaneous terbutaline C. Inhaled corticosteroids D. Oral Zafirlukast (leukotriene inhibitor) E. Antibiotic treatment 9054 people answer this question Your score: 0

Correct

Your choice

People`s statistic 3% 2% 78% 10% 7%

Question 33 A 24 year-old G0 presents with a one-year history of introital and deep thrust dyspareunia. She also has a 2year history of severe dysmenorrhea, despite the use of oral contraceptives. She underwent a diagnostic laparoscopy 6 months ago that showed minimal endometriosis with small implants in the posterior cul de sac only, which were ablated with a CO2 laser. On further questioning, she reports significant urinary frequency, urgency and nocturia. A recent urine culture was negative. What is the most likely diagnosis in this patient?

Possible answers A. Acute cystitis B. Interstitial cystitis C. Acute urethral syndrome D. Acute urethritis E. Salpingitis 6936 people answer this question Your score: 1

Correct

Your choice

People`s statistic 5% 74% 13% 4% 4%

Question 34 A 76-year-old G3P3 presents to the office with worsening stress urinary incontinence for the last 3 months. She reports an increase in urinary frequency, urgency and nocturia. On exam, she has a moderate size

cystocele and rectocele. A urine culture is negative. A post-void residual is 50 cc. A cystometrogram shows two bladder contractions while filling. Which of the following is the most likely diagnosis in this patient?

Possible answers A. Genuine stress incontinence B. Urge incontinence C. Overflow incontinence D. Functional incontinence E. Continuous incontinence 8404 people answer this question Your score: 0

Correct

Your choice

People`s statistic 8% 73% 6% 11% 2%

Question 35 A 15 year-old G0 presents with severe menstrual pain for the past 12 months. The pain is severe enough for her to miss school. The pain is not relieved with ibuprofen 600 mg every 4 hours. She is not sexually active and the workup reveals no pathology. The most appropriate next step in the management of this patient is to begin combination oral contraceptives. How do oral contraceptives relieve primary dysmenorrhea?

Possible answers A. Creating endometrial atrophy B. Decreasing inflammation C. Increasing prolactin levels D. Decreasing inhibin levels E. Thickening cervical mucous 6204 people answer this question Your score: 1

Correct

Your choice

People`s statistic 75% 12% 2% 7% 4%

Question 36 A 35 year-old G3P3 requests contraception. Her youngest child is 7 years old. Her periods have been regular since she discontinued breastfeeding 5 years ago. Her past medical history includes depression that is controlled with antidepressants, and a history of deep venous thrombosis. She denies smoking or alcohol use. In the past, oral contraceptive pills have caused her to have severe gastrointestinal upset. What in her history makes her an ideal candidate for progestin-only pills?

Possible answers

Correct

Your choice

People`s statistic

A. Depression B. Smoking history C. Severe nausea on combined oral contraceptives D. Lactation history E. Deep venous thrombosis 8643 people answer this question Your score: 1

1% 3% 4% 1% 91%

Question 37 A 27 year-old G0 woman comes to the clinic as she has been unable to conceive for the last year. She is in good health and has not used any hormonal contraception in the past. She had normal cycles in the past every 28 days until about 6 months ago. At that time, she began to have irregular menses every 2-3 months, with some spotting in between. She is not taking any medications. She has no history of abnormal Pap smears or sexually transmitted infections. Her physical examination is normal. Laboratory tests show: Results Normal Values TSH 10 mIU/ml 0.5-4.0 mIU/ml Free T40.2 ng/dl 0.8-1.8 ng/dl Prolactin 40 ng/ml <20 ng/ml FSH 6 mIU/ml 5-25 mIU/ml LH 4 mIU/ml 5-25 mIU/ml What is the most appropriate step in the management of this patient?

Possible answers A. Begin Synthroid B. Begin bromocriptine C. Order a Clomid ovulation challenge test D. Obtain a brain MRI E. Order a thyroid gland ultrasound 6134 people answer this question Your score: 0

Correct

Your choice

People`s statistic 59% 5% 3% 21% 12%

Question 38 A 40 year-old G3P2 at 17 weeks gestation would like to have serum screening for Down syndrome. Which of the following serum marker increases the sensitivity of a quadruple screen?

Possible answers A. Alpha fetoprotein (AFP) B. Pregnancy associated plasma protein A (PAPP A) C. Progesterone D. Unconjugated estriol

Correct

Your choice

People`s statistic 15% 13% 1% 3%

E. Inhibin A 9209 people answer this question Your score: 1

68%

Question 39 A 28 year-old G3P3 status post an uncomplicated spontaneous vaginal delivery of 4150 gram infant experiences profuse vaginal bleeding of 700 cc. Prior obstetric history was notable for a previous low uterine segment transverse Cesarean section, secondary to transverse fetal lie. The patient had no antenatal problems. The placenta delivered spontaneously without difficulty. Which of the following is the most likely cause of this patients hemorrhage?

Possible answers A. Vaginal or cervical lacerations B. Uterine inversion C. Uterine atony D. Uterine dehiscence E. Uterine rupture 8344 people answer this question Your score: 2

Correct

Your choice

People`s statistic 7% 1% 73% 5% 15%

Question 40 A 19-year-old G2P1 woman at 30 weeks gestation presents with preterm rupture of membranes, 6 hours ago. She denies labor. She takes prenatal vitamins and iron. She denies substance abuse, smoking or alcohol use. Her prior pregnancy was delivered vaginally at 41 weeks after spontaneous rupture of membranes. Her blood pressure is 110/70; pulse 84; temperature 98F. Pertinent sonographic findings reveal a cervical length of 34mm and an amniotic fluid index of 3. What is the likelihood she will deliver within a week?

Possible answers A. 80% B. 40% C. 20% D. 10% E. 5% 7998 people answer this question

Correct

Your choice

People`s statistic 65% 16% 9% 6% 4%

Your score: 1

Question 41 A 34-year-old G2P1 woman at 40 weeks gestation, with a history of one prior vaginal delivery, strongly desires an induction of labor, as she is unable to sleep secondary to severe back pain. Her cervical exam is closed, 20% effaced and -2 station. The cervix is firm and posterior. Which of the following is the most appropriate next step in the management of this patient?

Possible answers A. Wait until 42 weeks for induction B. Administer cytotec C. Insert a foley bulb in the cervix D. Perform artificial rupture of membranes E. Perform a Cesarean section 8394 people answer this question Your score: 1

Correct

Your choice

People`s statistic 13% 67% 11% 6% 2%

Question 42 An 18 year-old woman comes to the office due to vaginal spotting for the last two weeks. Her menstrual periods were regular until last month, occurring every 28-32 days. Menarche was at age 13. She started oral contraceptives 3 months ago. On pelvic examination, the uterus is normal in size, slightly tender with a mass palpable in the right adnexal region. No adnexal tenderness is noted. Which of the following tests is the most appropriate next step in the management of this patient?

Possible answers A. Endometrial biopsy B. Coagulation studies C. Pelvic sonography D. Abdominal CT scan E. Urine pregnancy test 6985 people answer this question Your score: 1

Correct

Your choice

People`s statistic 1% 0% 18% 1% 80%

Question 43

1.

A 22-year old G0 presents with 5 months of amenorrhea since discontinuing her oral contraceptive pills. She had been on the pill for the last 6 years and had normal menses every 28 days while taking them. She is in good health and not taking any medications. She is 5 feet 4 inches tall and weighs 140 pounds. Her examination, including a pelvic examination, is normal. Which of the following history elements would be most useful in determining the cause of amenorrhea in this patient?

Possible answers A. Age at first intercourse B. History of sexually transmitted infections C. Parity D. History of oligo-ovulatory cycles E. Recent history of weight loss 5762 people answer this question Your score: 1

Correct

Your choice

People`s statistic 1% 3% 3% 80% 13%

Question 44 A 16-year-old G1P0 woman at 39 weeks gestation presents to the labor and delivery room reporting a gush of blood-tinged fluid approximately 5 hours ago and the onset of uterine contractions shortly thereafter. She says that, over the past hour, the contractions have become stronger and closer together. After a brief history and physical, the patient is put on the fetal monitor. The fetal heart rate is 140 to 150 with accelerations and no decelerations. Uterine contractions are recorded every 2 to 3 minutes. A pelvic exam reveals that the cervix is 4 cm dilated and 100 percent effaced. Fetal station is 0. After walking around for 30 minutes the patient is put back in bed after complaining of further discomfort. She requests an epidural. However, obtaining the fetal heart rate externally has become difficult because the patient cannot lie still. What is the most appropriate next step in the management of this patient?

Possible answers A. Placing the epidural B. Applying a fetal scalp electrode C. Performing a fetal ultrasound to assess the fetal heart rate D. Place an intrauterine pressure catheter (IUPC) E. Recommending a cesarean delivery 10509 people answer this question Your score: 1

Correct

Your choice

People`s statistic 12% 72% 10% 6% 1%

Question 45

A 26 year-old G2P2 reports that she is sexually active with a new male partner. She is using oral contraception for birth control and, as such, did not use a condom. She reports the new onset of vulvar burning and irritation. She thought she had a cold about 10 days ago. Given her history, which of the following is the most likely diagnosis in this patient?

Possible answers A. Herpes simplex virus B. Primary syphilis C. Secondary syphilis Human immunodeficiency virus Trichomonas 7293 people answer this question Your score: 0

Correct

Your choice

People`s statistic 83% 3% 1% 4% 9%

Question 46 A 23 year-old G1P1 delivered vaginally a 42-week infant after a prolonged induction of labor. She had an epidural, with an indwelling catheter for 36 hours and three IV sites for her intravenous medications. She now complains of lower abdominal pain, frequency and dysuria. Her vital signs are temperature 98.6F , 37C; pulse 70; blood pressure 100/60; and respirations 12. On examination, her lungs are clear, cardiac exam is normal, abdomen is soft, uterine fundus is firm and nontender, and she has mild suprapubic tenderness. Which of the following organisms is most likely causing her discomfort?

Possible answers A. Group A streptococcus B. Gardnerella vaginalis C. Chlamydia trachomatis D. Escherichia coli E. Group B Streptococcus 6787 people answer this question Your score: 1

Correct

Your choice

People`s statistic 2% 0% 1% 93% 3%

Question 47 A 17 year-old G0 presents with a 3-year history of severe dysmenorrhea shortly after menarche at age 14. Her menstrual cycles are regular with heavy flow. She has been treated with NSAIDs and oral contraceptives for the last year without significant improvement. She misses 2-3 days of school each month due to her menses. She has never been sexually active. Physical examination is remarkable for Tanner

Stage IV breasts and pubic hair. Pelvic examination is normal, as is a pelvic ultrasound. Both the patient and her mother are concerned. What is the next best step in the management of this patient?

Possible answers A. Empiric treatment with GnRH agonist B. CT scan of the pelvis C. Diagnostic laparoscopy D. MRI of the pelvis E. Hysterosalpingogram 7010 people answer this question Your score: 1

Correct

Your choice

People`s statistic 25% 4% 59% 3% 9%

Question 48 A 45-year-old G4P3 woman presents with vaginal bleeding. Last week, she performed a home pregnancy test that was positive. She thinks her last menstrual period was four months ago. The last time she saw her doctor was 8 years ago, with the birth of her last child. She has no serious medical problems, has smoked a pack of cigarettes a day since the age of 20, occasionally has a beer and does not exercise. Her vitals are normal. Abdominal examination reveals a soft abdomen and the fundus palpable just below the umbilicus. Pelvic ultrasound reveals a fundal placenta and a fetus measuring 18 weeks with normal cardiac activity. Vaginal examination reveals a 3-centimeter lesion arising off the posterior lip of the cervix. It easily bleeds with palpation and is hard in consistency. Which of the following is the most likely cause of the bleeding?

Possible answers A. Trauma B. Cervicitis C. Threatened abortion D. Cervical cancer E. Nabothian cyst 7868 people answer this question Your score: 0

Correct

Your choice

People`s statistic 1% 3% 2% 80% 14%

Question 49 A 24 year-old G2P1 at 42 weeks presents in early labor. At amniotomy, there is thick meconium. Her sisterin-law had a procedure to dilute the meconium and she asks if this would be of benefit to her. Which of the following statements is the most accurate regarding the benefits of amnioinfusion?

Possible answers A. Decreases admissions to the neonatal intensive care unit B. Decreases post maturity syndrome C. Decreases repetitive variable decelerations D. Decreases the risk for cesarean section E. Decreases meconium below the vocal cords 6667 people answer this question Your score: 1

Correct

Your choice

People`s statistic 18% 6% 59% 4% 14%

Question 50 A 24-year-old G2P1 woman has a fetus that is affected by Rh disease. At 30 weeks gestation, the delta OD450 (optical density deviation at 450 nm) results plot on the Liley curve in Zone 3. Which of the following is the most appropriate next step in the management of this patient?

Possible answers A. Immediate cesarean delivery B. Repeat amniocentesis in 3-5 days C. Intrauterine intravascular fetal transfusion D. Umbilical blood sampling E. Maternal plasmapheresis 7762 people answer this question Your score: 1
Question 51

Correct

Your choice People`s statistic 15% 2% 62% 10% 11%

A 28-year-old G0 woman has her first abnormal Pap, which was read as high-grade squamous intraepithelial lesion (HSIL.) She has no complaints. She smokes one pack of cigarettes per day. Her pelvic exam is normal. Colposcopy is performed. The cervix is noted to have an ectropion and there is abundant aceto-white epithelium. Mosaicism, punctations and several disorderly, atypical vessels are noted. Several biopsies are obtained and sent to pathology. Which of the findings on this patients colposcopy is most concerning?

Possible answers A. Ectropion B. Acetol-white epithelium C. Mosaicism D. Punctations E. Disorderly, atypical vessels

Correct

Your choice

People`s statistic 3% 8% 6% 3% 79%

7480 people answer this question Your score: 0

Question 52 A 31 year-old G0 woman has been diagnosed with uterine fibroids. A fluid contrast ultrasound confirmed the presence of two intramural fibroids measuring 5 x 6 cm and 2 x 3 cm that appear to be distorting the patients uterine cavity. The patient has a two-year history of infertility. She has had a thorough infertility work up. No etiology for her infertility has been identified. Which of the following treatments is most appropriate for this patient?

Possible answers A. Hysteroscopy B. Uterine curettage C. Gonadotropin-releasing hormone agonist D. Uterine artery embolization E. Myomectomy 6591 people answer this question Your score: 0

Correct

Your choice

People`s statistic 6% 2% 9% 2% 80%

Question 53 A 36-year-old G5P4 woman with no prenatal care presented in active labor with a blood pressure of 170/105 and 3+ proteinuria. Fetal heart tones were found to be in the 170s with decreased variability and a sinusoidal pattern. Resting uterine tone was noted to be increased and she was having frequent contractions (every 1-2 minutes.) The patient complained of bright red vaginal bleeding for the past hour. Based on this history, what is the etiology of her vaginal bleeding?

Possible answers A. Uterine rupture B. Placenta previa C. Bloody show D. Abruptio placenta E. Cervical trauma 8564 people answer this question Your score: 1

Correct

Your choice

People`s statistic 4% 8% 6% 82% 1%

Question 54 A 39 year-old G1P1 woman comes to see you because of increased bleeding due to her known uterine fibroids, especially during her menses. She reports that her bleeding is so heavy that she has to miss two days of work every month. She has been using oral contraceptives and NSAIDs. Her most recent hematocrit was 27%. She is undecided about having more children. You discuss with her short and long-term options to decrease her bleeding. What is the next best step in the management of this patient?

Possible answers A. Blook transfusion B. Gonadotropin-releasing hormone agonists C. Endometrial ablation D. Uterine artery embolization E. Hysterectomy 6587 people answer this question Your score: 1

Correct

Your choice

People`s statistic 4% 80% 7% 8% 2%

Question 55 A 28 year-old G1P1 presents to your office. She delivered 4 days ago and tearfully reports that yesterday and the day before she had trouble sleeping, felt anxious and was irritable. She feels somewhat better today, but is still concerned. What is the most likely diagnosis?

Possible answers A. Hypothyroidism B. Blues C. Depression D. Normal postpartum state E. Anxiety 5579 people answer this question Your score: 1

Correct

Your choice

People`s statistic 0% 88% 1% 10% 1%

Question 56 A 24 year-old patient is considering pregnancy in the next year. Her medical history and physical examination are normal. She is unaware of any significant family history. She exercises regularly and does

not smoke or drink alcohol. She asks if her diet has adequate folate and what you recommend to your patients. Which of the following statements about folate is correct?

Possible answers A. Folate supplementation is recommended for this patient B. Most patients get an adequate intake by diet alone C. She is not currently planning a pregnancy and does not need to worry about folate D. Current grain supplementation adequately prevents neural tube defects E. Folate does not need to be started until after a pregnancy is documented 7746 people answer this question Your score: 1

Correct

Your choice

People`s statistic 93% 3% 1% 1% 2%

Question 57 A 57 year-old G2P2 woman is seen for a routine visit. She states she and her 75 year-old husband stopped having sexual intercourse 3 years ago when he had an operation for prostate cancer. Menopause occurred at age 50 and she denies taking hormones. Her husband now wishes to resume intercourse and is able to get an erection with sildenafil (Viagra). Attempts at intercourse have been unsuccessful due to the pain she experiences when insertion is attempted. Examination is normal except for a narrowed vagina with atrophic mucosa. Which of the following is the most appropriate recommendation at this time?

Possible answers A. Progesterone cream B. Estrogen cream C. Oral estrogen D. Testerone cream E. Vaginal dilators 5581 people answer this question Your score: 0

Correct

Your choice

People`s statistic 1% 95% 1% 0% 3%

Question 58 An 18 year-old G0 comes in for an annual exam with her mother. Her mother comments that she had severe PMS symptoms in her twenties and thirties. She would like to know if her daughter will inherit this as well. Which of the following has the strongest association with premenstrual syndrome?

Possible answers A. Obesity B. Positive family history C. History of early menarche D. Insulin dependent diabetes mellitus E. Vitamin K deficiency 5741 people answer this question Your score: 1

Correct

Your choice

People`s statistic 14% 74% 9% 1% 2%

Question 59 A 26 year-old G2P1 at 26 weeks gestation presents for a routine 50 gram glucose challenge test. After receiving a one-hour blood glucose value of 144, the patient has a follow up 100 gram 3-hour oral glucose tolerance test with the following plasma values: fasting blood-sugar 102, 1-hour 181, 2-hours 162, and 3hours 139 (Normal: fasting 95, 1-hour 180, 2-hours 155, 3-hours 140). Your next step in this patients management is:

Possible answers A. Repeat the glucose tolerance test in early or mid-third trimester B. Explain to the patient that she has gestational diabetes and begin diet and blood glucose monitoring C. Explain to the patient that she has gestational diabetes and begin diet, treatment with oral hypoglycemic agents and blood glucose monitoring D. Explain to the patient that she has gestational diabetes and begin diet, treatment with insulin and blood glucose monitoring E. Follow the patient as a normal gestation 9506 people answer this question Your score: 1

Correct

Your choice

People`s statistic 8% 78% 4%

5%

5%

Question 60 A 16 year-old girl comes to the doctor to discuss contraception. She recently became sexually active and states she has never had a menstrual cycle. She regularly attends school and participates in the band. On physical examination, she is 53 and weighs 130 pounds. She has no secondary sexual characteristics with

normal appearing external genitalia. The physician suspects Kallmann syndrome. Which of the following diagnostic tests will help confirm the diagnosis?

Possible answers A. An MRI of the pituitary B. Olfactory challenge C. Measurement of testosterone levels D. Pelvic ultrasound E. Cortisol levels 6961 people answer this question Your score: 0

Correct

Your choice

People`s statistic 5% 88% 3% 3% 2%

Question 61 A 35 year-old G4P3 comes in for a postpartum visit. She had a normal uncomplicated vaginal delivery two weeks ago. She has a history of postpartum depression, which required treatment with antidepressants with her last pregnancy. Which of the following signs or symptoms of postpartum depression are most useful to distinguish it from postpartum blues and normal changes that occur after delivery?

Possible answers A. Anhedonia B. Crying spells C. Ambivalence toward the newborn D. Sleeplessness E. Weight loss 8367 people answer this question Your score: 0

Correct

Your choice

People`s statistic 17% 1% 77% 2% 3%

Question 62 A 45 year-old G5P5 premenopausal woman was initially seen in your office for work-up and evaluation of a FIGO grade 2 endometrial cancer that was diagnosed by her gynecologist. Which of the following is the most appropriate treatment for this patient?

Possible answers Total laparoscopic hysterectomy with bilateral salpingo-

Correct

Your choice

People`s statistic 17%

oophorectomy Vaginal hysterectomy with bilateral salpingo-oophorectomy Total abdominal hysterectomy, bilateral salpingooophorectomy, bilateral pelvic and para-aortic lymphadenectomy, pelvic washings Supracervical abdominal hysterectomy with ovarian preservation Megace 7073 people answer this question Your score: 1

8% 58%

15% 1%

Question 63 A 50 year-old G4P4 woman presents for her yearly checkup. She states her menses are of normal flow every 32 days, with minimal cramping and 5-day duration. Review of systems is negative. She has no medical problems. She had a bilateral tubal ligation following her last child, and a laparoscopic cholecystectomy 5 years ago. She has a history of LGSIL Pap smear with colposcopy and cryotherapy 15 years ago; her Paps have been normal since then. She does not smoke, drink alcohol or use any drugs. She is sexually active with one partner with no problems. Her general exam, including a breast exam and pelvic exam, is normal. In addition to performing a Pap smear, which of the following is the most appropriate screening test for this patient?

Possible answers A. Pelvic ultrasound B. Endometrial biopsy C. Mammogram D. DEXA scan E. Colposcopy 6595 people answer this question Your score: 1

Correct

Your choice

People`s statistic 1% 1% 94% 2% 3%

Question 64 A 29-year-old G4P2 woman with no previous prenatal care presents to Labor and Delivery unit at 24 weeks 1 day gestation with signs and symptoms of preterm labor. Her cervix is 3 cm dilated and 80% effaced. Fundal height is 30 cm and an ultrasound examination reveals a twin gestation. Estimated fetal weights on the twins are 850 gm and 430 gm respectively. The maximum vertical amniotic fluid pocket around the smaller twin is 1 cm; the maximum vertical amniotic fluid pocket around the larger twin is 8 cm. Her last pregnancy was complicated by gestational diabetes. Which diagnosis do you suspect?

Possible answers A. Monozygotic dichorionic twinning B. Twin-twin transfusion C. Superfecundation D. Dichorionic diamniotic twins E. Gestational diabetes 7602 people answer this question Your score: 1

Correct

Your choice

People`s statistic 1% 95% 1% 2% 1%

Question 65 A 17 year-old G0 sexually active woman presents to the emergency room with acute right lower quadrant pain and nausea for 12 hours. Her periods have always been irregular, with her last one 6 weeks ago. She is otherwise completely healthy. She appears in mild distress. Physical examination: temperature 100.2F (37.9C); blood pressure 110/60; heart rate 108 beats/min. She has moderate abdominal tenderness with right greater than left pelvic tenderness. Pelvic exam reveals normal external genitalia and pink-tinged discharge is noted on speculum examination. Bimanual/rectovaginal exam confirms mild cervical motion tenderness and fullness in the right adnexa with moderate tenderness and some voluntary guarding. What is the single most important test to obtain?

Possible answers A. Pelvic ultrasound B. CT scan of the abdomen and pelvis C. GC and chlamydia DNA probe D. Beta-hCG E. CBC with differential 5693 people answer this question Your score: 1

Correct

Your choice

People`s statistic 11% 3% 5% 80% 1%

Question 66 An obese 30 year-old G3P1 Asian woman undergoes an uncomplicated dilation and curettage for a firsttrimester miscarriage. Pathology reveals a molar pregnancy. The patients medical history is significant for chronic hypertension. She has a history of a previous uncomplicated term pregnancy, and termination of a pregnancy at 16 weeks gestation for trisomy 18. What aspect of the patients history places her at increased risk for a molar pregnancy?

Possible answers A. Obesity B. Previous history of fetal aneuploidy C. Asian race D. Chronic hypertension E. Prior term pregnancy 6338 people answer this question Your score: 1

Correct

Your choice

People`s statistic 3% 28% 61% 5% 2%

Question 67 A 29 year-old G1P0 at 42 weeks presents to labor and delivery because of intermittent contractions. She denies ruptured membranes. Her prenatal course was uncomplicated. Her vital signs are: blood pressure 140/96; pulse 72; afebrile; fundal height 32 cm; and estimated fetal weight of 2900 gm. Cervix is closed, 25% effaced, -2 station. The fetal heart rate tracing shows occasional late decelerations. Of the following, what is the next best step in management?

Possible answers A. Maternal left lateral position B. Intrauterine resuscitation with terbutaline C. Start an amnioinfusion D. Begin magnesium sulfate E. Augment labor with oxytocin 6970 people answer this question Your score: 1

Correct

Your choice

People`s statistic 69% 2% 4% 4% 22%

Question 68 A 20-year-old G1P0 woman has vaginal spotting and mild cramping for the last 3 days. She had her last normal menstrual period approximately 6-1/2 weeks ago. She had a positive home pregnancy test. Her medical and gynecologic histories are negative and non-contributory. On physical exam: blood pressure 120/72; pulse 64; respirations 18; temperature 98.6F (37C). On pelvic exam, she has scant old blood in the vagina, with a normal appearing cervix and no discharge. On bimanual exam, her uterus is nontender and small, and there are no adnexal masses palpable. Pertinent labs: Quantitative Beta-hCG is 750 mIU/ml 48 hours ago; today, the level is 760 mIU/ml; progesterone level = 3.2 ng/ml; hematocrit is 37%. Transvaginal ultrasound shows a fluid collection in the uterus and no fetal pole, no masses and no free fluid in the pelvis. Which of the following is the most appropriate next step in the management of this patient?

Possible answers A. Exploratory surgery B. Treat with Methotrexate C. Treat with Mifepristone D. Dilatation and Curettage E. Repeat hCG level in one week 9350 people answer this question Your score: 0

Correct

Your choice

People`s statistic 4% 39% 6% 39% 13%

Question 69 An 88 year-old G2P2 nursing home resident is brought in for evaluation of blood found in her diapers. She has a long-standing history of incontinence. This is the first time that her caregivers have noted blood. They describe it as quarter size. Her nurses think that she may have been itching, as they frequently find her scratching through the diaper. On review of her medical record, biopsy documented lichen sclerosus of the vulva was diagnosed fifteen years ago. She has not been on any therapy for this condition for years. Examination of the external genitalia reveals an elevated, firm irregular lesion arising from the left labia. The lesion measures 2.5 cm in greatest dimension. The remainder of the external genitalia shows evidence of excoriation of thin, white skin with a wrinkled parchment appearance. The vagina and cervix are atrophic. No masses are noted on bimanual or rectovaginal exam and a sample of her stool is negative for blood. No nodularity is noted in her groin. Which of the following is the most appropriate next step in the management of this patient?

Possible answers A. Begin steroids for her lichen sclerosis B. Benadryl and xylocaine jelly for symptomatic relief C. Biopsy the lesion D. Exam under anesthesia with colposcopy and CO2 laser ablation E. Complete vulvectomy and lymph node dissection 6665 people answer this question Your score: 1

Correct

Your choice

People`s statistic 8% 2% 86% 1% 2%

Question 70

A 19 year-old G1P0 at 42 weeks presents to labor and delivery with spontaneous rupture of membranes for 13 hours and spontaneous onset of labor. Her vital signs are: blood pressure 120/70; pulse 72; afebrile; fundal height 36 cm; and estimated fetal weight of 2700 gm. Cervix is dilated to 4 cm, 100% effaced, + 1 station. Which statement best describes the tracing seen below?

Possible answers A. Normal fetal heart rate pattern B. Sinusoidal rhythm C. Late deceleration D. Variable decelerations E. Early decelerations 6959 people answer this question Your score: 0

Correct

Your choice

People`s statistic 2% 1% 7% 61% 30%

Question 71 A 25 year-old G0 presents to the clinic for follow-up of a first trimester spontaneous abortion. She wants to discuss the cause of this event. Which of the following etiologic categories accounts for the majority of first trimester spontaneous abortions?

Possible answers A. Immunologic abnormalities B. Conceptus genetic anomalies C. Maternal genetic anomalies D. Maternal chronic diseases E. Structural/uterine anomalies 8295 people answer this question Your score: 1

Correct

Your choice

People`s statistic 1% 93% 3% 2% 1%

Question 72

A 38-year-old G2P0 woman at 31-weeks gestation has been diagnosed with preterm labor and is currently stable on magnesium sulfate. Her cervical exam has remained unchanged at 2 cm dilated, 75% effaced and -2 station. Her vital signs are stable and fetal heart tones are reassuring. You recommend treatment with Betamethasone (a steroid). What is a possible fetal effect associated with Betamethasone therapy?

Possible answers A. Increased risk of infection in the newborn B. Increased incidence of intracerebral hemorrhage C. Enhancement of fetal growth D. Increased incidence of necrotizing enterocolitis E. Decreased incidence of intracerebral hemorrhage 8049 people answer this question Your score: 1

Correct

Your choice

People`s statistic 22% 7% 10% 8% 53%

Question 73 A 22-year-old G1P1 woman is undergoing treatment with magnesium sulfate for severe preeclampsia. She was delivered 10 hours previously via cesarean section for a non-reassuring fetal heart rate tracing. She has oliguria and appears lethargic. On exam, no deep tendon reflexes can be appreciated. Her magnesium level is 11mEq/L. You become concerned about magnesium toxicity at this level. What condition can magnesium toxicity at this level result in?

Possible answers A. Seizures B. Paralysis C. Respiratory depression D. Pulmonary edema E. Cardiac arrest 8584 people answer this question Your score: 1

Correct

Your choice

People`s statistic 2% 4% 71% 12% 11%

Question 74 A 22 year-old G2P1 is at 42 weeks gestation dated by an ultrasound performed 5 weeks ago. Her cervix is long and closed. She does not report contractions and states there is good fetal movement. She would like to wait until she goes into labor spontaneously. Which of the following treatment options is optimal at this time?

Possible answers A. w the patient to go into labor spontaneously B. Perform an ultrasound to determine gestational age C. Perform a non-stress test (NST) and amniotic fluid index (AFI) twice a week, with induction of labor for a nonreactive NST or oligohydramnios. D. Patient should perform daily fetal movement counts and proceed with induction for decreased fetal movement. E. Perform daily biophysical profiles and deliver if 4 or less 6655 people answer this question Your score: 1

Correct

Your choice

People`s statistic 3% 4% 79%

6% 9%

Question 75 A 22 year-old G0 college student returns for follow-up of mood swings and difficulty concentrating on her schoolwork the week before her menses for the past 12 months. Her past medical history is unremarkable and physical examination is normal. Which of the following would be an appropriate treatment option for this patient?

Possible answers A. Oral contraceptive pills B. Reassurance and observation C. Methylphenidate (Ritalin) D. Gabapentin E. Ginkgo 5683 people answer this question Your score: 1
Your score:

Correct

Your choice

People`s statistic 81% 13% 3% 2% 2%

Question 76 A 22 year-old P0 presents with a one-month history of profuse vaginal discharge with mild odor. She has a new sexual partner with whom she has had unprotected intercourse. She reports mild to moderate irritation, pruritus and pain. She thought she had a yeast infection, but had no improvement after using an over-thecounter antifungal cream. She is concerned about sexually transmitted infections. Her medical history is significant for lupus and chronic steroid use. Pelvic examination shows normal external genitalia, an erythematous vagina with a copious, frothy yellow discharge and multiple petechiae on the cervix. Vaginal pH is 7. Saline wet mount reveals motile, flagellated organisms and multiple white blood cells. Which of the following is the most appropriate treatment for this patient?

Possible answers A. Clindamycin B. Azithromycin C. Metronidazole D. Ampicillin E. Doxycycline 6650 people answer this question Your score: 1

Correct

Your choice

People`s statistic 1% 1% 94% 1% 2%

Question 77 A 23 year-old G0 reports having a solitary, painful vulvar lesion that has been present for three days. This lesion has occurred twice in the past. She states that herpes culture was done by her doctor during her last outbreak and was negative. She is getting frustrated in that she does not know her diagnosis. She has no significant previous medical history. She uses oral contraceptives and condoms. She has had four sexual partners in her lifetime. On physical examination, a cluster of three irregular erosions with a superficial crust is noted on the posterior fourchette. Urine pregnancy test is negative. You suspect recurrent genital herpes. How do you explain the negative culture?

Possible answers A. Cultures were taken too early B. The more definitive test would be serum herpes antibody testing C. The cultures were refrigerated prior to transport to the lab D. Herpes cultures have a 10-20% false negative rate E. The herpes virus cannot be recovered with recurrent infections 10547 people answer this question Your score: 1

Correct

Your choice

People`s statistic 5% 15% 1% 74% 4%

Question 78 A 20-year-old G1 woman presents to triage with uterine contractions every 4 minutes at 32 weeks gestation. On exam, her cervix is long, closed and posterior. Her urinalysis is normal and she is not dehydrated. Which of the following is the most appropriate next step in the management of this patient?

Possible answers

Correct

Your choice

People`s statistic

A. IV hydration B. Tocolysis C. Discharge home on bedrest D. Continued observation E. Treat with betamethasone 8017 people answer this question Your score: 1

6% 29% 9% 44% 12%

Question 79 A 28 year-old G2P1 presents in labor at term and delivers a 3500 gram infant spontaneously after oxytocin augmentation of labor. Thirty minutes later, the placenta has not delivered. Her past medical history is significant for leiomyoma uteri and male factor infertility. Her prenatal course was uncomplicated. What is the most likely risk factor for retained placenta in this case?

Possible answers A. Placenta abruption B. Labor augmentation C. Leiomyomas D. Multiparity E. Circumvallate placenta 7339 people answer this question Your score: 1

Correct

Your choice

People`s statistic 2% 6% 81% 3% 8%

Question 80 A 27 year-old G1P0 at 34 weeks gestation is brought in by ambulance after a motor vehicle accident. Although restrained in the car with a safety belt, she suffers a significant head laceration. When she arrives in the emergency room, her initial trauma survey is completed. On her secondary survey, there is bright red blood coming from the vagina. Her abdomen is noted to be tense. Subsequent documentation of the fetal heart tones reveals fetal tachycardia. Abruption is suspected and the patient is rushed to the operating room for an emergent Cesarean section. After delivery, the nurse notes that an informed surgical consent was never signed. Which of the following is true?

Possible answers A. Informed consent is valid if the doctor-patient discussion occurred soon after the patient received intravenous morphine for pain relief

Correct

Your choice

People`s statistic 0%

B. Informed consent is unnecessary in an emergency situation if a delay in treatment would risk the patients health/life C. Informed consent is only required for invasive procedures D. Informed consent would not have been valid anyway because the patient sustained a head laceration E. In an emergency situation, informed consent documents can be signed after the procedure is over and the patient is stable 6988 people answer this question Your score: 1

90%

0% 0% 9%

Question 81 A 19 year-old patient has just started a new sexual relationship and comes in to discuss contraception. She is most concerned about preventing a sexually transmitted infection. The contraceptive method most likely to prevent sexually transmitted infections is:

Possible answers A. The male condom B. The female condom C. Cervical cap D. Cervical cap and Spermicide E. Diaphragm 7690 people answer this question Your score: 1

Correct

Your choice

People`s statistic 94% 5% 0% 1% 1%

Question 82 A 32 year-old G0 presents with amenorrhea for the last 3 months. She has a long history of irregular cycles, 26 to 45 days apart, for the last two years. She is otherwise in good health and is not taking any medications. She is sexually active with her husband and uses condoms for contraception. She is 5 feet 4 inches tall and weighs 140 pounds. On exam, she has a slightly enlarged, non-tender uterus. There are no adnexal masses. What is the most appropriate next step in the management of this patient?

Possible answers A. Perform a pelvic ultrasound B. Check a TSH level

Correct

Your choice

People`s statistic 3% 2%

C. Check progesterone and estrogen levels D. Perform a urine pregnancy test E. Check FSH and LH levels 6421 people answer this question Your score: 1

1% 92% 2%

Question 83 A 25 year-old G1P0 is seen for an initial obstetrical appointment at 8 weeks gestation. She has had a small ventricular septal defect (VSD) since birth. She has no surgical history and no limitations on her activity. Pertinent examination findings: respiratory rate 12, heart rate 88, blood pressure 112/68, skin acyanotic, lungs clear to auscultation, heart regular rate and rhythm. There is an IV/VI coarse pansystolic murmur at the left sternal border, accompanied by a thrill. Chest x-ray and ECG are normal. Which of the following is the correct statement regarding cardiovascular adaptation in this patient?

Possible answers A. Approximately 2% of women will normally have a diastolic murmur B. Maternal systemic vascular resistance is normally less than pulmonary vascular resistance C. The maternal cardiac output will increase up to 33% during pregnancy D. Maternal systemic vascular resistance increases throughout pregnancy E. The increase in cardiac output is only due to the increase in the maternal stroke volume 10298 people answer this question Your score: 1

Correct

Your choice

People`s statistic 2% 4% 88% 2% 4%

Question 84 A 25-year-old female patient presents to her doctor for preconception counseling. She is healthy without significant medical problems. She takes no medications except for occasional Tylenol. She smokes one pack of cigarettes per day since age 16 and drinks occasionally. She weighs 140 pounds and her vital signs and examination are normal. The patient is at increased risk of which of the following during her pregnancy?

Possible answers A. Fetal chromosomal abnormality

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People`s statistic 3%

B. Breech presentation C. Placental abruption D. Macrosomia E. Cerebral palsy 7876 people answer this question Your score: 1

1% 91% 1% 4%

Question 85 An obese 30 year-old G3P1 Asian woman undergoes an uncomplicated dilation and curettage for a firsttrimester miscarriage. Pathology reveals a molar pregnancy. The patients medical history is significant for chronic hypertension. She has a history of a previous uncomplicated term pregnancy and a termination of a pregnancy at 16 weeks gestation with trisomy 18. Which of the following is most likely to decrease this womans risk of having another molar pregnancy in the future?

Possible answers A. Achieve an ideal body weight prior to conception B. Folic acid supplementation before and during pregnancy C. Use donor sperm D. Wait a minimum of two years before trying to conceive again E. Initiate a vegetarian diet 6334 people answer this question Your score: 0

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People`s statistic 14% 63% 7% 16% 1%

Question 86 A 19 year-old G1P0 notes vaginal spotting. Her last normal menstrual period occurred 6 weeks ago. She began having spotting early this morning and it has increased only slightly. She has no pain and denies other symptoms. Her medical history is noncontributory. On physical exam: blood pressure is 120/68; pulse 68; respirations 20; and temperature 98.6F (37.0C). On pelvic exam, her cervix is normal; uterus is small and nontender; and no masses are palpable. Initial labs show quantitative Beta-hCG 2000 mIU/ml and hematocrit is 38%. A repeat Beta-hCG level 48 hours later is 2100 mIU/ml. A transvaginal ultrasound shows an empty uterus with a thin endometrial stripe and no adnexal masses. What is the next best step in the management of this patient?

Possible answers

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People`s statistic

A. Dilatation and Curettage B. Treat with Methotrexate C. Exploratory laparotomy D. Repeat hCG level in 48 hours E. Repeat ultrasound in 24 hours 9327 people answer this question Your score: 0

14% 63% 11% 9% 3%

Question 87 A 14-year old G0 adolescent reports menarche six months ago, with increasingly heavy menstrual flow causing her to miss several days of school. Three months ago, her pediatrician started her on oral contraceptives to control her menstrual periods, but she continues to bleed heavily. Her previous medical history is unremarkable. The patient has a normal body habitus for her age. Appropriate breast and pubic hair development is present. Her hemoglobin is 9.1 mg/dl, hematocrit 27.8%, urine pregnancy test negative. Which of the following etiologies for menorrhagia is most likely the cause of her symptoms?

Possible answers A. Uterine leiomyoma B. Thyroid disorder C. Coagulation disorder D. Endometrial hyperplasia E. Chronic Endometritis 6955 people answer this question Your score: 1

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People`s statistic 5% 2% 87% 5% 1%

Question 88 A 48-year-old G0 woman comes to the office for a health maintenance exam. She is healthy and not taking any medications. She has no history of abnormal Pap smears or sexually transmitted diseases. She is not currently sexually active. Her menstrual cycles are normal and her last cycle was three weeks ago. She smokes one pack of cigarettes per day. Her mother was diagnosed with endometriosis and had a hysterectomy and removal of the ovaries at age 38. She is 5 feet 4 inches tall and weighs 130 pounds. On pelvic examination, the patient had a palpable left adnexal mass. An ultrasound was obtained, which showed a 4 cm complex left ovarian cyst and a 2 cm simple cyst on the right ovary. What is the most appropriate next step in the management of this patient?

Possible answers

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People`s statistic

A. CAT scan of the abdomen and pelvis B. MRI of the pelvis C. Abdominal hysterectomy and bilateral salpingooophorectomy (TAH/BSO) D. Repeat ultrasound in 2 months E. Oral contraceptives 7887 people answer this question Your score: 1

9% 5% 12% 63% 12%

Question 89 A 25-year-old G2P1 woman states her gestational age by a first trimester ultrasound is 16 weeks, 3 days. She reports no complaints and is not yet feeling fetal movement. Her fundal height is just above the umbilicus and measures 22 cm. The MSAFP (maternal serum alpha fetoprotein) result is elevated. Which of the following is the most likely cause for the abnormal MSAFP result?

Possible answers A. Fetal trisomy B. Dates in error C. Twin gestation D. Fetal gastroschisis E. Fetal demise 7658 people answer this question Your score: 0

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People`s statistic 4% 32% 62% 2% 1%

Question 90 A 28 year-old G1P0 is at 15 weeks gestation. Her husbands cousin has moderate mental retardation. The most common cause of inherited mental retardation in this patients child would be?

Possible answers A. Undiagnosed phenylketonuria (PKU) B. Neonatal hypothyroidism C. Fragile X syndrome D. Down syndrome E. Autism 9138 people answer this question

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People`s statistic 3% 1% 72% 21% 3%

Your score: 1

Question 91 A 52 year-old G3P3 woman presents to your office with severe hot flashes and vaginal dryness for 6 months. Her last menstrual period was 15 months ago. After discussing the risks and benefits of hormone therapy with this patient, she decides to begin treatment. This patient is most likely to stop hormone therapy secondary to what side effect?

Possible answers A. Vaginal bleeding B. Development of breast cancer C. Hirsutism D. Nausea E. Relief of menopausal symptoms 6573 people answer this question Your score: 0

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People`s statistic 57% 7% 3% 23% 11%

Question 92 A 34 year-old woman comes to you for a chief complaint of hirsutism. She states that this has been present since menarche, but has gotten worse in the past two years. Her menses have become more irregular, now every 28-45 days apart. She states that she quit smoking and gained approximately thirty pounds in the past three years. Her mother is obese, diabetic and has hirsutism. There is no hair seen on her chin, but she shaves every few days. TSH, prolactin, 17-hydroxyprogesterone and DHEAS are normal. Testosterone is mildly elevated. Which of the following is the most likely etiology of her hirsutism?

Possible answers A. Polycystic ovarian syndrome B. Ovarian neoplasm C. Diabetes D. Cushings syndrome E. Adrenal tumor 6596 people answer this question Your score: 1

Correct

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People`s statistic 93% 2% 2% 2% 1%

Question 93 A 19-year-old G1P0 woman at 41-weeks gestation with two prior prenatal visits at 35-weeks and 40-weeks, presents to the labor room in active labor. Review of available maternal labs shows blood type O+, RPR non-reactive, HBsAg negative, HIV negative. She delivers a small female infant who cries spontaneously. On examination, you find the infant has a slightly flattened nasal bridge. Her ears are small and slightly rotated. What is the most appropriate next step?

Possible answers A. Tell the mother that her newborn has Down syndrome B. Further examine the infant for wide-spaced nipples and lymphedema C. Question the patient why an amniocentesis was not performed D. Tell the mother the infant will be fine E. Further examine the infant for sandal gap toes and hypotonia 8757 people answer this question Your score: 1

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People`s statistic 3% 16% 1% 3% 77%

Question 94 A 23 year-old G1P0 presents in labor at term. Her prenatal course was uncomplicated. She delivers a 3500 gram infant spontaneously after oxytocin augmentation of labor. Immediately postpartum, there is excessive bleeding greater than 2000 cc. There are no lacerations and the uterus is found to be boggy. Her blood pressure is 70/30; pulse 144; and hematocrit is 20%. Conservative and medical management have failed and you proceed with an exploratory laparotomy. Which of the following is the most appropriate next step in the management of this patient?

Possible answers A. Cervical artery ligation B. Ovarian artery ligation C. External iliac artery ligation D. Hypogastric artery ligation E. Hysterectomy 7378 people answer this question Your score: 0

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People`s statistic 6% 7% 5% 59% 24%

Question 95 A 32 year-old G0 woman comes to the office due to the inability to conceive for last two years. She reports having been on oral contraceptives for 8 years prior. She had menarche at age 14 and has had irregular cycles about every 3 months until she started oral contraceptives, which regulated her cycles. In the last year, she has had about 5 cycles in total; her last menstrual period was 6 weeks ago. She is otherwise in good health and has not had any surgeries. She has no history of abnormal Pap smears or sexually transmitted infections. She is 54 tall and weighs 165 pounds. On general appearance, she seems to be hirsute on the face and the abdomen. The rest of her exam is otherwise normal. Which of the following is most likely to help identify the underlying cause of this womans infertility?

Possible answers A. Lutenizing hormone levels B. Testosterone levels C. Follicle stimulating hormone levels D. Thyroid function tests E. Progesterone levels 6186 people answer this question Your score: 0

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People`s statistic 15% 72% 10% 1% 2%

Question 96 A 90-year-old G7P7 woman presents with severe vaginal prolapse. The entire apex, anterior and posterior wall are prolapsed beyond the introitus. She cannot urinate without reduction of the prolapse. Hydronephrosis was noted on ultrasound of the kidneys and it is thought to be related to the prolapse. She has a long-standing history of diabetes and cardiac disease. She is not a candidate for general or regional anesthesia. She has failed a trial of pessaries. Which of the following is the next best step in the management of this patient?

Possible answers A. Do nothing and observe B. Anterior and posterior repair C. Colpocleisis D. Sacrospinous fixation E. Sacrocolpopexy 8432 people answer this question Your score:

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People`s statistic 12% 11% 57% 9% 11%

Question 97

A 36 year-old G0 presents to the emergency department accompanied by her female partner. The patient notes severe belly pain. She states that this pain began 2-3 days ago and was associated with diarrhea as well as some nausea. It has gotten progressively worse and she has now developed a fever. Neither her partner, nor other close contacts report any type of viral illness. She had her appendix removed as a teenager. On examination, her temperature is 102.0F (38.9C), her abdomen is tender with mild guarding and rebound, and she has an elevated white count. On pelvic examination, she is exquisitely tender, such that you cannot complete the examination. Pelvic ultrasound demonstrates bilateral 3-4 cm complex masses. What is the most likely underlying pathogenesis of her illness?

Possible answers A. Diverticulitis B. Gastroenteritis C. Reactivation of an old infection D. Ascending infection E. Pyelonephritis 6558 people answer this question Your score:

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People`s statistic 7% 3% 6% 77% 7%

Question 98 A 36 year-old G3P2 presents in active labor at full term with a known placenta previa. She reports brisk vaginal bleeding. Evaluation shows that fetus and patient are currently hemodynamically stable. She has had two normal vaginal deliveries in the past. She declines your recommendation to undergo Cesarean section. Which of the following is not advisable during your initial management of this patient?

Possible answers A. Soliciting her reasons for not undergoing a Cesarean section B. Obtaining hospital Ethics Committee recommendation C. Proceeding with an emergency Cesarean section D. Explaining your reasons for recommending a Cesarean section E. Informing risk management of the situation that has developed 7020 people answer this question Your score:

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People`s statistic 5% 6% 84% 4% 2%

Question 99

An 18 year-old college student is seen in the emergency room, claiming she was raped by a 29 year-old janitor in her dorm 4 hours ago. He threatened her with a knife and she did not resist. She appears calm and has a flattened affect when the history is taken. Currently, she is sexually active with a fellow student and is taking birth control pills. The alleged attacker used a condom, which she helped him put on. The student is 52 tall and weighs 110 pounds. She is a cheerleader for the college football team. Examination reveals no bruising and gynecologic examination reveals no apparent injuries. Which of the following statements is the most likely explanation for this patients presentation?

Possible answers A. The attack was not emotionally traumatic B. The student is in shock C. The attack never happened D. The student cooperated with the attacker E. The student suffers from chronic depression 5108 people answer this question Your score:

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People`s statistic 0% 74% 6% 18% 1%

Question 100 A 21-year-old G0 woman has her first Pap smear, and it shows a high-grade squamous intraepithelial lesion (HSIL.) Colposcopy is performed, and three biopsies and an endocervical curettage are obtained. The biopsies and endocervical curettage were read as normal. Which of the following would be the most appropriate next step in the management of this patient?

Possible answers A. Pap smear in 6 months B. Colposcopy with directed biopsies in 3-6 months C. Cryotherapy D. Cervical conization E. Treat for presumed infection and repeat Pap in 4-6 weeks 7412 people answer this question Your score:

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People`s statistic 49% 9% 2% 38% 2%