ChatGBT Questions

Question 1

A 22-year-old woman presents to the clinic with a complaint of irregular menstrual cycles ranging from 21 to 45 days over the past six months. She denies any significant medical history but reports increased stress from college examinations. Her physical exam is unremarkable, and her BMI is 20 kg/m². Which of the following is the most likely cause of her menstrual irregularity?**
- A) Polycystic ovary syndrome (PCOS)
- B) Hypothalamic-pituitary dysfunction
- C) Uterine fibroids
- D) Thyroid dysfunction

Answer 1

B) Hypothalamic-pituitary dysfunction

In young women, stress can lead to alterations in the hypothalamic-pituitary axis, resulting in inconsistent GnRH secretion and, consequently, irregular menstruation. Her normal BMI and lack of other symptoms make PCOS and thyroid dysfunction less likely.

Question 2

A 30-year-old woman complains of severe dysmenorrhea that has worsened over the past year. She uses NSAIDs with minimal relief. Her menstrual cycles are regular, and she has no children. On examination, her uterus is retroverted and fixed. What is the most appropriate next step in management?**
- A) Schedule a laparoscopy
- B) Prescribe oral contraceptive pills
- C) Recommend pregnancy
- D) Initiate gonadotropin-releasing hormone (GnRH) agonists

Answer 2

A) Schedule a laparoscopy

The patient’s symptoms and physical findings suggest endometriosis, especially with a fixed, retroverted uterus. Laparoscopy is the definitive method for diagnosis and can be therapeutic as well.

Question 3

A 45-year-old woman presents with heavy menstrual bleeding and a feeling of heaviness in the pelvis. Her physical examination reveals an enlarged, irregularly shaped uterus. Which of the following is the most likely diagnosis?**
- A) Endometrial cancer
- B) Uterine fibroids
- C) Adenomyosis
- D) Cervical polyps

Answer 3

B) Uterine fibroids

The presence of an enlarged, irregular uterus in a woman with heavy menstrual bleeding and pelvic heaviness is characteristic of uterine fibroids.

Question 4

A 28-year-old woman presents to the emergency department with sudden onset of severe pelvic pain midway through her menstrual cycle. Her last menstrual period was 14 days ago. On examination, she has rebound tenderness and guarding. Which of the following is the most likely diagnosis?**
- A) Ovarian torsion
- B) Ruptured ovarian cyst
- C) Ectopic pregnancy
- D) Appendicitis

Answer 4

B) Ruptured ovarian cyst

The timing of her pain (mid-cycle), known as Mittelschmerz, and her acute presentation suggest a ruptured ovarian cyst, particularly given the lack of pregnancy or gastrointestinal symptoms.

Question 5

A 35-year-old woman with a history of type 2 diabetes mellitus presents complaining of menstrual cycles that vary significantly in duration and volume of flow. She is obese with a BMI of 32 kg/m². Which of the following underlying conditions is most likely contributing to her menstrual irregularities?**
- A) Cushing’s syndrome
- B) PCOS
- C) Hypothyroidism
- D) Premature ovarian failure

Answer 5

B) PCOS

PCOS is common in obese women and can lead to irregular menstrual cycles due to hormonal imbalances, especially in those with insulin resistance and type 2 diabetes.

Question 6

A 23-year-old woman presents with a three-month history of amenorrhea following discontinuation of oral contraceptives. Her pregnancy test is negative. Which of the following tests is most appropriate to evaluate her amenorrhea?**
- A) Serum prolactin
- B) Repeat pregnancy test in two weeks
- C) Thyroid-stimulating hormone (TSH) level
- D) Follicle-stimulating hormone (FSH) level

Answer 6

C) Thyroid-stimulating hormone (TSH) level

Evaluating thyroid function is crucial in the workup of secondary amenorrhea due to the effect of thyroid hormones on ovulation and menstrual regularity. Thyroid disorders can cause disruptions in menstrual patterns.

Question 7

A 19-year-old college student visits your clinic complaining of painful menses and pain during intercourse. She also mentions that she frequently uses a heating pad for abdominal pain relief. Physical examination reveals a tender, nodular mass on her posterior vaginal fornix. What is the most likely diagnosis?**
- A) Pelvic inflammatory disease
- B) Endometriosis
- C) Ovarian cyst
- D) Uterine fibroids

Answer 7

B) Endometriosis

The combination of dysmenorrhea, dyspareunia, and a nodular mass in the posterior vaginal fornix strongly suggests endometriosis, particularly given her age and symptoms.

Question 8

A 32-year-old woman presents with a history of menorrhagia and recent severe anemia. Pelvic ultrasound shows multiple intramural fibroids. What is the best initial treatment option for her condition while preserving fertility?**
- A) High-dose progestin therapy
- B) Uterine artery embolization
- C) Myomectomy
- D) Hysterectomy

Answer 8

C) Myomectomy

Myomectomy is the preferred option for women with symptomatic fibroids who wish to preserve fertility, as it involves the surgical removal of fibroids while leaving the uterus intact.

Question 9

A 25-year-old woman reports a two-year history of cyclic pelvic pain, which intensifies during her periods. She has not responded to NSAIDs. No abnormalities are noted on pelvic ultrasound. What is the next best step in management?**
- A) Prescribe oral contraceptive pills
- B) Initiate antidepressants
- C) Recommend laparoscopic evaluation
- D) Administer GnRH agonists

Answer 9

C) Recommend laparoscopic evaluation

Given the chronic nature of her symptoms and failure to respond to NSAIDs, along with normal ultrasound findings, a laparoscopic evaluation is warranted to directly visualize and possibly treat conditions like endometriosis.

Question 10

A 40-year-old woman with a history of irregular menses and a recent diagnosis of hypertension is found to have elevated androgens and serum sodium. Which of the following should be suspected?**
- A) Adrenal hyperplasia
- B) PCOS
- C) Cushing’s syndrome
- D) Pheochromocytoma

Answer 10

C) Cushing’s syndrome

The presence of hypertension, irregular menses, and elevated androgens suggests Cushing’s syndrome, characterized by excessive cortisol production, often affecting multiple body systems including the reproductive axis.

Question 11

A 17-year-old female presents with a history of severe acne and irregular periods. She has a BMI of 36 kg/m² and reports significant weight gain over the last year. Physical examination shows hirsutism. What is the most appropriate initial step to manage her condition?**
- A) Start metformin
- B) Prescribe a combination oral contraceptive pill
- C) Recommend weight loss only
- D) Initiate spironolactone therapy

Answer 11

B) Prescribe a combination oral contraceptive pill

This patient likely has polycystic ovary syndrome (PCOS), which is suggested by her symptoms of irregular periods, acne, and hirsutism. The first-line treatment for managing menstrual irregularities and hyperandrogenism in PCOS is a combination oral contraceptive pill, which provides both menstrual regulation and androgen suppression.

Question 12

A 29-year-old woman presents to the clinic complaining of intermittent pelvic pain and irregular, heavy menstrual bleeding. She has unsuccessfully tried NSAIDs and tranexamic acid. Her ultrasound shows no abnormalities. Which treatment option is most appropriate for managing her symptoms?**
- A) Gonadotropin-releasing hormone (GnRH) agonists
- B) Therapeutic laparoscopy
- C) Levonorgestrel-releasing intrauterine system (IUS)
- D) High-dose estrogen therapy

Answer 12

C) Levonorgestrel-releasing intrauterine system (IUS)

The Levonorgestrel-releasing IUS is highly effective in reducing menstrual bleeding and alleviating pain associated with conditions like adenomyosis or endometrial hyperplasia, even when no structural abnormalities are detected on ultrasound.

Question 13

A 38-year-old woman is evaluated for secondary amenorrhea. She has not menstruated for the past 10 months but reports occasional hot flashes and night sweats. Her FSH levels are elevated. What is the most likely diagnosis?**
- A) Hypothyroidism
- B) Premature ovarian insufficiency
- C) Pituitary adenoma
- D) Polycystic ovary syndrome

Answer 13

B) Premature ovarian insufficiency

Elevated FSH levels and symptoms such as hot flashes in a woman under 40 suggest premature ovarian insufficiency, indicating reduced function of the ovaries leading to decreased hormone production and amenorrhea.

Question 14

A 24-year-old woman comes to the clinic with a one-year history of dysmenorrhea that does not respond well to over-the-counter medications. She describes her pain as sharp and cramping, worsening during the first two days of her period. Her gynecological history is unremarkable. What is the next best step in her management?**
- A) Recommend dietary modifications
- B) Prescribe a nonsteroidal anti-inflammatory drug (NSAID) regimen
- C) Start hormonal contraception
- D) Order a diagnostic laparoscopy

Answer 14

C) Start hormonal contraception

Hormonal contraception can be effective in reducing menstrual pain by stabilizing endometrial growth and decreasing menstrual flow. This approach is appropriate before considering more invasive diagnostic procedures.

Question 15

A 34-year-old woman reports a 3-month history of infrequent menstrual periods, sometimes going 45-60 days between cycles. She is not currently sexually active and does not use contraception. Examination reveals no abnormalities. What diagnostic test should initially be performed?**
- A) Pelvic ultrasound
- B) Serum prolactin
- C) Thyroid function tests
- D) Hysteroscopy

Answer 15

C) Thyroid function tests

Thyroid dysfunction can cause menstrual irregularities, including infrequent periods. Initial evaluation should include thyroid function tests to rule out hypothyroidism or hyperthyroidism as a cause of her symptoms.

Question 16

A 21-year-old woman presents with menorrhagia and dysmenorrhea. She desires effective contraception. Her blood tests show no abnormalities. Which contraceptive method is most suitable for reducing her menstrual symptoms?**
- A) Copper intrauterine device (IUD)
- B) Levonorgestrel-releasing intrauterine system
- C) Combined oral contraceptives
- D) Contraceptive implant

Answer 16

B) Levonorgestrel-releasing intrauterine system

The Levonorgestrel-releasing intrauterine system (IUS) not only provides reliable contraception but also significantly reduces menstrual bleeding and pain, which can improve quality of life for women with menorrhagia and dysmenorrhea.

Question 17

A 26-year-old woman presents with a history of painful menses and cyclic pelvic pain. She suspects that she might have endometriosis. Which symptom would most likely strengthen the suspicion of endometriosis in her clinical history?**
- A) Frequent urination
- B) Pain during intercourse
- C) Excessive menstrual flow
- D) Intermittent spotting

Answer 17

B) Pain during intercourse

Dyspareunia, or pain during intercourse, is a common symptom of endometriosis due to lesions in the pelvic area, and its presence can significantly support the diagnosis in symptomatic women.

Question 18

A 23-year-old female reports that her menstrual cycle has been increasingly heavy and prolonged over the last six months. She has a history of easy bruising. A complete blood count is normal but her bleeding time is prolonged. What is the most likely diagnosis?**
- A) Von Willebrand Disease
- B) Idiopathic thrombocytopenic purpura
- C) Leukemia
- D) Hemophilia

Answer 18

A) Von Willebrand Disease

Von Willebrand Disease, a common inherited bleeding disorder, should be suspected in a patient with a normal platelet count, prolonged bleeding time, menorrhagia, and a history of easy bruising.

Question 19

A 31-year-old woman consults her gynecologist due to difficulty conceiving for the past 18 months. She mentions irregular menstrual cycles as a possible factor. Which initial test should be ordered to evaluate her fertility issues?**
- A) Hysterosalpingography
- B) Day 21 progesterone
- C) Fasting glucose and insulin levels
- D) Pelvic ultrasound

Answer 19

B) Day 21 progesterone

A Day 21 progesterone test is used to confirm ovulation, an essential factor in fertility. Given her irregular cycles, determining whether she is ovulating is a critical first step in assessing her fertility issues.

Question 20

A 27-year-old woman has been experiencing severe premenstrual symptoms including mood swings, breast tenderness, and irritability. These symptoms are affecting her daily life. What is the most appropriate management strategy?**
- A) Cognitive-behavioral therapy
- B) Dietary modifications and exercise
- C) Antidepressant therapy
- D) Hormonal contraception

Answer 20

D) Hormonal contraception

Hormonal contraception can help stabilize hormone fluctuations that contribute to severe premenstrual syndrome (PMS) symptoms, thus potentially alleviating the physical and emotional symptoms she experiences.

Question 21

A 16-year-old female presents to your clinic with her mother, concerned about not having reached menarche. She exhibits normal development of secondary sexual characteristics and is an active participant in competitive gymnastics. Her BMI is 18. Which of the following is the most likely explanation for her delayed menarche?**
- A) Constitutional delay
- B) Hypothalamic amenorrhea
- C) Androgen insensitivity syndrome
- D) Turner syndrome

Answer 21

B) Hypothalamic amenorrhea

Hypothalamic amenorrhea is common in athletes due to the high energy expenditure and low body fat associated with intense physical activity, which can suppress hypothalamic function and delay the onset of menstruation.

Question 22

A 25-year-old woman presents with cyclical pelvic pain, heavy menstrual bleeding, and dyspareunia. Her sister was recently diagnosed with endometriosis. A pelvic ultrasound shows a 3 cm ovarian cyst. What is the most likely diagnosis?**
- A) Ovarian torsion
- B) Functional ovarian cyst
- C) Endometriosis with an endometrioma
- D) Pelvic inflammatory disease

Answer 22

C) Endometriosis with an endometrioma

Given the patient’s symptoms of cyclical pelvic pain, heavy bleeding, and family history of endometriosis, along with the ultrasound finding of an ovarian cyst, an endometrioma related to endometriosis is likely.

Question 23

A 36-year-old woman seeks advice for irregular menstrual cycles and hot flashes. She reports that her mother had early menopause at the age of 39. Laboratory tests show elevated FSH and low estradiol levels. What condition should be primarily considered?**
- A) Hyperthyroidism
- B) Premature ovarian failure
- C) Chronic anovulation
- D) Polycystic ovary syndrome

Answer 23

B) Premature ovarian failure

Premature ovarian failure, especially with a family history of early menopause and symptomatic presentation including hot flashes and irregular periods accompanied by relevant lab findings, is the most probable diagnosis.

Question 24

A 28-year-old woman complains of painful menstrual periods and occasional spotting between periods. She uses a copper IUD for contraception. Physical examination is unremarkable, except for mild cervical motion tenderness. What is the next best step in management?**
- A) Remove the IUD and start oral contraceptives
- B) Prescribe NSAIDs during menstruation
- C) Order transvaginal ultrasound
- D) Initiate antibiotic therapy for suspected PID

Answer 24

C) Order transvaginal ultrasound

A transvaginal ultrasound should be performed to investigate possible complications from the IUD, such as malposition, which could be causing her symptoms, before considering removal or changing her contraceptive method.

Question 25

A 32-year-old woman presents with a six-month history of short menstrual cycles, lasting only 21 days, and a recent increase in menstrual flow. She denies any pain. Her physical examination is normal, and she is not currently using any form of contraception. What is the most appropriate diagnostic test to perform next?** - A) Endometrial biopsy - B) Serum progesterone level - C) Complete blood count (CBC) - D) Thyroid function tests

Answer 25

D) Thyroid function tests ## Footnote Thyroid disorders can alter menstrual cycle length and flow. Evaluating thyroid function is a crucial first step when investigating menstrual irregularities in the absence of other symptoms.

Question 26

A 44-year-old woman reports that her menstrual periods have been progressively getting closer together and heavier over the past year. She also mentions new onset of intermenstrual spotting. What is the most likely diagnosis?** - A) Endometrial hyperplasia - B) Uterine fibroids - C) Perimenopause - D) Cervical cancer

Answer 26

A) Endometrial hyperplasia ## Footnote Given her age and symptoms of increased frequency and heaviness of periods along with spotting, endometrial hyperplasia should be considered. It is commonly seen in women approaching menopause due to hormonal changes.

Question 27

A 39-year-old woman with a history of two cesarean sections presents with intermenstrual bleeding and a sense of fullness in the lower abdomen. On pelvic examination, the uterus is uniformly enlarged and non-tender. What diagnostic procedure is most appropriate to evaluate her symptoms?** - A) Pelvic MRI - B) Endometrial biopsy - C) Hysteroscopy - D) Pelvic ultrasound

Answer 27

D) Pelvic ultrasound ## Footnote Pelvic ultrasound is the first-line imaging modality to assess uterine abnormalities such as adenomyosis or fibroids, particularly in a woman with a uniformly enlarged uterus and a history of surgical interventions.

Question 28

A 20-year-old university student presents with dysmenorrhea so severe that it affects her academic performance. She desires an effective long-term management strategy. She is not sexually active and has no contraindications to hormonal treatments. What is the most appropriate recommendation?** - A) Cognitive-behavioral therapy - B) NSAIDs as needed - C) Levonorgestrel-releasing intrauterine system (IUS) - D) Laparoscopic investigation

Answer 28

C) Levonorgestrel-releasing intrauterine system (IUS) ## Footnote For severe dysmenorrhea affecting quality of life, the Levonorgestrel-releasing IUS is an effective long-term treatment that reduces menstrual pain and volume, suitable for women not seeking immediate pregnancy.

Question 29

A 23-year-old woman with irregular menstrual periods seeks contraception. She is obese, with a BMI of 34, and has recently been diagnosed with type 2 diabetes. Which contraceptive method is most appropriate for her?** - A) Estrogen-containing oral contraceptive pills - B) Progestin-only pills - C) Copper intrauterine device (IUD) - D) Implantable progestin device

Answer 29

D) Implantable progestin device ## Footnote Given her obesity and diabetes, a non-estrogen method like the implantable progestin device is preferred to minimize the risk of thrombotic complications associated with estrogen in high-risk patients.

Question 30

A 27-year-old woman reports sudden onset of unilateral pelvic pain mid-cycle, which has occurred intermittently over the past six months. She describes the pain as sharp and lasting for a few hours. What is the most likely explanation for her symptoms?** - A) Ectopic pregnancy - B) Mittelschmerz - C) Ovarian torsion - D) Pelvic inflammatory disease

Answer 30

B) Mittelschmerz ## Footnote Mittelschmerz is a German term that describes ovulatory pain and typically occurs mid-cycle, correlating with her symptom timing. It is usually unilateral, brief, and does not require intervention unless symptoms are severe.

Question 31

A 32-year-old woman presents to the clinic complaining of vaginal discharge that is greenish-yellow, frothy, and has a foul smell. She reports mild itching and discomfort during intercourse. On examination, you note a strawberry cervix. What is the most likely causative agent? - A) Candida albicans - B) Trichomonas vaginalis - C) Neisseria gonorrhoeae - D) Chlamydia trachomatis

Answer 31

B) Trichomonas vaginalis ## Footnote The clinical presentation of greenish-yellow, frothy discharge, along with a strawberry cervix, is indicative of Trichomonas vaginalis infection. This protozoan parasite is commonly associated with these symptoms in infected individuals.

Question 32

A 25-year-old woman presents with pelvic pain, dysuria, and a mucopurulent cervical discharge. She has had multiple sexual partners in the past year and occasionally uses condoms. On physical examination, her cervical motion tenderness is noted. What additional finding is most suggestive of a diagnosis of pelvic inflammatory disease? - A) Positive Whiff test - B) Adnexal tenderness - C) Uterine tenderness - D) Vaginal pH greater than 4.5

Answer 32

B) Adnexal tenderness ## Footnote Adnexal tenderness, when associated with cervical motion tenderness and mucopurulent discharge in the context of risky sexual behavior, strongly supports a diagnosis of pelvic inflammatory disease (PID), likely caused by sexually transmitted infections like Chlamydia trachomatis or Neisseria gonorrhoeae.

Question 33

A 28-year-old woman presents for evaluation of recurrent vulvovaginal candidiasis. She describes four episodes in the past year, all of which were temporarily resolved with over-the-counter antifungal treatments. Which underlying condition is most important to rule out in this patient? - A) Diabetes mellitus - B) Hypothyroidism - C) Hyperlipidemia - D) Anemia

Answer 33

A) Diabetes mellitus ## Footnote Recurrent vulvovaginal candidiasis can be a sign of poorly controlled diabetes mellitus, as hyperglycemia fosters the growth of Candida species. Evaluating for diabetes is a crucial step in managing patients with recurrent yeast infections.

Question 34

A 19-year-old college student presents to the health center with lower abdominal pain and a new vaginal discharge that is yellow and foul-smelling. She is sexually active with one partner and uses oral contraceptives for birth control. She denies any recent illness or antibiotic use. A pelvic examination reveals cervical friability and a yellow cervical discharge. What is the most likely diagnosis? - A) Bacterial vaginosis - B) Gonorrheal infection - C) Chlamydial infection - D) Trichomoniasis

Answer 34

C) Chlamydial infection ## Footnote Chlamydial infection often presents with mucopurulent cervical discharge, cervical friability, and symptoms like lower abdominal pain. It is a common sexually transmitted infection, especially in young adults, and can be asymptomatic, making routine screening important in this demographic.

Question 35

A 23-year-old woman presents with complaints of a painful "bump" in her genital area. On examination, you observe a tender, fluctuant mass at the left labial majora. She is febrile and there is no evidence of vaginal discharge. What is the most appropriate initial management? - A) Incision and drainage - B) Oral antibiotics - C) Topical estrogen cream - D) Cryotherapy

Answer 35

A) Incision and drainage ## Footnote The patient likely has a Bartholin gland abscess, given her symptoms of a tender, fluctuant mass on the labial majora and fever. Incision and drainage are the appropriate initial management for relief and to prevent further infection progression.

Question 36

A 29-year-old woman, G1P0, at 12 weeks gestation presents with complaints of increased vaginal discharge that is thin and white. She denies any odor, itching, or irritation. On examination, the vaginal pH is normal, and the wet mount is negative for clue cells and trichomonads. What is the most likely diagnosis? - A) Bacterial vaginosis - B) Trichomoniasis - C) Candidiasis - D) Physiological leukorrhea of pregnancy

Answer 36

D) Physiological leukorrhea of pregnancy ## Footnote The increase in estrogen levels during pregnancy can lead to physiological leukorrhea, characterized by thin, white, odorless vaginal discharge. This is a normal finding and does not require treatment.

Question 37

A 26-year-old woman presents with a three-day history of severe itching and burning in the genital area. She has recently completed a course of antibiotics for a urinary tract infection. On examination, there is erythema and white plaques on the vulva. The potassium hydroxide (KOH) preparation shows pseudohyphae. What is the most likely diagnosis? - A) Genital herpes - B) Contact dermatitis - C) Vulvovaginal candidiasis - D) Lichen sclerosus

Answer 37

C) Vulvovaginal candidiasis ## Footnote This patient's symptoms of severe itching, burning, erythema, and the presence of white plaques following antibiotic use, along with pseudohyphae on KOH prep, are indicative of vulvovaginal candidiasis.

Question 38

A 24-year-old woman presents with dysuria, urinary frequency, and a yellow vaginal discharge. She has a history of similar episodes and her last sexual partner was treated for Chlamydia six months ago. Urine culture and sensitivity were negative. Which additional test is most appropriate to confirm the diagnosis? - A) Repeat urine culture - B) Urinary tract ultrasound - C) Nucleic acid amplification test (NAAT) for Chlamydia and Gonorrhea - D) Complete blood count

Answer 38

C) Nucleic acid amplification test (NAAT) for Chlamydia and Gonorrhea ## Footnote Given her history and symptoms, a NAAT for Chlamydia and Gonorrhea is appropriate to identify these common sexually transmitted infections, especially in the context of a previous partner's diagnosis and negative urine culture.

Question 39

A 27-year-old woman presents complaining of intermittent pelvic pain and dyspareunia. She reports a mucopurulent cervical discharge and a history of untreated Chlamydia infection one year ago. What is the most likely complication that has developed in this patient? - A) Cervical cancer - B) Pelvic inflammatory disease - C) Endometrial carcinoma - D) Vaginal candidiasis

Answer 39

B) Pelvic inflammatory disease ## Footnote Untreated Chlamydia infection significantly increases the risk of developing pelvic inflammatory disease (PID), which can present with pelvic pain, dyspareunia, and mucopurulent discharge. Chronic PID can lead to serious complications like infertility.

Question 40

A 31-year-old woman presents to the emergency room with acute lower abdominal pain. She is sexually active and uses a copper IUD for contraception. She is febrile, and a pelvic exam reveals cervical motion tenderness and adnexal tenderness. What is the most likely diagnosis? - A) Appendicitis - B) Ectopic pregnancy - C) Pelvic inflammatory disease - D) Ovarian torsion

Answer 40

C) Pelvic inflammatory disease ## Footnote The presence of cervical motion tenderness, adnexal tenderness, fever, and the use of an IUD are indicative of PID. Although IUDs are generally safe, they can increase the risk of PID shortly after insertion.

Question 41

A 22-year-old woman presents to the clinic with complaints of lower abdominal pain and a foul-smelling vaginal discharge. She has a history of multiple sexual partners and infrequent condom use. Physical examination shows cervical erythema and a yellowish discharge. A pregnancy test is negative. Which diagnostic test would most effectively confirm your suspected diagnosis? - A) Urine culture - B) Pap smear - C) Nucleic acid amplification test (NAAT) for Chlamydia and Gonorrhea - D) Bacterial culture of the discharge

Answer 41

C) Nucleic acid amplification test (NAAT) for Chlamydia and Gonorrhea ## Footnote Given the symptoms of lower abdominal pain, foul-smelling discharge, and multiple sexual partners, a NAAT for Chlamydia and Gonorrhea is the most appropriate test to confirm these common sexually transmitted infections, which are likely causing her symptoms.

Question 42

A 30-year-old woman presents with dysuria, increased urinary frequency, and vaginal itching. She also notes a thick, white vaginal discharge. Which of the following treatments is most appropriate based on her likely diagnosis? - A) Metronidazole - B) Fluconazole - C) Azithromycin - D) Ciprofloxacin

Answer 42

B) Fluconazole ## Footnote The patient's symptoms of dysuria, vaginal itching, and a thick, white discharge are suggestive of a Candida (yeast) infection. Fluconazole is an antifungal medication appropriate for the treatment of vulvovaginal candidiasis.

Question 43

A 24-year-old woman presents with pelvic pain and spotting between periods. She has a history of unprotected sex and previous treatment for Chlamydia. A pelvic ultrasound shows thickened fallopian tubes and free pelvic fluid. What is the most likely complication represented by these findings? - A) Ovarian cysts - B) Pelvic inflammatory disease with tubal involvement - C) Endometriosis - D) Uterine fibroids

Answer 43

B) Pelvic inflammatory disease with tubal involvement ## Footnote The ultrasound findings of thickened fallopian tubes and free pelvic fluid, coupled with her history of Chlamydia and symptoms, are characteristic of pelvic inflammatory disease (PID) with tubal involvement, which can lead to chronic pelvic pain and infertility.

Question 44

A 35-year-old woman presents complaining of severe vaginal itching and a curd-like discharge. She has diabetes mellitus type 2, which is poorly controlled. Which of the following factors is most likely contributing to her recurrent symptoms? - A) Hyperglycemia - B) Hypothyroidism - C) Hyperlipidemia - D) Anemia

Answer 44

A) Hyperglycemia ## Footnote In patients with diabetes, particularly when poorly controlled, hyperglycemia can lead to increased glycogen levels in the vaginal tract, which promotes the growth of Candida, causing recurrent vulvovaginal candidiasis.

Question 45

A 20-year-old woman presents to the clinic with a one-week history of vaginal discharge that is greenish and frothy, accompanied by a foul odor. She is sexually active with multiple partners and does not use barrier protection regularly. On examination, the cervix appears erythematous with small petechial hemorrhages. What is the most appropriate treatment for her diagnosis? - A) Metronidazole - B) Fluconazole - C) Doxycycline - D) Acyclovir

Answer 45

A) Metronidazole ## Footnote The clinical presentation of greenish, frothy discharge and a cervix with petechial hemorrhages suggests Trichomonas vaginalis. Metronidazole is the treatment of choice for this protozoal infection.

Question 46

A 27-year-old woman presents to the emergency department with acute, severe pelvic pain. She has a temperature of 38.6°C (101.5°F) and lower abdominal guarding. She is currently menstruating and uses tampons. Her blood pressure is 100/60 mmHg, and her heart rate is 110 bpm. Which condition should be urgently ruled out? - A) Ectopic pregnancy - B) Toxic shock syndrome - C) Appendicitis - D) Ovarian torsion

Answer 46

B) Toxic shock syndrome ## Footnote The combination of severe pelvic pain, fever, use of tampons during menstruation, and signs of hemodynamic instability are suggestive of toxic shock syndrome, a rare but life-threatening condition associated with tampon use.

Question 47

A 33-year-old woman presents for evaluation due to a painful genital ulcer. She reports that the ulcer appeared a few days after unprotected intercourse with a new partner. Examination reveals a single, deep, painful ulcer with a purulent base on the labia majora. What is the most likely causative organism? - A) Herpes simplex virus - B) Haemophilus ducreyi - C) Treponema pallidum - D) Human papillomavirus

Answer 47

B) Haemophilus ducreyi ## Footnote The description of a painful genital ulcer with a purulent base is characteristic of chancroid, which is caused by Haemophilus ducreyi. This condition is typically associated with sexual contact.

Question 48

A 28-year-old woman presents with a three-day history of urinary frequency, urgency, and suprapubic pain. She has noted a strong, unpleasant smell to her urine. She is sexually active and in a monogamous relationship. A clean-catch midstream urine sample reveals pyuria. What is the most appropriate antibiotic for treatment? - A) Nitrofurantoin - B) Metronidazole - C) Fluconazole - D) Acyclovir

Answer 48

A) Nitrofurantoin ## Footnote The patient's symptoms are indicative of a urinary tract infection (UTI), particularly with the presence of pyuria. Nitrofurantoin is a suitable choice for treating uncomplicated cystitis in sexually active women.

Question 49

A 21-year-old college student presents with complaints of intense vaginal itching, redness, and swelling. She recently completed a course of antibiotics for strep throat. Examination reveals swollen labia and satellite red lesions. What is the most appropriate management for this patient's condition? - A) Oral fluconazole - B) Intravenous vancomycin - C) Topical hydrocortisone - D) Topical miconazole

Answer 49

D) Topical miconazole ## Footnote The patient's symptoms suggest vulvovaginal candidiasis, likely triggered by recent antibiotic use. Topical miconazole is an effective treatment for this yeast infection.

Question 50

A 36-year-old woman presents to her gynecologist with complaints of intermittent postcoital bleeding and a watery vaginal discharge. She has not had a Pap smear in over five years. What is the most urgent step in the management of this patient? - A) Schedule an immediate colposcopy - B) Perform a Pap smear and HPV testing - C) Prescribe a course of oral antibiotics - D) Advise the use of contraceptive methods

Answer 50

B) Perform a Pap smear and HPV testing ## Footnote Given the patient's symptoms of postcoital bleeding and prolonged interval since last Pap smear, immediate cervical cancer screening with a Pap smear and HPV testing is essential to rule out malignancy or precancerous changes.

Question 51

A 31-year-old woman presents with complaints of recurrent painful blisters on her genitalia. Each episode is preceded by tingling and itching. Examination reveals multiple small vesicles on the vulva. She is sexually active with one steady partner. What is the most likely etiology of her symptoms? - A) Herpes simplex virus - B) Human papillomavirus - C) Syphilis - D) Chancroid

Answer 51

A) Herpes simplex virus ## Footnote The presentation of recurrent, painful vesicular lesions preceded by prodromal symptoms such as tingling and itching is characteristic of genital herpes, caused by the herpes simplex virus.

Question 52

A 24-year-old woman presents to the clinic with a three-day history of yellow-green vaginal discharge and vulvar irritation. She reports a new sexual partner two weeks ago. On examination, a copious frothy discharge is observed, and a wet mount microscopy reveals flagellated protozoa. What is the most appropriate treatment? - A) Metronidazole 500 mg orally twice daily for 7 days - B) Fluconazole 150 mg orally as a single dose - C) Azithromycin 1 g orally as a single dose - D) Doxycycline 100 mg orally twice daily for 7 days

Answer 52

A) Metronidazole 500 mg orally twice daily for 7 days ## Footnote The presence of flagellated protozoa and symptoms of yellow-green frothy discharge suggest Trichomonas vaginalis. Metronidazole is the treatment of choice for trichomoniasis.

Question 53

A 27-year-old woman presents with lower abdominal pain and a mucopurulent cervical discharge. She has a history of untreated Chlamydia infection. Pelvic ultrasound shows no abnormalities. What is the most likely diagnosis? - A) Bacterial vaginosis - B) Chronic pelvic inflammatory disease - C) Cervicitis - D) Uterine fibroids

Answer 53

C) Cervicitis ## Footnote Given the history of untreated Chlamydia and the presence of mucopurulent discharge, cervicitis is the most likely diagnosis. It is important to treat with appropriate antibiotics to prevent complications such as pelvic inflammatory disease.

Question 54

A 29-year-old woman presents to the emergency department with severe pelvic pain. She mentions the recent use of intrauterine device (IUD) and has a fever of 38.5°C. Examination shows cervical motion tenderness. Which is the most immediate next step in management? - A) Order a pelvic ultrasound - B) Administer broad-spectrum antibiotics - C) Remove the IUD - D) Perform endometrial biopsy

Answer 54

B) Administer broad-spectrum antibiotics ## Footnote This patient is presenting with signs of pelvic inflammatory disease, likely related to her recent IUD insertion. Immediate administration of broad-spectrum antibiotics is crucial to manage the infection and prevent further complications.

Question 55

A 33-year-old woman presents with complaints of itching and burning sensation in her genital area along with a cottage cheese-like vaginal discharge. She has a history of diabetes. What is the most likely diagnosis? - A) Bacterial vaginosis - B) Trichomoniasis - C) Vulvovaginal candidiasis - D) Genital herpes

Answer 55

C) Vulvovaginal candidiasis ## Footnote The symptoms of itching, burning, and a cottage cheese-like discharge are typical of vulvovaginal candidiasis, particularly in a patient with diabetes, where fluctuating glucose levels can predispose to yeast infections.

Question 56

A 22-year-old woman presents with lower abdominal pain and irregular menstrual bleeding. She admits to frequent unprotected intercourse. Physical exam reveals cervical motion tenderness and adnexal tenderness. What is the most appropriate initial treatment? - A) NSAIDs for pain management - B) Hormonal contraception to regulate bleeding - C) Empiric antibiotic therapy for suspected PID - D) Laparoscopy to further investigate

Answer 56

C) Empiric antibiotic therapy for suspected PID ## Footnote The combination of lower abdominal pain, irregular bleeding, and signs of cervical and adnexal tenderness in a sexually active young woman suggests pelvic inflammatory disease. Immediate empiric antibiotic therapy is crucial.

Question 57

A 36-year-old woman presents to the clinic for a routine check-up. She complains of a fishy odor from her vaginal area, especially after sexual intercourse. Examination reveals a thin, white discharge. Vaginal pH is elevated. What is the most likely diagnosis? - A) Candidiasis - B) Bacterial vaginosis - C) Trichomoniasis - D) Chlamydial infection

Answer 57

B) Bacterial vaginosis ## Footnote A fishy odor, especially post-coital, along with thin, white discharge and elevated vaginal pH, are classic signs of bacterial vaginosis.

Question 58

A 25-year-old woman is diagnosed with HPV following an abnormal Pap smear showing low-grade squamous intraepithelial lesions (LSIL). She is asymptomatic. What is the most appropriate management? - A) Immediate colposcopy - B) Cryotherapy - C) HPV vaccination - D) Repeat Pap smear in one year

Answer 58

D) Repeat Pap smear in one year ## Footnote For a young woman with LSIL and no other risk factors, current guidelines recommend a follow-up Pap smear in one year to monitor changes, as many low-grade lesions can regress spontaneously.

Question 59

A 40-year-old woman presents with postmenopausal bleeding. She is not on hormone replacement therapy and has no significant past medical history. What is the most appropriate next step in her evaluation? - A) Transvaginal ultrasound - B) Endometrial biopsy - C) Hormonal profile testing - D) Immediate hysterectomy

Answer 59

B) Endometrial biopsy ## Footnote Postmenopausal bleeding requires ruling out endometrial cancer, and an endometrial biopsy is a direct method for evaluating the endometrial lining.

Question 60

A 23-year-old sexually active woman presents with pain during intercourse and spotting. She has a history of irregular Pap smears. Examination reveals a cervical ectropion. What is the most likely cause of her symptoms? - A) Cervical cancer - B) Cervical polyp - C) Cervicitis - D) Normal cervical ectropion

Answer 60

D) Normal cervical ectropion ## Footnote Cervical ectropion, where glandular cells are exposed on the cervix, can cause symptoms such as post-coital bleeding and pain during intercourse. It is a benign condition often seen in young, sexually active women.

Question 61

A 45-year-old woman presents with intermittent vaginal bleeding for the past 3 months. She reports a recent unexplained weight loss and pelvic pain. Her past medical history is significant for obesity and hypertension. Physical examination reveals a slightly enlarged uterus. A transvaginal ultrasound shows a 5 cm mass in the endometrial cavity. Which of the following is the most likely diagnosis? A) Endometrial hyperplasia B) Leiomyoma C) Endometrial cancer D) Cervical polyps

Answer 61

C) Endometrial cancer ## Footnote Endometrial cancer commonly presents in postmenopausal women but can also occur in premenopausal women with risk factors such as obesity and hypertension. The symptoms of intermittent vaginal bleeding, unexplained weight loss, and the presence of an endometrial mass on ultrasound are suggestive of endometrial cancer. Leiomyomas typically cause symptoms of menorrhagia and pelvic pressure without significant weight loss, and endometrial hyperplasia usually presents with abnormal uterine bleeding without a discrete mass.

Question 62

A 31-year-old woman visits your clinic with complaints of heavy menstrual bleeding and severe dysmenorrhea. She mentions that her mother was diagnosed with endometrial cancer at the age of 50. An MRI of the pelvis reveals multiple intramural fibroids with the largest measuring 4 cm. The patient expresses concern about her risk for developing cancer. Which of the following is the most appropriate next step in management? A) Immediate hysterectomy B) Genetic counseling and testing for Lynch syndrome C) Endometrial biopsy D) No further action is required as fibroids are benign

Answer 62

B) Genetic counseling and testing for Lynch syndrome ## Footnote Given the family history of endometrial cancer, particularly in a first-degree relative, this patient may have an inherited predisposition such as Lynch syndrome, which increases the risk of developing several types of cancer, including endometrial cancer. An endometrial biopsy is indicated if there are signs of endometrial abnormalities, but in this case, genetic counseling and testing are appropriate to assess her risk and discuss further preventive or surveillance measures.

Question 63

A 52-year-old woman with no significant past medical history presents to the emergency department complaining of acute onset right lower quadrant pain. A pelvic ultrasound reveals a 6 cm complex ovarian mass with septations and solid components. CA-125 levels return at 250 U/mL (normal < 35 U/mL). What is the most likely diagnosis? A) Ovarian torsion B) Ovarian cyst C) Ovarian cancer D) Ectopic pregnancy

Answer 63

C) Ovarian cancer ## Footnote The presence of a complex ovarian mass with septations and solid components in a postmenopausal woman, along with elevated CA-125 levels, strongly suggests ovarian cancer. Ovarian torsion typically presents with acute, severe pain and often involves a simple cyst or benign tumor. An ectopic pregnancy should be considered in reproductive-age women but is less likely given the patient's age and the characteristics of the mass.

Question 64

A 38-year-old woman with a history of irregular menses and infertility presents to your office. She has recently been diagnosed with multiple small ovarian cysts via ultrasound during an infertility workup. She is obese and has a family history of type 2 diabetes. Which of the following is the most likely diagnosis? A) Polycystic ovary syndrome (PCOS) B) Endometriosis C) Ovarian cancer D) Prolactinoma

Answer 64

A) Polycystic ovary syndrome (PCOS) ## Footnote PCOS is characterized by clinical signs such as irregular menses, infertility, obesity, and the presence of multiple ovarian cysts. The patient's family history of type 2 diabetes also supports the diagnosis of PCOS, given the association with insulin resistance.

Question 65

A 48-year-old woman presents complaining of vaginal bleeding one year after menopause. She has a history of hypertension and diabetes. On examination, you note a friable lesion protruding from the cervical os. A biopsy of the lesion is performed. What is the most likely diagnosis? A) Cervical cancer B) Endometrial hyperplasia C) Uterine prolapse D) Cervical polyp

Answer 65

A) Cervical cancer ## Footnote Postmenopausal bleeding and the presence of a friable lesion protruding from the cervical os are highly suggestive of cervical cancer. A biopsy is necessary for diagnosis to distinguish from benign causes such as cervical polyps, which are usually non-friable and asymptomatic.

Question 66

A 27-year-old woman presents with pelvic pain and irregular menstruation. She has a known BRCA1 mutation. Transvaginal ultrasound reveals a 3 cm complex adnexal mass on the right ovary with some solid components. Her CA-125 is elevated. What is the most appropriate initial management strategy for this patient? A) Serial ultrasound monitoring B) Immediate referral to a gynecologic oncologist C) Trial of oral contraceptives D) Laparoscopic cystectomy

Answer 66

B) Immediate referral to a gynecologic oncologist ## Footnote The presence of a complex adnexal mass, elevated CA-125, and a known BRCA1 mutation significantly increase the risk of ovarian cancer. Immediate referral to a gynecologic oncologist is warranted for further evaluation and management, potentially including surgical intervention.

Question 67

A 35-year-old woman with a history of pelvic inflammatory disease presents with intermenstrual bleeding and a foul-smelling vaginal discharge. On examination, a friable mass is noted on the cervix. Biopsy confirms squamous cell carcinoma. Which of the following risk factors is most likely associated with her diagnosis? A) HPV infection B) Hereditary nonpolyposis colorectal cancer (Lynch syndrome) C) Use of oral contraceptives D) Early age at first sexual intercourse

Answer 67

A) HPV infection ## Footnote HPV infection is the most significant risk factor for cervical squamous cell carcinoma. Other factors such as early onset of sexual activity can increase the risk of HPV infection, thereby indirectly contributing to the risk of developing cervical cancer.

Question 68

A 55-year-old woman who is 5 years postmenopausal presents complaining of a rapidly enlarging abdominal mass. CT scan reveals a 10 cm mass arising from the left ovary with solid and cystic areas. No ascites or lymphadenopathy is noted. Which of the following is the most likely histological type of this ovarian tumor? A) Serous cystadenocarcinoma B) Mucinous cystadenocarcinoma C) Endometrioid carcinoma D) Granulosa cell tumor

Answer 68

A) Serous cystadenocarcinoma ## Footnote Serous cystadenocarcinoma is the most common type of ovarian cancer and often presents as a complex mass with both solid and cystic components in postmenopausal women. It is aggressive and can rapidly increase in size.

Question 69

A 44-year-old woman presents with menorrhagia and pelvic pressure. Ultrasound reveals multiple uterine fibroids, the largest of which measures 6 cm. She is anemic and desires future fertility. What is the most appropriate treatment option? A) Hysterectomy B) Myomectomy C) Uterine artery embolization D) Endometrial ablation

Answer 69

B) Myomectomy ## Footnote Myomectomy is the preferred treatment for symptomatic fibroids in women who wish to retain their fertility. This procedure removes fibroids while preserving the uterus, addressing symptoms and maintaining reproductive potential.

Question 70

A 59-year-old woman presents with postmenopausal bleeding. Endometrial biopsy reveals endometrial adenocarcinoma. Imaging studies indicate no evidence of metastasis. Which of the following is the most appropriate next step in management? A) Total abdominal hysterectomy and bilateral salpingo-oophorectomy B) Pelvic radiation C) Progestin therapy D) Chemotherapy

Answer 70

A) Total abdominal hysterectomy and bilateral salpingo-oophorectomy ## Footnote The standard treatment for localized endometrial adenocarcinoma is surgical, involving total abdominal hysterectomy and bilateral salpingo-oophorectomy to remove the primary tumor and reduce the risk of recurrence.

Question 71

A 23-year-old woman presents with dysmenorrhea and a palpable mass in her right lower abdomen. Ultrasound reveals a 4 cm right ovarian mass. Serum tumor markers, including CA-125, are within normal limits. What is the most likely diagnosis? A) Dermoid cyst B) Endometrioma C) Ovarian cancer D) Tubo-ovarian abscess

Answer 71

A) Dermoid cyst ## Footnote Dermoid cysts, or mature cystic teratomas, are common benign ovarian neoplasms in young women. They often present as a palpable mass and are typically not associated with elevated CA-125 levels.

Question 72

A 68-year-old woman presents with vaginal bleeding. She had a total hysterectomy for benign reasons 20 years ago. Pelvic examination reveals a 2 cm friable lesion in the vaginal vault. Biopsy of the lesion is performed. Which of the following is the most likely diagnosis? A) Vaginal atrophy B) Vaginal carcinoma C) Recurrent endometrial carcinoma D) Cervical stump cancer

Answer 72

B) Vaginal carcinoma ## Footnote Vaginal carcinoma can present as a friable lesion in the vaginal vault, especially in women with a history of a hysterectomy. Biopsy is necessary to confirm the diagnosis and rule out other causes of postmenopausal bleeding and lesions.

Question 73

A 39-year-old woman presents with persistent bloating and recent onset of satiety. A pelvic ultrasound shows a 12 cm complex ovarian mass. Family history is significant for breast cancer in her mother at age 45. Which of the following steps is most appropriate to assess her cancer risk? A) Immediate surgery B) CA-125 and HE4 tumor markers C) Genetic testing for BRCA mutations D) Diagnostic laparoscopy

Answer 73

C) Genetic testing for BRCA mutations ## Footnote Given her significant family history of breast cancer and the presentation of an ovarian mass, this patient should undergo genetic testing for BRCA mutations to assess her risk for hereditary breast and ovarian cancer syndrome before deciding on further invasive procedures.

Question 74

A 32-year-old woman, G2P1, presents with irregular bleeding and a positive pregnancy test. Ultrasound reveals no intrauterine pregnancy, but a 2 cm mass is seen in the left adnexal region. Which of the following is the most likely diagnosis? A) Ectopic pregnancy B) Miscarriage C) Ovarian torsion D) Benign ovarian cyst

Answer 74

A) Ectopic pregnancy ## Footnote The presence of a positive pregnancy test and a mass in the adnexal region with no evidence of intrauterine pregnancy strongly suggests an ectopic pregnancy. Immediate management is required to prevent complications.

Question 75

A 57-year-old woman with a history of hypertension and diabetes presents with a palpable left adnexal mass during a routine examination. Further imaging suggests a solid ovarian mass, and her CA-125 level is elevated. What is the most appropriate initial management? A) Watchful waiting B) CA-125 monitoring C) Referral to gynecologic oncology D) Start of hormonal therapy

Answer 75

C) Referral to gynecologic oncology ## Footnote The combination of a palpable solid adnexal mass and elevated CA-125 in a postmenopausal woman warrants immediate referral to a gynecologic oncologist for further evaluation, including the possibility of malignancy and appropriate management.

Question 76

A 22-year-old woman presents with lower abdominal pain and a palpable mass on pelvic examination. Ultrasound reveals a 7 cm complex mass in her left ovary. She is sexually active and uses oral contraceptives. Her pregnancy test is negative. Which of the following is the best next step in her management? A) High-dose progesterone therapy B) Surgical exploration and possible cystectomy C) Repeat ultrasound in 3 months D) Start antibiotic therapy

Answer 76

B) Surgical exploration and possible cystectomy ## Footnote Given the size and complex nature of the ovarian mass, surgical exploration is indicated to rule out malignancy and determine the exact nature of the mass. Oral contraceptives provide some protection against ovarian cancer but do not eliminate the risk entirely, especially in the presence of a sizable complex mass.

Question 77

A 49-year-old woman reports intermenstrual bleeding and a significant increase in pelvic pressure over the last six months. She has no significant past medical or surgical history. A pelvic MRI shows a 9 cm mass on the posterior wall of the uterus, suggestive of a leiomyoma. Given her age and symptoms, which of the following treatments is most appropriate? A) Uterine artery embolization B) High-dose estrogen therapy C) Myomectomy D) Observation

Answer 77

A) Uterine artery embolization ## Footnote Uterine artery embolization is a minimally invasive procedure that is effective for reducing symptoms caused by fibroids, such as heavy bleeding and pelvic pressure, particularly in women who are nearing menopause and wish to avoid major surgery.

Question 78

A 53-year-old woman, who is five years post-menopause, presents with new onset vaginal bleeding. Endometrial thickness measured by transvaginal ultrasound is 11 mm. An endometrial biopsy is performed, which reveals grade 1 endometrial adenocarcinoma. What is the most appropriate initial treatment? A) Total hysterectomy with bilateral salpingo-oophorectomy B) Radiation therapy C) Hormonal therapy with progesterone D) Observation and repeat biopsy in 6 months

Answer 78

A) Total hysterectomy with bilateral salpingo-oophorectomy ## Footnote For early-stage endometrial cancer, especially in postmenopausal women, the recommended treatment is total hysterectomy with bilateral salpingo-oophorectomy to remove the source of estrogen that may be fueling the cancer's growth.

Question 79

A 36-year-old woman with a known BRCA2 mutation presents with a palpable right ovarian mass detected during a routine exam. She has a family history of ovarian cancer. Which of the following is the most appropriate management option? A) Salpingo-oophorectomy B) Serial CA-125 testing and ultrasound monitoring C) Initiation of oral contraceptives D) Immediate chemotherapy

Answer 79

A) Salpingo-oophorectomy ## Footnote Given her BRCA2 mutation and family history of ovarian cancer, the risk of malignancy is significant. Prophylactic salpingo-oophorectomy is recommended to reduce her risk of developing ovarian cancer.

Question 80

A 28-year-old woman presents with dyspareunia and irregular bleeding. She has multiple sexual partners and smokes. Colposcopy shows a suspicious lesion on the cervix, and biopsy confirms squamous cell carcinoma. What is the most likely etiologic agent for this carcinoma? A) Herpes simplex virus B) Human papillomavirus (HPV) C) Cytomegalovirus D) Human immunodeficiency virus (HIV)

Answer 80

B) Human papillomavirus (HPV) ## Footnote HPV is the primary etiologic agent in the development of cervical cancer, particularly squamous cell carcinoma. Smoking and having multiple sexual partners are significant risk factors that increase the likelihood of HPV infection and subsequent cancer development.

Question 81

A 42-year-old woman presents with pelvic pain and irregular menses. Ultrasound shows a 4 cm left ovarian mass described as having a 'ground glass' appearance. What is the most likely diagnosis? A) Ovarian fibroma B) Dermoid cyst C) Endometrioma D) Ovarian carcinoma

Answer 81

C) Endometrioma ## Footnote Endometriomas are characterized by their typical 'ground glass' appearance on ultrasound and are associated with endometriosis, which could explain her symptoms of pelvic pain and irregular menses.

Question 82

A 56-year-old woman presents with pelvic discomfort and vaginal bleeding. She underwent menopause at 50 years of age. An endometrial biopsy reveals endometrioid adenocarcinoma. Which of the following is the most common risk factor associated with this type of cancer? A) Cigarette smoking B) Chronic anovulation C) Genetic predisposition D) Use of intrauterine device

Answer 82

B) Chronic anovulation ## Footnote Chronic anovulation can lead to prolonged estrogen exposure without progesterone counterbalance, which increases the risk of developing endometrioid adenocarcinoma, a common type of endometrial cancer.

Question 83

A 30-year-old woman presents to the clinic with a history of multiple miscarriages. She mentions a recent diagnosis of a uterine anomaly during an infertility evaluation. Which of the following anomalies is associated with an increased risk of malignancy? A) Septate uterus B) Bicornuate uterus C) Unicornuate uterus D) Didelphys uterus

Answer 83

A) Septate uterus ## Footnote Although uterine anomalies generally do not have a direct association with increased cancer risk, the septate uterus is mentioned here as a distractor. It is typically associated with reproductive issues like miscarriages but not increased cancer risk. This question tests the examinee's knowledge of reproductive anatomy and its complications rather than oncology.

Question 84

A 48-year-old woman presents with bloating and early satiety. CT scan shows a bilateral ovarian mass with ascites and omental caking. CA-125 is elevated. What is the most likely diagnosis? A) Ovarian fibroma B) Metastatic ovarian cancer C) Primary peritoneal carcinoma D) Benign ovarian cyst

Answer 84

B) Metastatic ovarian cancer ## Footnote The presentation of bilateral ovarian masses, ascites, omental caking, and elevated CA-125 strongly suggests advanced or metastatic ovarian cancer. The combination of symptoms and imaging findings is typical of this diagnosis.

Question 85

A 40-year-old woman presents with a one-year history of progressive abdominal enlargement and constipation. CT scan reveals a large mass arising from the ovary, measuring approximately 20 cm in diameter. What is the initial step in the management of this patient? A) Initiate chemotherapy B) Perform a biopsy to confirm diagnosis C) Surgical exploration and staged debulking D) Palliative care consultation

Answer 85

C) Surgical exploration and staged debulking ## Footnote For large ovarian masses, especially when malignancy is suspected based on the size and symptoms, surgical exploration and staged debulking are crucial to reduce tumor burden and improve subsequent treatment outcomes, including chemotherapy effectiveness.

Question 86

A 42-year-old woman comes to the clinic complaining of a palpable lump in her right breast that she noticed one week ago. She reports no pain, nipple discharge, or changes in skin texture. Her family history is significant for her mother who was diagnosed with breast cancer at age 47. Physical examination reveals a firm, non-mobile mass approximately 2 cm in diameter in the upper outer quadrant of the right breast. There are no associated skin changes or axillary lymphadenopathy. Which of the following is the most appropriate next step in management? A) Reassurance and routine follow-up in one year B) Immediate full mastectomy C) Referral for mammography and ultrasound D) Prescribe antibiotics and reassess in two weeks

Answer 86

C) Referral for mammography and ultrasound ## Footnote In a premenopausal woman with a palpable breast lump and a significant family history of breast cancer, the appropriate next step is imaging with mammography and ultrasound. This approach helps in characterizing the lump further, assessing for any suspicious features that may require biopsy. Immediate surgical intervention or prescribing antibiotics without further assessment would be inappropriate given the potential risk of malignancy.

Question 87

A 34-year-old female presents to your office for a routine check-up. She mentions during the visit that she has been experiencing occasional clear nipple discharge from both breasts when she squeezes them. She has no family history of breast cancer and is currently not on any medications. Physical examination does not reveal any masses, and there is no associated tenderness. What is the most likely diagnosis? A) Intraductal papilloma B) Breast cancer C) Galactorrhea D) Fibrocystic breast disease

Answer 87

C) Galactorrhea ## Footnote Galactorrhea refers to the inappropriate discharge of milk-containing fluid from the breast, which is not associated with childbirth or nursing. It can be caused by various factors including medications, endocrine disorders, and benign tumors but is often idiopathic, especially when discharge is bilateral and occurring without other concerning features like a mass or asymmetry.

Question 88

A 51-year-old woman reports discomfort in her left breast. Upon examination, you note an area of thickening in the lower quadrant but no distinct mass. Mammography shows dense breast tissue but no distinct lesion. What would be the most appropriate follow-up action? A) Immediate chemotherapy initiation B) Biannual clinical breast exams C) Magnetic Resonance Imaging (MRI) of the breast D) No further action is necessary

Answer 88

C) Magnetic Resonance Imaging (MRI) of the breast ## Footnote In cases where mammography is inconclusive, especially in women with dense breasts, breast MRI is recommended to further evaluate the area of concern. MRI is more sensitive in detecting breast changes that are not visible on mammograms.

Question 89

A 28-year-old woman is seen for a painful lump in her right breast, which she states fluctuates in size with her menstrual cycle. She denies any nipple discharge or systemic symptoms. Examination reveals a mobile, tender mass in the right breast. What is the most likely diagnosis? A) Breast abscess B) Fibroadenoma C) Fibrocystic change D) Breast carcinoma

Answer 89

C) Fibrocystic change ## Footnote Fibrocystic changes are common and often associated with hormonal fluctuations during the menstrual cycle. These changes can cause the development of lumps, which are typically tender, mobile, and vary in size throughout the menstrual cycle.

Question 90

A 45-year-old woman presents with a complaint of a non-tender, fixed mass in her left breast that she discovered a month ago. She has no personal or family history of breast cancer. Examination reveals a 1.5 cm, hard, immobile mass in the upper outer quadrant. The overlying skin is intact without dimpling or retraction. Mammography indicates a spiculated lesion. What is the most appropriate next step in the management of this patient? A) Schedule an excisional biopsy B) Initiate hormonal therapy C) Perform a fine needle aspiration biopsy D) Start chemotherapy

Answer 90

A) Schedule an excisional biopsy ## Footnote Given the presence of a spiculated lesion on mammography and the physical findings of a hard, immobile mass, the next step is to perform an excisional biopsy to obtain a definitive diagnosis. This approach is indicated to evaluate potentially malignant lesions and guide further treatment.

Question 91

A 29-year-old female presents complaining of multiple tender lumps in both breasts that seem to come and go. She notes that the lumps become more noticeable and painful just before her menstrual period. There are no overlying skin changes or nipple discharge. Which of the following conditions is most consistent with her symptoms? A) Breast carcinoma B) Mastitis C) Fibrocystic breast condition D) Inflammatory breast cancer

Answer 91

C) Fibrocystic breast condition ## Footnote Fibrocystic breast condition is characterized by cyclic breast pain, tenderness, and lumpiness, particularly in the premenstrual phase due to hormonal influences. It is a benign condition and the most likely diagnosis given the patient's age and symptomatology.

Question 92

A 53-year-old postmenopausal woman presents for evaluation of a newly noticed 'orange peel' appearance of the skin over her right breast. She has no breast pain or discharge. Examination confirms peau d'orange appearance with underlying induration of the breast tissue. There is no palpable lymphadenopathy. Which of the following is the most likely diagnosis? A) Cellulitis B) Fibroadenoma C) Breast carcinoma D) Dermatitis

Answer 92

C) Breast carcinoma ## Footnote Peau d'orange, or orange peel appearance of the breast skin, along with underlying breast induration in a postmenopausal woman, is highly suggestive of inflammatory breast carcinoma. This condition warrants immediate further investigation, including imaging and biopsy, due to its aggressive nature.

Question 93

A 40-year-old woman comes to your office concerned about possible breast cancer after her friend was recently diagnosed. She has no symptoms or abnormal findings on clinical examination. Her mother had breast cancer at age 65. What is the most appropriate screening recommendation for this patient? A) Annual mammography starting now B) Biennial mammography starting at age 50 C) Monthly breast self-examination only D) Immediate genetic testing

Answer 93

A) Annual mammography starting now ## Footnote For a woman with a first-degree relative who had breast cancer, it is appropriate to start annual mammography screenings at age 40 or earlier based on risk assessment. This strategy helps in early detection of potential breast cancer.

Question 94

A 23-year-old woman presents to the clinic for evaluation of a tender mass in her left breast that she noticed a week ago. She is currently breastfeeding her 6-month-old infant. On examination, the mass is warm, red, and tender. Which of the following is the most appropriate management? A) Immediate referral for a mammogram B) Initiation of antibiotic therapy C) Surgical drainage D) Observation for spontaneous resolution

Answer 94

B) Initiation of antibiotic therapy ## Footnote The clinical presentation is consistent with mastitis, a common infection in breastfeeding women. Treatment involves antibiotics, and most patients do not require surgical intervention unless there is an abscess formation.

Question 95

A 65-year-old woman presents for a routine check-up. She mentions that she has felt a slight thickening in her right breast, but it isn't visible. She has no pain or nipple discharge. She has a history of hypertension controlled with medication. What is the most appropriate initial diagnostic test? A) Breast MRI B) Diagnostic mammography C) Ultrasound of the breast D) Clinical breast examination by a specialist

Answer 95

B) Diagnostic mammography ## Footnote In a woman over 50, the first step in evaluating any breast abnormality, even if it's just a perceived thickening, should be a diagnostic mammography. This test is crucial for detecting changes that might not be palpable or visible yet.

Question 96

A 38-year-old woman presents with a complaint of unilateral bloody nipple discharge from her left breast. She denies any pain or palpable mass. She has no family history of breast cancer. On examination, the discharge is confirmed without any associated mass or skin changes. Which of the following is the most likely diagnosis? A) Ductal carcinoma in situ B) Intraductal papilloma C) Mastitis D) Fibrocystic breast condition

Answer 96

B) Intraductal papilloma ## Footnote Intraductal papilloma is a benign tumor that typically presents with bloody nipple discharge in the absence of a palpable mass. While ductal carcinoma in situ is a concern with any nipple discharge, the absence of other symptoms and the unilateral presentation make intraductal papilloma more likely.

Question 97

A 47-year-old female presents for evaluation of a palpable mass in her right breast discovered during self-examination. She has no symptoms of pain or nipple discharge. Her last mammogram two years ago was normal. Physical examination reveals a mobile, firm mass in the lower outer quadrant of the right breast. Which of the following steps is most appropriate to further evaluate this mass? A) Immediate surgical excision B) Hormonal therapy C) Ultrasound-guided biopsy D) Reassurance and follow-up in one year

Answer 97

C) Ultrasound-guided biopsy ## Footnote Given the new discovery of a palpable mass, the most appropriate next step is to perform an ultrasound-guided biopsy. This allows for precise sampling of the mass to determine its nature, essential for guiding further management, including the consideration of surgery if malignant.

Question 98

A 55-year-old postmenopausal woman complains of a new onset of bilateral breast tenderness. She started hormone replacement therapy three months ago. There are no palpable masses, and her recent mammogram was normal. What is the most likely cause of her breast tenderness? A) Breast cancer B) Hormone replacement therapy C) Fibrocystic breast condition D) Inflammatory breast disease

Answer 98

B) Hormone replacement therapy ## Footnote In postmenopausal women, the onset of bilateral breast tenderness following the initiation of hormone replacement therapy is typically a side effect of the therapy. Adjustments in therapy may be required if the symptom persists or affects the quality of life.

Question 99

A 31-year-old woman presents with a high fever, chills, and localized pain and swelling in her left breast. She is currently breastfeeding her 2-month-old baby. On examination, you note localized redness and warmth over the affected area. What is the most appropriate management? A) Advise to stop breastfeeding immediately B) Initiate IV antibiotics C) Start oral antibiotics and encourage continued breastfeeding D) Immediate breast ultrasound

Answer 99

C) Start oral antibiotics and encourage continued breastfeeding ## Footnote This patient likely has lactational mastitis. The appropriate management is to start oral antibiotics and encourage continued breastfeeding or pumping from both breasts to help clear the infection and prevent milk stasis, which can exacerbate the problem.

Question 100

A 70-year-old woman reports a new retraction of her nipple on the left breast during her annual check-up. She has no pain or discharge. Her last mammogram was 18 months ago and was unremarkable. What is the most appropriate next step in evaluation? A) Reassurance and continue annual mammograms B) Immediate referral for a mammogram and breast ultrasound C) Start empirical treatment for breast infection D) Hormone therapy evaluation

Answer 100

B) Immediate referral for a mammogram and breast ultrasound ## Footnote Nipple retraction can be an indication of an underlying malignancy, particularly if it is a new finding in an older woman. An immediate referral for diagnostic mammography and breast ultrasound is warranted to rule out any serious pathology.

Question 101

A 44-year-old woman comes to the clinic for a routine visit. She has no complaints but requests a screening test for breast cancer as her sister was recently diagnosed at age 48. There are no palpable masses on examination, and she has no other risk factors. What is the most appropriate screening recommendation for this patient? A) Start annual mammography now B) Genetic counseling and testing C) Biennial mammography starting at age 50 D) No screening until age 50

Answer 101

A) Start annual mammography now ## Footnote Given the family history of breast cancer in a first-degree relative diagnosed before age 50, it would be prudent to initiate annual mammography screening at this time to increase the likelihood of early detection.

Question 102

A 50-year-old woman is concerned about her risk of breast cancer because her mother was diagnosed with breast cancer at age 45. She has dense breasts and is worried about the efficacy of mammography in her case. What additional screening modality should be discussed to enhance breast cancer detection? A) Breast MRI B) Thermography C) Ultrasound D) PET scan

Answer 102

A) Breast MRI ## Footnote For women with dense breasts and a family history of breast cancer, adding a breast MRI can improve the detection of breast cancer. MRI is more sensitive than mammography alone in dense breast tissue.

Question 103

A 22-year-old woman presents to the clinic with a painful lump in her right breast that she has noticed over the last week. She is currently menstruating. Examination reveals a small, tender mass in the right breast. What is the most likely diagnosis? A) Fibroadenoma B) Cyst C) Cancer D) Mastitis

Answer 103

B) Cyst ## Footnote Breast cysts are fluid-filled sacs within the breast, which are common and can be particularly tender during menstruation. They are benign and often resolve on their own or with minimal intervention.

Question 104

A 63-year-old woman undergoing treatment for breast cancer presents with a complaint of a new onset of sharp, burning pain in her left breast. She is currently on chemotherapy. Examination reveals a red, swollen area on the upper quadrant of the left breast. What is the most likely cause of her symptoms? A) Inflammatory breast cancer B) Radiation dermatitis C) Cellulitis D) Post-surgical changes

Answer 104

C) Cellulitis ## Footnote Given the chemotherapy treatment, which can compromise the immune system, and the presentation of redness and swelling, cellulitis is a likely diagnosis. This bacterial infection of the skin requires prompt treatment with antibiotics.

Question 105

A 39-year-old woman presents for her annual exam. She reports occasional bilateral breast pain. She mentions that the pain seems to peak during the middle of her menstrual cycle and resolves after her period begins. What is the most likely explanation for her symptoms? A) Hormonal changes related to her menstrual cycle B) Breast cancer C) Intraductal papilloma D) Mastitis

Answer 105

A) Hormonal changes related to her menstrual cycle ## Footnote Cyclical breast pain is a common symptom associated with the hormonal changes of the menstrual cycle. It is typically bilateral and peaks during the luteal phase, resolving with the onset of menstruation.

Question 106

A 32-year-old woman presents with intermittent pelvic pain and menorrhagia. Her menstrual cycles are typically 35-40 days apart. Physical examination reveals a uniformly enlarged, mobile uterus. Ultrasound shows multiple intramural fibroids with the largest measuring 5 cm. Which of the following is the most appropriate next step in management? A. High-dose progestin therapy B. Hysteroscopic myomectomy C. Magnetic resonance-guided focused ultrasound D. No treatment necessary

Answer 106

B. Hysteroscopic myomectomy ## Footnote Hysteroscopic myomectomy is indicated in this patient who presents with symptoms (pelvic pain and menorrhagia) that are likely attributable to fibroids. The choice of hysteroscopic myomectomy, particularly when fibroids are intramural and the uterus is uniformly enlarged, targets symptom relief while preserving uterine integrity, important for her reproductive age.

Question 107

A 28-year-old woman comes to the clinic complaining of severe dysmenorrhea and dyspareunia. She has a history of irregular menstrual cycles and has been trying to conceive for the past year without success. A pelvic ultrasound reveals a bicornuate uterus. Which of the following is the most likely associated finding? A. Renal agenesis B. Normal fallopian tubes C. Cervical incompetence D. Endometrial hyperplasia

Answer 107

A. Renal agenesis ## Footnote Müllerian duct anomalies, like a bicornuate uterus, are often associated with urinary tract abnormalities due to their close embryologic origin. Renal agenesis is a common concurrent anomaly found in patients with a bicornuate uterus. Recognizing this association is crucial for comprehensive management.

Question 108

A 22-year-old woman presents to the emergency department with acute onset of severe pelvic pain. She mentions that she is sexually active and uses a contraceptive implant for birth control. An ultrasound is performed and shows a large ovarian cyst with signs of torsion. What is the most appropriate management for this condition? A. Laparoscopic cystectomy B. Laparoscopic detorsion C. Conservative management with analgesia D. Immediate initiation of hormone therapy

Answer 108

B. Laparoscopic detorsion ## Footnote Ovarian torsion is a surgical emergency, and the first-line treatment is laparoscopic detorsion to preserve ovarian function and viability. Immediate intervention is necessary to prevent irreversible damage to the ovary due to disrupted blood flow.

Question 109

A 36-year-old woman, G2P1, presents with pelvic pressure and a sensation of something 'coming down' her vagina. She denies any urinary or fecal incontinence. On examination, there is a notable cystocele. Which of the following is the most likely cause of her condition? A. Uterine atony B. Traumatic vaginal delivery C. Pelvic inflammatory disease D. Chronic constipation

Answer 109

B. Traumatic vaginal delivery ## Footnote A cystocele, or prolapse of the bladder into the vagina, commonly results from weakening of the pelvic floor muscles and fascia, often due to traumatic vaginal delivery. This history is crucial in linking her symptoms to the physical findings.

Question 110

A 29-year-old woman presents to the clinic for a routine check-up. She mentions having painful periods and a recent increase in menstrual flow. Examination reveals a retroverted, fixed uterus. Which of the following conditions is most consistent with these findings? A. Endometriosis B. Uterine polyps C. Cervical stenosis D. Adenomyosis

Answer 110

A. Endometriosis ## Footnote Endometriosis can cause a retroverted, fixed uterus due to fibrotic adhesions resulting from the inflammatory process. The symptoms of dysmenorrhea and menorrhagia further support this diagnosis, correlating the structural findings with her clinical presentation.

Question 111

A 31-year-old woman presents with recurrent pelvic pain and a history of multiple laparoscopies for endometriosis. She is currently using oral contraceptives for management. During a routine ultrasound, a complex adnexal mass is identified. What is the most appropriate management strategy for this patient? A. Continued observation with follow-up ultrasound in 3 months B. Immediate surgical intervention C. Cancellation of oral contraceptives and initiation of GnRH analogs D. Biopsy of the mass during laparoscopy

Answer 111

D. Biopsy of the mass during laparoscopy ## Footnote In a patient with a history of endometriosis and new finding of a complex adnexal mass, biopsy during laparoscopy is indicated to rule out malignant transformation. This approach allows for both diagnostic and potential therapeutic intervention.

Question 112

A 45-year-old woman, G3P3, presents with a one-year history of menorrhagia and intermenstrual bleeding. She is noted to have a 3 cm mass in the uterine fundus on ultrasound. What is the most likely diagnosis? A. Leiomyosarcoma B. Uterine polyp C. Adenomyosis D. Submucosal fibroid

Answer 112

D. Submucosal fibroid ## Footnote Submucosal fibroids are benign tumors of the uterus that commonly cause symptoms of menorrhagia and intermenstrual bleeding due to their location within the uterine cavity. The ultrasound findings of a localized mass in the fundus correlate well with this diagnosis.

Question 113

A 39-year-old woman is evaluated for urinary urgency and frequency. On examination, a palpable anterior vaginal wall mass is noted. Which of the following is the most likely diagnosis? A. Urethral diverticulum B. Bladder cancer C. Urethral caruncle D. Cystocele

Answer 113

A. Urethral diverticulum ## Footnote A urethral diverticulum presents as a palpable anterior vaginal wall mass and is commonly associated with symptoms of urinary urgency, frequency, and dysuria. Recognizing this association is key in differentiating it from other conditions like bladder cancer or cystocele.

Question 114

A 24-year-old nulliparous woman presents with cyclic pelvic pain, especially during menstruation. Magnetic resonance imaging (MRI) of the pelvis reveals multiple uterine fibroids, the largest being 8 cm. What is the most likely complication of untreated fibroids in this patient? A. Acute urinary retention B. Iron deficiency anemia C. Sudden torsion of the uterus D. Progression to malignancy

Answer 114

B. Iron deficiency anemia ## Footnote Menorrhagia, a common symptom of uterine fibroids, can lead to chronic blood loss, resulting in iron deficiency anemia. This diagnosis correlates her symptoms with the potential complication of untreated fibroids.

Question 115

A 27-year-old woman presents with a one-year history of painful menses and dyspareunia. She is sexually active and has been using a copper intrauterine device (IUD) for the past three years. Pelvic examination reveals a tender, retroverted uterus. Ultrasound shows thickening of the uterosacral ligaments. What is the most appropriate next step in management? A. Removal of the IUD B. Initiation of NSAIDs C. Laparoscopic evaluation D. Empirical antibiotic therapy

Answer 115

C. Laparoscopic evaluation ## Footnote The patient's symptoms, combined with ultrasound findings suggestive of pelvic adhesions or endometriosis (thickening of the uterosacral ligaments), indicate the need for a laparoscopic evaluation to confirm the diagnosis and potentially treat any identifiable pathology.

Question 116

A 23-year-old woman presents with cyclic pelvic pain and no relief from NSAIDs. She has a history of severe acne and hirsutism. Her pelvic ultrasound shows bilateral enlarged ovaries with multiple cystic structures. Which of the following is the most likely diagnosis? A. Endometriosis B. Polycystic ovary syndrome (PCOS) C. Ovarian cancer D. Pelvic inflammatory disease

Answer 116

B. Polycystic ovary syndrome (PCOS) ## Footnote The combination of cyclic pelvic pain, severe acne, hirsutism, and ultrasound findings of enlarged ovaries with multiple cysts suggests PCOS. This endocrine disorder often presents with these symptoms due to hormonal imbalances.

Question 117

A 30-year-old woman, nulliparous, reports a heavy menstrual cycle lasting 10-12 days each month. She also experiences frequent constipation and lower back pain. Pelvic examination and imaging suggest multiple submucosal fibroids. Which of the following treatment options is most appropriate to preserve fertility? A. Uterine artery embolization B. Gonadotropin-releasing hormone (GnRH) agonists C. Myomectomy D. Hysterectomy

Answer 117

C. Myomectomy ## Footnote Myomectomy is the preferred treatment for submucosal fibroids in a woman wishing to preserve fertility. It involves the surgical removal of fibroids while leaving the uterus intact, which can alleviate symptoms and enhance fertility prospects.

Question 118

A 35-year-old woman presents with a sensation of vaginal fullness and a visible protrusion at the vaginal introitus. She reports difficulty voiding completely. Pelvic examination reveals a posterior vaginal bulge. Which of the following is the most likely diagnosis? A. Cystocele B. Rectocele C. Enterocele D. Uterine prolapse

Answer 118

B. Rectocele ## Footnote A rectocele presents as a posterior vaginal bulge and can cause symptoms of incomplete voiding due to the herniation of the rectal wall into the vagina, often exacerbated by childbirth or chronic straining.

Question 119

A 27-year-old woman presents with severe dysmenorrhea and chronic pelvic pain unresponsive to oral contraceptives. She has a history of a laparoscopy confirming endometriosis. What is the most appropriate step to manage her pain? A. Initiation of a GnRH antagonist B. Prescribing an opioid analgesic C. Another diagnostic laparoscopy D. Immediate hysterectomy

Answer 119

A. Initiation of a GnRH antagonist ## Footnote In cases of endometriosis with pain unresponsive to typical hormonal treatments like oral contraceptives, a GnRH antagonist can be effective. It reduces estrogen production, thereby potentially alleviating endometriosis-related symptoms.

Question 120

A 40-year-old woman with a palpable mass in her pelvis on examination reports pressure symptoms and frequent urination. Imaging reveals a large mass distorting the bladder. What is the initial management approach? A. Scheduling for immediate surgery B. Conducting a biopsy to rule out malignancy C. Observational management with serial ultrasounds D. Starting hormone therapy for possible fibroid

Answer 120

B. Conducting a biopsy to rule out malignancy ## Footnote Given the size of the mass and its effect on adjacent structures like the bladder, a biopsy is crucial to determine the nature of the mass, particularly to rule out malignancy before deciding on further management.

Question 121

A 25-year-old woman presents with intermittent sharp pelvic pain and a history of irregular menses. Pelvic MRI shows a septate uterus. What is the most likely complication of this condition? A. Chronic pelvic pain B. Recurrent pregnancy loss C. Ascending pelvic infections D. Severe dysmenorrhea

Answer 121

B. Recurrent pregnancy loss ## Footnote A septate uterus is a congenital malformation where a septum divides the uterine cavity, significantly associated with recurrent pregnancy loss due to impaired implantation and placental development.

Question 122

A 42-year-old woman reports post-coital bleeding and pelvic pain. On examination, a friable mass is noted on the cervix. Which of the following is the most immediate next step? A. Pap smear B. HPV vaccination C. Cervical biopsy D. Prescribing antibiotics

Answer 122

C. Cervical biopsy ## Footnote The presence of a friable cervical mass with symptoms like post-coital bleeding necessitates a cervical biopsy to rule out cervical cancer, an immediate concern in such presentations.

Question 123

A 37-year-old woman complains of a mass descending into her vagina during straining, accompanied by discomfort but no pain. Examination reveals a bulging anterior vaginal wall. What is the most likely diagnosis? A. Enterocele B. Rectocele C. Cystocele D. Uterine prolapse

Answer 123

C. Cystocele ## Footnote A cystocele results from the herniation of the bladder into the anterior vaginal wall, often evident during straining or standing and can cause a sensation of a bulge or mass in the vagina.

Question 124

A 19-year-old woman presents with amenorrhea and cyclic abdominal pain. On examination, her vagina ends in a blind pouch, and she has normal secondary sexual characteristics. What is the most likely diagnosis? A. Asherman’s syndrome B. Mayer-Rokitansky-Küster-Hauser syndrome C. Polycystic ovary syndrome D. Endometrial hyperplasia

Answer 124

B. Mayer-Rokitansky-Küster-Hauser syndrome ## Footnote Mayer-Rokitansky-Küster-Hauser syndrome involves congenital absence of the uterus and upper part of the vagina, which explains her amenorrhea and the presence of a blind-ending vaginal pouch despite normal external genitalia and secondary sexual development.

Question 125

A 33-year-old woman, G1P1, reports prolonged menstrual bleeding and frequent spotting. Ultrasound reveals adenomyosis. What is the most appropriate management for her if she desires future fertility? A. Uterine artery embolization B. High-dose progestin therapy C. Hysterectomy D. Laparoscopic myomectomy

Answer 125

B. High-dose progestin therapy ## Footnote In patients with adenomyosis who desire future fertility, conservative management with high-dose progestin therapy is recommended to control symptoms while preserving uterine function and potential for pregnancy.

Question 126

A 34-year-old woman presents with dysmenorrhea and dyspareunia. She reports that her symptoms have progressively worsened over the last year. During a pelvic exam, you note nodularity in the posterior cul-de-sac. An MRI confirms endometriosis with deep infiltrative lesions. What is the most appropriate management option? A. Initiation of continuous oral contraceptives B. Prescribing a nonsteroidal anti-inflammatory drug (NSAID) C. Surgical excision of endometriotic lesions D. Observation with annual follow-up

Answer 126

C. Surgical excision of endometriotic lesions ## Footnote Surgical excision of endometriotic lesions is indicated for patients with deep infiltrative endometriosis, especially when symptoms are severe and progressive like in this case. This approach not only addresses immediate symptoms but also helps prevent further complications related to deep infiltrative endometriosis.

Question 127

A 24-year-old woman is evaluated for primary amenorrhea. Physical examination reveals normal breast development and scant pubic hair. An ultrasound shows a normal uterus but no visible ovaries, and karyotype analysis confirms a 46, XY genotype. What is the most likely diagnosis? A. Androgen insensitivity syndrome B. Turner syndrome C. Klinefelter syndrome D. Congenital adrenal hyperplasia

Answer 127

A. Androgen insensitivity syndrome ## Footnote Androgen insensitivity syndrome (AIS) is characterized by a 46, XY karyotype in an individual who has female external genitalia with normal breast development but no ovaries. This is due to the body's inability to respond to androgens.

Question 128

A 27-year-old woman presents with recurrent mid-cycle pain and a history of three consecutive early miscarriages. A hysterosalpingogram shows a septate uterus. What is the most appropriate management to improve her chances of a successful pregnancy? A. Hysteroscopic septum resection B. Administering progesterone supplements in early pregnancy C. In vitro fertilization D. Serial beta-hCG measurements

Answer 128

A. Hysteroscopic septum resection ## Footnote A septate uterus can lead to recurrent pregnancy loss due to impaired implantation. Hysteroscopic septum resection is the recommended management to remove the septum, thereby improving uterine architecture and increasing the chances of a successful pregnancy.

Question 129

A 31-year-old woman, G1P0, presents at 18 weeks of gestation with a history of a bicornuate uterus identified on an earlier ultrasound. She is concerned about the risk of preterm labor. What would be the most appropriate advice for her at this stage of pregnancy? A. Scheduled cesarean section at 37 weeks B. Routine prenatal care with serial ultrasounds to monitor cervical length C. Immediate cerclage placement D. Initiation of daily progesterone therapy

Answer 129

B. Routine prenatal care with serial ultrasounds to monitor cervical length ## Footnote In a pregnant woman with a bicornuate uterus, the primary concern is the risk of preterm labor due to abnormal uterine shape. Monitoring cervical length through serial ultrasounds allows for early detection and management of changes that could indicate impending preterm labor.

Question 130

A 45-year-old woman presents with vaginal bleeding 1 year after menopause. Pelvic ultrasound reveals a thickened endometrium. What is the most appropriate next step in management? A. Reassurance and annual follow-up B. Endometrial biopsy C. Initiation of hormone replacement therapy D. Immediate hysterectomy

Answer 130

B. Endometrial biopsy ## Footnote Postmenopausal bleeding with a thickened endometrium is a red flag for endometrial cancer until proven otherwise. An endometrial biopsy is necessary to determine the cause of bleeding and to rule out malignancy.

Question 131

A 38-year-old woman complains of a persistent feeling of 'something coming out' of her vagina, particularly towards the end of the day or after prolonged standing. Physical examination shows a visible cervical protrusion at the vaginal introitus. What is the most likely diagnosis? A. Cystocele B. Rectocele C. Uterine prolapse D. Enterocele

Answer 131

C. Uterine prolapse ## Footnote Uterine prolapse is characterized by the descent of the uterus toward or through the vaginal introitus, often noticeable after physical exertion or at the end of the day when pelvic floor muscles are fatigued.

Question 132

A 22-year-old woman, G0, presents with painful menses and a palpable mass on her right adnexa. Ultrasound reveals a 6 cm ovarian cyst. What is the most likely type of cyst given her symptoms? A. Dermoid cyst B. Hemorrhagic cyst C. Endometrioma D. Follicular cyst

Answer 132

C. Endometrioma ## Footnote Given her symptoms of painful menses and the presence of a significant adnexal mass, an endometrioma (a type of ovarian cyst formed from ectopic endometrial tissue) is likely. These cysts are associated with endometriosis and can cause cyclical pain.

Question 133

A 33-year-old woman is being evaluated for infertility. She has regular menstrual cycles, normal hormonal profile, and her husband's semen analysis is normal. Hysterosalpingography shows bilateral tubal occlusion. What is the most likely cause for this finding? A. Previous pelvic inflammatory disease B. Congenital tubal anomaly C. Endometriosis D. Uterine fibroids

Answer 133

A. Previous pelvic inflammatory disease ## Footnote Bilateral tubal occlusion is most commonly caused by scarring from previous pelvic inflammatory disease (PID), which can occur even if the PID was subclinical or the symptoms were mild and overlooked.

Question 134

A 25-year-old woman presents with severe menstrual pain and irregular bleeding. She was recently treated for Chlamydia. A pelvic exam reveals a fixed, retroverted uterus. What complication is most likely causing her symptoms? A. Chronic endometritis B. Pelvic inflammatory disease with sequelae C. Adenomyosis D. Residual Chlamydia infection

Answer 134

B. Pelvic inflammatory disease with sequelae ## Footnote Given her history of Chlamydia and current symptoms, the patient likely has sequelae from pelvic inflammatory disease, including adhesions that can cause a fixed, retroverted uterus and associated pain.

Question 135

A 39-year-old woman presents with heavy and prolonged menstrual bleeding. She is found to have multiple intramural fibroids. She is not interested in fertility but wants to avoid major surgery. What is the most appropriate management? A. Myomectomy B. Uterine artery embolization C. Hysterectomy D. High-dose progestin therapy

Answer 135

B. Uterine artery embolization ## Footnote Uterine artery embolization (UAE) is a minimally invasive procedure that reduces fibroid size and symptoms by cutting off their blood supply. It's suitable for patients who wish to avoid surgery and do not desire future fertility.

Question 136

A 32-year-old female presents with a six-month history of irregular menstrual cycles and excessive facial hair growth. She reports weight gain and acne, which she finds distressing. Her BMI is 30 kg/m². On examination, you note acanthosis nigricans around her neck. Which of the following is the most likely diagnosis? A) Cushing's syndrome B) Polycystic ovary syndrome (PCOS) C) Hyperthyroidism D) Prolactinoma

Answer 136

B) Polycystic ovary syndrome (PCOS) ## Footnote The patient's symptoms of irregular menstrual cycles, hirsutism, acne, and obesity along with acanthosis nigricans are highly suggestive of PCOS. PCOS is a common endocrine disorder in women of reproductive age characterized by hyperandrogenism and insulin resistance.

Question 137

A 28-year-old woman comes to the clinic complaining of pelvic pain, especially during menstruation. Her pain is severe enough to affect her daily activities. She has tried over-the-counter NSAIDs with little relief. She is sexually active and uses condoms for contraception. Her last Pap smear was normal. What is the most appropriate next step in management? A) Prescribe oral contraceptive pills B) Recommend laparoscopy C) Order a transvaginal ultrasound D) Initiate gonadotropin-releasing hormone agonists

Answer 137

C) Order a transvaginal ultrasound ## Footnote A transvaginal ultrasound is a non-invasive test that helps in evaluating uterine and ovarian abnormalities, such as endometriosis or ovarian cysts, which could be causing her symptoms. This should be the next step before more invasive procedures or treatments.

Question 138

A 44-year-old woman presents for a routine check-up and mentions that her mother was recently diagnosed with ovarian cancer. She is concerned about her own risk and inquires about preventive measures. Which of the following is the most appropriate recommendation? A) Genetic counseling and testing for BRCA mutations B) Total abdominal hysterectomy and bilateral salpingo-oophorectomy C) Annual transvaginal ultrasound D) Start a low-fat diet

Answer 138

A) Genetic counseling and testing for BRCA mutations ## Footnote Given her family history of ovarian cancer, genetic counseling and testing for BRCA mutations are recommended to assess her risk and discuss preventive strategies if she is a carrier.

Question 139

A 37-year-old woman presents complaining of vaginal discharge that is white and curd-like in appearance. She denies any odor but reports pruritus. She has diabetes mellitus type 2, which is controlled with metformin. What is the most likely diagnosis? A) Bacterial vaginosis B) Trichomoniasis C) Candidiasis D) Gonorrhea

Answer 139

C) Candidiasis ## Footnote The patient's symptoms of white, curd-like vaginal discharge and pruritus are classic for candidiasis, especially considering her background of diabetes, which predisposes her to yeast infections due to elevated glucose levels.

Question 140

A 23-year-old woman comes to the office complaining of missed periods and milky breast discharge. She is not pregnant and has no history of headaches or vision changes. Which of the following tests is most appropriate to order first? A) Serum prolactin level B) Brain MRI C) Thyroid function tests D) Pregnancy test

Answer 140

A) Serum prolactin level ## Footnote The presentation of galactorrhea (milky breast discharge) and amenorrhea (missed periods) suggests hyperprolactinemia. Measuring serum prolactin levels is the appropriate first step to confirm the diagnosis and guide further management.

Question 141

A 19-year-old female comes to the clinic concerned about a burning sensation during urination and increased frequency. Her medical history is unremarkable, and she is sexually active with one partner. A clean catch urine sample reveals pyuria. What is the most likely diagnosis? A) Acute pyelonephritis B) Interstitial cystitis C) Urinary tract infection (UTI) D) Urethral syndrome

Answer 141

C) Urinary tract infection (UTI) ## Footnote The patient's symptoms of dysuria (burning sensation during urination) and frequency along with pyuria are indicative of a UTI. This is a common condition in sexually active young women.

Question 142

A 26-year-old woman presents with a one-year history of pain during sex and generalized pelvic pain that worsens during her periods. She has used several types of birth control pills, which have not alleviated her symptoms. What is the most likely diagnosis? A) Endometriosis B) Pelvic inflammatory disease C) Uterine fibroids D) Ovarian cysts

Answer 142

A) Endometriosis ## Footnote Endometriosis should be suspected in women with chronic pelvic pain, dyspareunia (pain during sex), and pain that worsens with menstruation, especially when hormonal contraception does not relieve symptoms.

Question 143

A 51-year-old woman reports that she has not had a menstrual period in the past 12 months. She now experiences hot flashes, night sweats, and occasional mood swings. Which condition is most consistent with her presentation? A) Premenstrual syndrome B) Menopause C) Premature ovarian failure D) Hypothyroidism

Answer 143

B) Menopause ## Footnote The cessation of menstruation for 12 months, combined with symptoms like hot flashes, night sweats, and mood swings, strongly suggests menopause.

Question 144

A 22-year-old female presents to the clinic with a three-day history of lower abdominal pain and a fever of 101°F (38.3°C). She is sexually active and does not use contraception. On examination, there is tenderness in the right lower quadrant and cervical motion tenderness. What is the most likely diagnosis? A) Appendicitis B) Ectopic pregnancy C) Pelvic inflammatory disease (PID) D) Ovarian torsion

Answer 144

C) Pelvic inflammatory disease (PID) ## Footnote PID is likely given her risk factors (sexually active, no contraception), symptoms (lower abdominal pain, fever), and signs (right lower quadrant tenderness, cervical motion tenderness) indicative of a pelvic infection.

Question 145

A 34-year-old woman, who is a mother of two, complains of leaking urine when she coughs or sneezes. This has been more frequent over the past six months and is affecting her quality of life. What is the most likely diagnosis? A) Urge incontinence B) Stress incontinence C) Overflow incontinence D) Functional incontinence

Answer 145

B) Stress incontinence ## Footnote Stress incontinence, characterized by the involuntary leakage of urine during activities that increase abdominal pressure such as coughing or sneezing, is common in women post-childbirth.