PACKRAT - OBGYN; Questions and Answers 100%
Correct
1. History & Physical/Obstetrics/Gynecology
A 26 year-old monogamous female presents with cyclic pelvic pain that has been increasing
over the last 6 months. She complains of significant dysmenorrhea and dyspareunia. She uses
condoms for birth control. On physical examination her uterus is retroverted and non-mobile,
and she has a palpable adnexal mass on the left side. Her serum pregnancy test is negative.
Which of the following is the most likely diagnosis?
A. Ovarian cancer
B. Endometriosis
C. Functional ovarian cyst
D. Pelvic inflammatory disease CORRECT ANSWER-(u) A. It is important to consider
ovarian cancer in a patient with a pelvic mass however, ovarian cancer usually occurs in older
women over age 55 and patients are often asymptomatic until the disease is more advanced
(c) B. With endometriosis, the uterus is often fixed and retroflexed in the pelvis. The palpable
mass is an endometrioma or "chocolate cyst". The patient with endometriosis also often has
dysmenorrhea, dyspareunia, and dyschezia.
(u) C. Functional ovarian cysts occur from ovulation and usually are not symptomatic.
(u) D. With PID the patient will have abdominal tenderness, adnexal tenderness, cervical motion
tenderness and an elevated temperature.
2. Health Maintenance/Obstetrics/Gynecology
What is the recommended method for screening pregnant women for gestational diabetes?
A. Fasting blood sugar and 2 hour post prandial
B. 50 gram glucose load followed by a blood sugar in 1 hour
C. 75 gram glucose load followed by a blood sugar in 2 hours
, PACKRAT - OBGYN; Questions and Answers 100%
Correct
D. 100 gram glucose load followed by a blood sugar at 1 hour, 2 hours, and 3 hours
CORRECT ANSWER-(u) A. Fasting blood sugar and 2 hour postprandial blood test is used to
follow patient with gestational diabetes.
(c) B. One hour Glucola is the screening test for gestational diabetes. It is a 50 gram glucose
load, with a serum glucose obtained 1 hour after the dose. Normal value is less than 140 mg/dL.
(u) C. A 75 gram glucose load is used in non-pregnant patients.
(u) D. This describes a three-hour GTT, which is ordered if the 1 hour Glucola is elevated above
140 gm/dL.
3. Clinical Therapeutics/Obstetrics/Gynecology
What is the treatment of magnesium sulfate toxicity?
A. Nifedipine
B. Terbutaline
C. Potassium carbonate
D. Calcium gluconate CORRECT ANSWER-(u) A. Nifedipine, a calcium-channel blocker is
used to treat both preterm labor and hypertension in pregnancy. It works by inhibiting calcium
transport through slow-type channels, causing reduction in systemic and pulmonary vascular
resistance and tocolysis.
(u) B. Terbutaline is a beta-blocker that is used to treat pre-term labor.
(u) C. Potassium carbonate is a treatment for metabolic acidosis, not magnesium sulfate toxicity.
(c) D. 10% calcium gluconate is used to treat magnesium sulfate toxicity.
4. Clinical Intervention/Obstetrics/Gynecology
, PACKRAT - OBGYN; Questions and Answers 100%
Correct
A 52 year-old obese patient with persistent heavy menses undergoes an endometrial biopsy and
is diagnosed with atypical adenomatous hyperplasia. What is the next step in the management
of this patient?
A. Total abdominal hysterectomy
B. Observation and endometrial biopsy in 3 months
C. Endometrial curettage followed by progesterone daily
D. Oral progesterone days 16-25 of the month for 6 months and repeat biopsy CORRECT
ANSWER-(c) A. Atypical adenomatous hyperplasia contains cellular atypia and mitotic figures in
addition to glandular crowding and complexity. This has a 20-30% risk of progression to
endometrial cancer and the recommendation is hysterectomy.
(h) B. Observation and biopsy again in 3 months would increase the risk of endometrial cancer
for this patient.
(h) C. Endometrial curettage would remove the hyperplasia and progesterone will decrease the
endometrial glandular proliferation. This would be appropriate management in a patient with
endometrial hyperplasia without atypia.
(h) D. Oral progesterone for 10 days of the month will cause the patient to have a withdrawal
bleed every month. This would be an appropriate treatment in a premenopausal patient with
endometrial hyperplasia without atypia
5. Diagnostic Studies/Obstetrics/Gynecology
A 23 year-old female is in active labor and has progressed from 3 cm to 6 cm in the last six
hours. Fetal monitoring demonstrates mild repetitive late decelerations. Which of the following
is the most likely cause of this finding?
A. Fetal hypoxia
, PACKRAT - OBGYN; Questions and Answers 100%
Correct
B. Head compression
C. Cord compression
D. Uteroplacental insufficiency CORRECT ANSWER-(u) A. Fetal hypoxia would be a
concern if deep late FHR decelerations were present with absent beat-to-beat variability.
(u) B. Early decelerations are due to head compression of the fetus. Pressure on the fetal head
causes an alteration in cerebral blood flow causing a central vagal stimulation and subsequent
FHR deceleration. The deceleration is a mirror image of the contraction.
(u) C. Variable decelerations are from cord compression. The decelerations have a sharp,
angular, decline in FHR with duration less than 2 minutes.
(c) D. Late decelerations are from uteroplacental insufficiency. The decelerations have a smooth,
gradual symmetrical decrease in FHR beginning at or after the peak of the contraction.
6. Diagnosis/Obstetrics/Gynecology
A 16 year-old G0P0 patient presents complaining of lower pelvic pain that alternates from right
to left side of her pelvis. She states that it is related to her cycle and occurs most commonly
midcycle. She denies sexual activity. She reports that she has taken ibuprofen at the time of the
discomfort with some relief. Her pelvic examination is unremarkable. Which of the following is
the most likely diagnosis?
A. Endometriosis
B. Mittelschmerz
C. Functional ovarian cyst
D. Pelvic inflammatory disease 29 CORRECT ANSWER-(u) A. With endometriosis, the
uterus is often fixed and retroflexed in the pelvis. The palpable mass is an endometrioma or
Correct
1. History & Physical/Obstetrics/Gynecology
A 26 year-old monogamous female presents with cyclic pelvic pain that has been increasing
over the last 6 months. She complains of significant dysmenorrhea and dyspareunia. She uses
condoms for birth control. On physical examination her uterus is retroverted and non-mobile,
and she has a palpable adnexal mass on the left side. Her serum pregnancy test is negative.
Which of the following is the most likely diagnosis?
A. Ovarian cancer
B. Endometriosis
C. Functional ovarian cyst
D. Pelvic inflammatory disease CORRECT ANSWER-(u) A. It is important to consider
ovarian cancer in a patient with a pelvic mass however, ovarian cancer usually occurs in older
women over age 55 and patients are often asymptomatic until the disease is more advanced
(c) B. With endometriosis, the uterus is often fixed and retroflexed in the pelvis. The palpable
mass is an endometrioma or "chocolate cyst". The patient with endometriosis also often has
dysmenorrhea, dyspareunia, and dyschezia.
(u) C. Functional ovarian cysts occur from ovulation and usually are not symptomatic.
(u) D. With PID the patient will have abdominal tenderness, adnexal tenderness, cervical motion
tenderness and an elevated temperature.
2. Health Maintenance/Obstetrics/Gynecology
What is the recommended method for screening pregnant women for gestational diabetes?
A. Fasting blood sugar and 2 hour post prandial
B. 50 gram glucose load followed by a blood sugar in 1 hour
C. 75 gram glucose load followed by a blood sugar in 2 hours
, PACKRAT - OBGYN; Questions and Answers 100%
Correct
D. 100 gram glucose load followed by a blood sugar at 1 hour, 2 hours, and 3 hours
CORRECT ANSWER-(u) A. Fasting blood sugar and 2 hour postprandial blood test is used to
follow patient with gestational diabetes.
(c) B. One hour Glucola is the screening test for gestational diabetes. It is a 50 gram glucose
load, with a serum glucose obtained 1 hour after the dose. Normal value is less than 140 mg/dL.
(u) C. A 75 gram glucose load is used in non-pregnant patients.
(u) D. This describes a three-hour GTT, which is ordered if the 1 hour Glucola is elevated above
140 gm/dL.
3. Clinical Therapeutics/Obstetrics/Gynecology
What is the treatment of magnesium sulfate toxicity?
A. Nifedipine
B. Terbutaline
C. Potassium carbonate
D. Calcium gluconate CORRECT ANSWER-(u) A. Nifedipine, a calcium-channel blocker is
used to treat both preterm labor and hypertension in pregnancy. It works by inhibiting calcium
transport through slow-type channels, causing reduction in systemic and pulmonary vascular
resistance and tocolysis.
(u) B. Terbutaline is a beta-blocker that is used to treat pre-term labor.
(u) C. Potassium carbonate is a treatment for metabolic acidosis, not magnesium sulfate toxicity.
(c) D. 10% calcium gluconate is used to treat magnesium sulfate toxicity.
4. Clinical Intervention/Obstetrics/Gynecology
, PACKRAT - OBGYN; Questions and Answers 100%
Correct
A 52 year-old obese patient with persistent heavy menses undergoes an endometrial biopsy and
is diagnosed with atypical adenomatous hyperplasia. What is the next step in the management
of this patient?
A. Total abdominal hysterectomy
B. Observation and endometrial biopsy in 3 months
C. Endometrial curettage followed by progesterone daily
D. Oral progesterone days 16-25 of the month for 6 months and repeat biopsy CORRECT
ANSWER-(c) A. Atypical adenomatous hyperplasia contains cellular atypia and mitotic figures in
addition to glandular crowding and complexity. This has a 20-30% risk of progression to
endometrial cancer and the recommendation is hysterectomy.
(h) B. Observation and biopsy again in 3 months would increase the risk of endometrial cancer
for this patient.
(h) C. Endometrial curettage would remove the hyperplasia and progesterone will decrease the
endometrial glandular proliferation. This would be appropriate management in a patient with
endometrial hyperplasia without atypia.
(h) D. Oral progesterone for 10 days of the month will cause the patient to have a withdrawal
bleed every month. This would be an appropriate treatment in a premenopausal patient with
endometrial hyperplasia without atypia
5. Diagnostic Studies/Obstetrics/Gynecology
A 23 year-old female is in active labor and has progressed from 3 cm to 6 cm in the last six
hours. Fetal monitoring demonstrates mild repetitive late decelerations. Which of the following
is the most likely cause of this finding?
A. Fetal hypoxia
, PACKRAT - OBGYN; Questions and Answers 100%
Correct
B. Head compression
C. Cord compression
D. Uteroplacental insufficiency CORRECT ANSWER-(u) A. Fetal hypoxia would be a
concern if deep late FHR decelerations were present with absent beat-to-beat variability.
(u) B. Early decelerations are due to head compression of the fetus. Pressure on the fetal head
causes an alteration in cerebral blood flow causing a central vagal stimulation and subsequent
FHR deceleration. The deceleration is a mirror image of the contraction.
(u) C. Variable decelerations are from cord compression. The decelerations have a sharp,
angular, decline in FHR with duration less than 2 minutes.
(c) D. Late decelerations are from uteroplacental insufficiency. The decelerations have a smooth,
gradual symmetrical decrease in FHR beginning at or after the peak of the contraction.
6. Diagnosis/Obstetrics/Gynecology
A 16 year-old G0P0 patient presents complaining of lower pelvic pain that alternates from right
to left side of her pelvis. She states that it is related to her cycle and occurs most commonly
midcycle. She denies sexual activity. She reports that she has taken ibuprofen at the time of the
discomfort with some relief. Her pelvic examination is unremarkable. Which of the following is
the most likely diagnosis?
A. Endometriosis
B. Mittelschmerz
C. Functional ovarian cyst
D. Pelvic inflammatory disease 29 CORRECT ANSWER-(u) A. With endometriosis, the
uterus is often fixed and retroflexed in the pelvis. The palpable mass is an endometrioma or
