1. A 24-year-old woman presents to the gynecolo- A Exercising consistently
gy clinic for evaluation of breast tenderness and
bloating that occurs the week before menses.
She also says she is irritable, and the symptoms
together make it difficult for her to work. These
symptoms occur consistently month to month.
Which of the following changes may help with
this condition?
A Exercising consistently
B Increasing salt
C Reducing red meats
D Reducing starches
2. A 30-year-old nulliparous woman presents to D Progestin-releasing intrauterine
her gynecologist with prolonged and heavy device
menstrual bleeding for the past 6 weeks. Upon
further questioning, she states she has also had
abdominal discomfort. She is not currently tak-
ing any medications. She is sexually active with
three male partners and does not use contra-
ception. Pelvic examination is significant for a
mildly enlarged uterus (7 cm) without cervical
motion tenderness or adnexal masses. Trans-
vaginal ultrasound confirms the suspected diag-
nosis. Which of the following treatments is most
appropriate for the patient at this time?
A Azithromycin only
B Ceftriaxone and azithromycin
C Gonadotropin-releasing hormone agonist
D Progestin-releasing intrauterine device
,3. A 32-year-old woman returns to her obstetrician B Insulin
for a follow-up of her glucose tolerance testing
results and is advised her blood glucose lev-
els were elevated with each of the tests. She
has been trying to adjust her diet ever since
her first prenatal visit and is frustrated that her
glucose levels are elevated. She has obesity at
baseline and a family history of diabetes mel-
litus. Her interim history and exam are other-
wise unremarkable. Based on her test results,
you discuss that medical management is recom-
mended. Which of the following is the first-line
pharmacologic therapy recommended for this
patient?
A Glyburide
B Insulin
C Metformin
D Myoinositol
4. A 25-year-old G2P1 woman at 20 weeks gesta- C Proteinuria e300 mg in a 24-hour
tion presents for a routine visit. Her blood pres- urine collection
sure at this visit is 152/92 mm Hg. A repeat blood
pressure taken the following day is 148/92 mm
Hg. Which of the following additional findings is
required for a diagnosis of preeclampsia?
A A third single systolic blood pressure reading e
140 mm Hg
B Protein to creatinine ratio < 0.2
C Proteinuria e300 mg in a 24-hour urine collec-
, tion
D Thrombocytosis > 500,000/mcL
5. A 26-year-old G4P3 woman presents at 40 weeks B Cesarean section
gestation for induction of labor. She has a his-
tory of type 2 diabetes mellitus, and her body
mass index is 37 kg/m2. During the second
stage of labor, the fetal head delivers then re-
tracts into the perineum. Gentle downward trac-
tion applied to the fetal head, while the patient's
legs are elevated and her thighs brought to her
abdomen, results in tearing of the perineum but
is unsuccessful in delivering the infant. Maneu-
vers to deliver the posterior shoulder and plac-
ing the patient on her hands and knees are also
unsuccessful. The obstetrician places the fetal
head back into the pelvis. What is the best next
step in the management of this patient?
A Applying more downward traction with simul-
taneous fundal pressure
B Cesarean section
C Clamping and cutting the umbilical cord
D Episiotomy
6. A 67-year-old woman presents with a persistent A Colposcopic biopsy of the vulva
vulvovaginal dermatitis. Her symptoms have
persisted for 1 month. She reports frequent vul-
var itching and burning. She has a longstand-
ing history of vulvar erythema, which is usually
not bothersome when she uses a barrier cream.
She has treated the area with over-the-counter
, monistat and athlete foot medication without
relief in symptoms for the last 6 weeks. Last
week, she took fluconazole 150 mg in a sin-
gle dose and began treating the symptomatic
area with clotrimazole-betamethasone 1% top-
ical cream twice a day. On vulvar exam, she has
erythema and scaling bilaterally, which appears
to be unchanged since her last visit. The above
image details her physical exam findings. Which
of the following is the best next intervention?
A Colposcopic biopsy of the vulva
B Human papillomavirus testing
C Potassium hydroxide preparation
D Vulvar culture
7. A 19-year-old woman presents to the urgent A Avoid alcohol
care with symptoms of a urinary tract infec-
tion. A urine specimen is obtained, and micro-
scopic examination reveals the finding shown in
the image above. A pelvic examination is sub-
sequently performed and reveals an inflamed
cervix with punctuate hemorrhages and frothy
green discharge. Which of the following should
the patient be informed about regarding her
treatment?
A Avoid alcohol
B Night terrors
C Red-orange discoloration of urine
D Tendon rupture