Women's Health EOR Exam 2023/ 75
Questions and Answers / Graded A+
A 15-year-old sexually active female presents with non-pruritic mucopurulent cervicitis
and post coital bleeding. She was given medication for the same symptoms three weeks
ago but reports she did not take it. Which of the following is the best treatment?
A azithromycin x 1 dose
B benzathine penicillin G x 1 dose
C doxycycline x 7 days
D tetracycline x 14 days - -A
The patient has Chlamydia trachomatis, one of the the most common bacterial STI in
women. Risk factor for chlamydia include being sexually active under 20 years of age
and having multiple sex partners. Azithromycin is highly effective when given as a single
dose. Since this patient has a history of non-compliance, the one dose medication, taken
in the office, is the treatment of choice. She must also be counseled on having her sexual
partner(s) treated.
-A 55-year-old female presents complaining of vaginal bleeding. LMP was 3 years ago;
Pap smear is normal. An endometrial biopsy is performed. Which of the following
histological cells types is most likely to be found?
A adenocarcinoma
B adenosquamous
C clear cell
D secretory - -A
In the US, adenocarcinoma comprises 70-80% of endometrial carcinoma. This figure is
even higher in other countries.
, -A 28-year-old female describes a one year history of weight gain, irritability and
increased tension which occur 5 days before onset of menses. Which of the following
dietary modifications will most likely decrease her symptoms?
A decreasing snacking throughout day
B decreasing sodium intake
C limiting caffeine
D limiting complex carbohydrates - -C
The woman is suffering from premenstrual syndrome (PMS). The etiology is not known
but it is thought that estrogen and progesterone may influence serotonin centrally,
causing the symptoms of PMS. Limiting caffeine, alcohol, tobacco, and chocolate has
been found to help with some patients.
-A 32-year-old G2P1001 presents at 27 weeks gestation. Glucose challenge returns at
165 mg/dl. Results of a glucose tolerance test are:
fasting: 90 mg/dl
1-hour: 195 mg/dl
2-hour: 145 mg/dl
3-hour: 130 mg/dl
According to the White Classification, which of the following is the best diagnosis?
A no gestational diabetes
B class A-1 gestational diabetes
C class A-2 gestational diabetes
D class B gestational diabetes - -A
Gestational diabetes screening is recommended between 24-28 weeks gestation.
Initially a 50-gram non fasting glucose load is performed. If the results are over 140
mg/dL, a fasting 3-hour glucose tolerance test is done. Normal values are: fasting: <95
mg/dL; 1-hour: < 180 mg/dL; 2-hour: < 155 mg/dL; 3 hour: < 140 mg/dL. To make the
diagnosis of gestational diabetes, at least two values must be elevated. Only the 1-hour
glucose level is high in this patient.
,-A woman presents at 30 weeks gestation complaining of a slow constant trickle of fluid
from her vagina x 3 days. Physical exam shows positive pooling in the posterior fornix
and the ferning test is positive. External monitoring shows the fetal heart rate at 140
beats per minute with beat to beat variability and accelerations; biophysical profile is 10.
What is the next step in management?
A admit to hospital for bedrest and monitoring
B induction of labor
C stat Cesarean section
D send home with instructions to return when contractions begin - -A
The woman has experienced premature rupture of membranes (PROM). Because the
fetus is preterm (under 37 weeks gestation) but shows no sign of distress (fetal heart
reactivity tracing and biophysical profile are reassuring), in-hospital conservative
management is warranted. In addition to the above management, prophylactic
antibiotics and maternal corticosteroids (to accelerate fetal lung maturity) may be
administered as well.
-A 22-year-old obese female presents complaining of anovulation and hirsutism.
Testosterone levels are mildly elevated and LH/FSH ratio is 4. She does not wish to
become pregnant at this time. Which of the following is the best treatment?
A danazol
B glucocorticoids
C medroxyprogesterone acetate
D spironolactone - -C
The patient's diagnosis is polycystic ovarian syndrome (PCOS). Patients are often obese,
anovulatory and often present with hirsutism. Testosterone levels are mildly elevated
and the LH/FSH ratio is greater than 3. Medroxyprogesterone acetate given on the first
10 days of each month will promote regular shedding of the endometrium. If
contraception is desired, a low dose oral contraceptive can be used. Often, the use of
insulin-sensitizing agents (metformin) is successful in promoting ovulation.
, -A 13-year-old female presents 15 months after initial onset of menses. Her cycles have
been irregular in timing as well as severity of bleeding. At times the bleeding is so heavy
she misses school. Which of the following would be the most appropriate initial
diagnostic step?
A dilation & curettage
B endometrial biopsy
C hysteroscopy
D ultrasonography - -D
In younger patients (adolescents), a pelvic exam and ultrasonography should be
performed to rule out pregnancy or pathology.
-A 67-year-old nulliparous white female with a history of diabetes presents with
postmenopausal bleeding. Further gynecologic history reveals menarche at age 10 and
menopause at age 59. For the most likely diagnosis, which of the following is the most
common type?
A adenocarcinoma
B clear cell carcinoma
C mucinous carcinoma
D serous carcinoma - -A
Adenocarcinoma is the most common type of endometrial carcinoma. In the US, 80% of
endometrial carcinomas are of this type. Longer exposure to estrogen (i.e., early
menarche, late menopause, and diabetes) is a risk factor for carcinoma.
-A 34-year-old African-American female G2P2002 presents with heavy menstrual
bleeding. CBC shows a microcytic, hypochromic anemia. Physical exam reveals several
smooth, spherical uterine masses. She and her husband would like have another child.
Which of the following would be the best treatment option?
A embolization
B endometrial ablation
C hysterectomy
Questions and Answers / Graded A+
A 15-year-old sexually active female presents with non-pruritic mucopurulent cervicitis
and post coital bleeding. She was given medication for the same symptoms three weeks
ago but reports she did not take it. Which of the following is the best treatment?
A azithromycin x 1 dose
B benzathine penicillin G x 1 dose
C doxycycline x 7 days
D tetracycline x 14 days - -A
The patient has Chlamydia trachomatis, one of the the most common bacterial STI in
women. Risk factor for chlamydia include being sexually active under 20 years of age
and having multiple sex partners. Azithromycin is highly effective when given as a single
dose. Since this patient has a history of non-compliance, the one dose medication, taken
in the office, is the treatment of choice. She must also be counseled on having her sexual
partner(s) treated.
-A 55-year-old female presents complaining of vaginal bleeding. LMP was 3 years ago;
Pap smear is normal. An endometrial biopsy is performed. Which of the following
histological cells types is most likely to be found?
A adenocarcinoma
B adenosquamous
C clear cell
D secretory - -A
In the US, adenocarcinoma comprises 70-80% of endometrial carcinoma. This figure is
even higher in other countries.
, -A 28-year-old female describes a one year history of weight gain, irritability and
increased tension which occur 5 days before onset of menses. Which of the following
dietary modifications will most likely decrease her symptoms?
A decreasing snacking throughout day
B decreasing sodium intake
C limiting caffeine
D limiting complex carbohydrates - -C
The woman is suffering from premenstrual syndrome (PMS). The etiology is not known
but it is thought that estrogen and progesterone may influence serotonin centrally,
causing the symptoms of PMS. Limiting caffeine, alcohol, tobacco, and chocolate has
been found to help with some patients.
-A 32-year-old G2P1001 presents at 27 weeks gestation. Glucose challenge returns at
165 mg/dl. Results of a glucose tolerance test are:
fasting: 90 mg/dl
1-hour: 195 mg/dl
2-hour: 145 mg/dl
3-hour: 130 mg/dl
According to the White Classification, which of the following is the best diagnosis?
A no gestational diabetes
B class A-1 gestational diabetes
C class A-2 gestational diabetes
D class B gestational diabetes - -A
Gestational diabetes screening is recommended between 24-28 weeks gestation.
Initially a 50-gram non fasting glucose load is performed. If the results are over 140
mg/dL, a fasting 3-hour glucose tolerance test is done. Normal values are: fasting: <95
mg/dL; 1-hour: < 180 mg/dL; 2-hour: < 155 mg/dL; 3 hour: < 140 mg/dL. To make the
diagnosis of gestational diabetes, at least two values must be elevated. Only the 1-hour
glucose level is high in this patient.
,-A woman presents at 30 weeks gestation complaining of a slow constant trickle of fluid
from her vagina x 3 days. Physical exam shows positive pooling in the posterior fornix
and the ferning test is positive. External monitoring shows the fetal heart rate at 140
beats per minute with beat to beat variability and accelerations; biophysical profile is 10.
What is the next step in management?
A admit to hospital for bedrest and monitoring
B induction of labor
C stat Cesarean section
D send home with instructions to return when contractions begin - -A
The woman has experienced premature rupture of membranes (PROM). Because the
fetus is preterm (under 37 weeks gestation) but shows no sign of distress (fetal heart
reactivity tracing and biophysical profile are reassuring), in-hospital conservative
management is warranted. In addition to the above management, prophylactic
antibiotics and maternal corticosteroids (to accelerate fetal lung maturity) may be
administered as well.
-A 22-year-old obese female presents complaining of anovulation and hirsutism.
Testosterone levels are mildly elevated and LH/FSH ratio is 4. She does not wish to
become pregnant at this time. Which of the following is the best treatment?
A danazol
B glucocorticoids
C medroxyprogesterone acetate
D spironolactone - -C
The patient's diagnosis is polycystic ovarian syndrome (PCOS). Patients are often obese,
anovulatory and often present with hirsutism. Testosterone levels are mildly elevated
and the LH/FSH ratio is greater than 3. Medroxyprogesterone acetate given on the first
10 days of each month will promote regular shedding of the endometrium. If
contraception is desired, a low dose oral contraceptive can be used. Often, the use of
insulin-sensitizing agents (metformin) is successful in promoting ovulation.
, -A 13-year-old female presents 15 months after initial onset of menses. Her cycles have
been irregular in timing as well as severity of bleeding. At times the bleeding is so heavy
she misses school. Which of the following would be the most appropriate initial
diagnostic step?
A dilation & curettage
B endometrial biopsy
C hysteroscopy
D ultrasonography - -D
In younger patients (adolescents), a pelvic exam and ultrasonography should be
performed to rule out pregnancy or pathology.
-A 67-year-old nulliparous white female with a history of diabetes presents with
postmenopausal bleeding. Further gynecologic history reveals menarche at age 10 and
menopause at age 59. For the most likely diagnosis, which of the following is the most
common type?
A adenocarcinoma
B clear cell carcinoma
C mucinous carcinoma
D serous carcinoma - -A
Adenocarcinoma is the most common type of endometrial carcinoma. In the US, 80% of
endometrial carcinomas are of this type. Longer exposure to estrogen (i.e., early
menarche, late menopause, and diabetes) is a risk factor for carcinoma.
-A 34-year-old African-American female G2P2002 presents with heavy menstrual
bleeding. CBC shows a microcytic, hypochromic anemia. Physical exam reveals several
smooth, spherical uterine masses. She and her husband would like have another child.
Which of the following would be the best treatment option?
A embolization
B endometrial ablation
C hysterectomy
