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Category: Obstetrics & Gynecology--->Benign and Malignant Disorders of the Breast and Pelvis
Page: 12

Question 56#Print Question

A 20-year-old G2P0020 with an LMP 5 days ago presents to the emergency department with a chief complaint of a 24-hour history of increasing pelvic pain. This morning she experienced chills and fever, although she did not take her temperature. She reports no changes in her bladder or bowel habits. She has had nausea or vomiting, and has not been able to tolerate liquids. She reports no medical problems, and her only surgery was a laparoscopy performed last year for an ectopic pregnancy. She reports regular menses without dysmenorrhea. She is currently sexually active with a new sexual partner, and had intercourse with him just prior to her last menstrual period. She reports no history of abnormal Pap smears or sexually transmitted diseases. Urine pregnancy test is negative. Urinalysis is normal. WBC is 18,000. Temperature is 38.8°C (102°F). On physical examination, her abdomen is diffusely tender in the lower quadrants with rebound and voluntary guarding. Bowel sounds are present but diminished.

Which of the following is the most appropriate initial antibiotic treatment regimen for this patient?

a. Doxycycline 100 mg PO twice daily for 14 days
b. Clindamycin 450 mg IV every 8 hours plus gentamicin 1 mg/kg load followed by 1 mg/kg every 12 hours
c. Cefoxitin 2 g IV every 6 hours with doxycycline 100 mg IV twice daily
d. Ceftriaxone 250 mg IM plus doxycycline 100 mg PO twice daily for 14 days
e. Ofloxacin 400 mg PO twice daily for 14 days plus Flagyl 500 mg PO twice daily for 14 days


Question 57#Print Question

A 43-year-old G2P2 comes to your office reporting intermittent right nipple discharge that is bloody. She says the discharge is spontaneous and not associated with any nipple pruritus, burning, or discomfort. On physical examination, you do not detect any dominant breast masses, skin changes, or axillary lymphadenopathy.

Which of the following conditions is the most likely cause of this patient’s problem?

a. Breast cancer
b. Duct ectasia
c. Intraductal papilloma
d. Fibrocystic breast disease
e. Pituitary adenoma


Question 58#Print Question

A 20-year-old G0, LMP 1 week ago, presents to your clinic reporting a mass in her left breast that she discovered during routine breast self-examination in the shower. When you perform a breast examination on her, you palpate a 2-cm firm, nontender mass in the upper inner quadrant of the left breast that is smooth, well-circumscribed, and mobile. You do not detect any skin changes, nipple discharge, or axillary lymphadenopathy.

Which of the following is the most likely diagnosis?

a. Fibrocystic breast change
b. Fibroadenoma
c. Breast carcinoma
d. Fat necrosis
e. Cystosarcoma phyllodes


Question 59#Print Question

A 55-year-old G3P3 with a history of fibroids presents to you complaining of irregular vaginal bleeding. Until last month, she had not had a period in over 9 months. She thought she was in menopause, but because she started bleeding again last month she is not sure. Over the past month she has had irregular, spotty vaginal bleeding. The last time she bled was 1 week ago. She also complains of frequent hot flushes and emotional lability. She does not have any medical problems and is not taking any medications. She is a nonsmoker and does not consume alcohol or drugs. Her gynecologic history is significant for cryotherapy of the cervix 10 years ago for mild dysplasia. She has had three cesarean deliveries and a tubal ligation. On physical examination, her uterus is 12 weeks in size, mobile, nontender, and irregularly shaped. Her ovaries are not palpable. A urine pregnancy test is negative.

Which of the following is the most reasonable next step in the evaluation of this patient?

a. Schedule her for a hysterectomy
b. Insert a progesterone-containing intrauterine device (IUD)
c. Arrange for outpatient endometrial ablation
d. Perform an office endometrial biopsy
e. Arrange for outpatient conization of the cervix


Question 60#Print Question

A 57-year-old menopausal patient presents to your office for evaluation of postmenopausal bleeding. She is morbidly obese and has chronic hypertension and adult onset diabetes. An office endometrial biopsy shows complex endometrial hyperplasia with atypia, and a pelvic ultrasound demonstrates multiple, large uterine fibroids.

Which of the following is the best next step in management for this patient?

a. Myomectomy
b. Total abdominal hysterectomy
c. Hysteroscopy with dilation and curettage
d. Uterine artery embolization
e. Oral progesterone




Category: Obstetrics & Gynecology--->Benign and Malignant Disorders of the Breast and Pelvis
Page: 12 of 12