ABFM Care of Women KSA Latest Update

ABFM Care of Women KSA Latest Update - with 60 Questions and 100% Verified Detailed Correct Answers Guaranteed A+ Approved by Professor A 14-year-old competitive gymnast presents for a well child examination. The patient's mother is concerned that her daughter has not yet started her period. Over the last year the patient has noted breast development and growth of hair in the pubic and axillary areas, and she has had a growth spurt. Which one of the following would be appropriate advice for the patient and her mother?

• The patient should have a laboratory evaluation at this visit
• The patient's pubertal development is within the normal range for girls
• Intense training is not associated with menstrual delay
• Increased skeletal growth typically follows menarche in pubertal development -

CORRECT ANSWER: ANSWER: B

Puberty is the process leading to physical and sexual maturation that involves the development of secondary sex characteristics, as well as an increase in height, changes in body composition, and psychosocial maturation. The normal age range for the onset of puberty in girls is 8-14 years. The average age at menarche is 12.5 years, and the absence of any pubertal development by 13 years of age is an indication to evaluate the patient for delayed puberty. This patient has evidence that puberty has begun, including increased skeletal growth, breast development, and the appearance of pubic and axillary hair. Menarche generally follows peak skeletal growth by about a year. Primary amenorrhea is defined as the absence of menarche by age 15, or within 3 years of thelarche.

Reassurance would be appropriate for this patient but continued observation is warranted for development of the female athlete triad. This triad is a spectrum of disorders that principally involve three components: low energy availability, menstrual dysfunction, and low bone mineral density.

A 21-year-old primigravida at 12 weeks gestation with no previous history of any drug allergies or urologic problems presented 2 days ago for her first prenatal visit. She 1 / 4

reported no urinary tract or systemic symptoms. Today you receive a report that her urine culture is growing >100,000 colonies of a gram-negative rod, with identification and sensitivities to follow. Which one of the following is true regarding this situation?

• Nulliparity is a risk factor for higher rates of asymptomatic bacteriuria in pregnancy
• This condition is associated with an increased risk of low birthweight
• Because the patient is asymptomatic, no further treatment is recommended
• Because the patient is asymptomatic, antibiotic therapy for 3 days with amoxicillin or

nitrofurantoin (Macrodantin) is recommended

E. A repeat urine culture will be needed for proof of cure - CORRECT ANSWER:

ANSWER: B

This patient meets the criteria for asymptomatic bacteriuria (ASB) of pregnancy: >100,000 colonies of a single organism on urine culture with no urinary symptoms. ASB is found in 2%-15% of all pregnancies. Due to the relatively high prevalence and potential complications associated with ASB, the U.S. Preventive Services Task Force and the Infectious Diseases Society of America (IDSA) both recommend that all pregnant women be screened with a urine culture at 12-16 weeks gestation (SOR A).Urine dipstick screening is not recommended because it lacks sensitivity and specificity for this diagnosis.

Prospective randomized, controlled trials (RCTs) have shown that antibiotic treatment reduces the incidence of pyelonephritis, recurrence of ASB, and development of symptomatic urinary tract infections (UTIs). Antibiotic treatment is also associated with lower rates of preterm labor and very-low-birthweight infants. Risk factors for ASB in pregnancy include low socioeconomic status, higher parity, diabetes mellitus, a history of recurrent UTIs, and any anatomic abnormalities of the urinary tract.

In evaluating the best available evidence for which antibiotic agent is most effective with respect to cure rates, recurrence of infection, and prevention of adverse pregnancy outcomes, a Cochrane review of five RCTs of two antibiotic regimens was unable to draw any definitive conclusions regarding the safety and effectiveness of various treatment options. Nitrofurantoin appears to be the antibiotic choice for ASB during pregnancy, but consideration of cost, local availability, and side effects should help guide selection of the most appropriate antibiotic for each patient. Local resistance patterns of specific pathogens should also be considered, and the antibiotic choice should be based on antimicrobial resistance testing.

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A 22-year-old female comes to your office following an unprotected sexual encounter 2 nights ago. She does not wish to become pregnant. Safe and effective options for emergency contraception include all of the following EXCEPT

• levonorgestrel (Plan B One-Step)
• ulipristal (Ella)
• combined oral contraceptive pills (Yuzpe method)
• medroxyprogesterone injection (Depo-Provera)
• the copper IUD (Paragard) - CORRECT ANSWER: ANSWER: D

Emergency contraception is used to prevent pregnancy after an unprotected or inadequately protected act of sexual intercourse. Oral mifepristone, ulipristal, levonorgestrel-releasing emergency contraception, ethinyl estradiol/levonorgestrel, and both the copper and levonorgestrel IUDs are safe and effective for emergency contraception. Medroxyprogesterone injection has not been shown to be effective in the management of emergency contraception.

The most commonly used oral emergency contraceptive regimen is the progestin-only pill, containing levonorgestrel, which is available over the counter with no age restriction. Ulipristal is a selective progesterone receptor modulator that is approved by the FDA for emergency contraception for up to 120 hours after coitus and requires a prescription. It is slightly more effective than levonorgestrel for preventing unintended pregnancies if prescribed within 72 hours (SOR A). Both levonorgestrel and, to a lesser degree, ulipristal are less effective in women with a higher BMI.

The Yuzpe method may also be used, consisting of a combined oral contraceptive containing 100 µg ethinyl estradiol and 0.5 mg levonorgestrel (equivalent to 1 mg norgestrel) given as two doses 12 hours apart within 72 hours of intercourse. This can be advantageous for patients who already have pills at home. The number needed to treat to prevent one pregnancy is 17. Oral mifepristone (25-50 mg) is also a more effective method of emergency contraception than other oral forms.

The copper IUD is the most effective method used for emergency contraception (0.09% failure rate) and it should be considered in women who are not at high risk for sexually transmitted infections (SOR A). An added advantage is that it can be placed within 7 days of sexual intercourse (SOR A). It also provides continued contra

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A 22-year-old female presents with lower abdominal pain and vaginal discharge. She has been sexually active with one male partner for the past 2 months and reports a lifetime total of three partners. She has a levonorgestrel IUD (Mirena) that was placed 2 years ago, and she has no prior history of sexually transmitted infections. She is afebrile, and a pelvic examination demonstrates moderate cervical motion tenderness but no adnexal masses. Which one of the following is true regarding the diagnosis and treatment of this patient?

• Transvaginal ultrasonography should be ordered before treatment
• She should be treated presumptively for pelvic inflammatory disease (PID) without

waiting for the results of testing

• Antibiotic regimens that include a fluoroquinolone are recommended for empiric

treatment

• The IUD should be removed as soon as the diagnosis of PID is made - CORRECT

ANSWER: ANSWER: B

Since 2015, the reported incidence of pelvic infections due to Chlamydia increased by 19% and those due to gonorrhea increased by 53%. The index of suspicion should therefore always be high in sexually active patients with vaginal or pelvic symptoms.This patient is presumed to have pelvic inflammatory disease (PID) based on the history and examination. PID is a clinical diagnosis in women with a supporting history and an examination that demonstrates pelvic pain and either cervical motion tenderness or uterine/adnexal tenderness, as well as the absence of other apparent causes. Uterine or adnexal tenderness, vaginal discharge, fever >38.3°C (100.9°F), and an elevated erythrocyte sedimentation rate and C-reactive protein level also add support for the diagnosis. Ultrasonography is not needed for this patient unless she develops severe symptoms or fails to improve after 72 hours of treatment.

Starting empiric antibiotic treatment at the time of presentation is critical to preventing problems such as infertility, chronic pelvic pain, an intra-abdominal abscess, or an ectopic pregnancy. PID can generally be treated in the outpatient setting in women with mild to moderate symptoms (SOR B). Due to increasing macrolide resistance, doxycycline is now recommended for treatment of all chlamydial infections. Similarly, azithromycin is no longer recommended for gonococcal infections, due to a sevenfold increase in resistance. A single intramuscular dose of ceftriaxone for gonococcal infection, along with 14 days of oral doxycycline to treat chlamydial infection is considered the best option for empiric therapy (SOR A). If there is a history of recent uterine instrumentation or either bacterial vaginosis or Trichomonas is found on pelvic examination samples, metronidazole is recommended for 14 days. The emergence of res

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