EOR EXAM WOMENS HEALTH ACTUAL

EOR EXAM WOMEN'S HEALTH (ACTUAL

QUESTIONS AND VERIFIED ELABORATED ANSWERS I

ALREADY GRADED A+

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?

• Ovarian cancer
• Endometriosis
• Functional ovarian cyst
• Pelvic inflammatory disease - ----Answers-----(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. 1 / 4

(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.

What is the recommended method for screening pregnant women for gestational diabetes?

• Fasting blood sugar and 2 hour post prandial
• 50 gram glucose load followed by a blood sugar in 1 hour
• 75 gram glucose load followed by a blood sugar in 2 hours
• 100 gram glucose load followed by a blood sugar at 1 hour, 2

hours, and 3 hours - ----Answers-----(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.

What is the treatment of magnesium sulfate toxicity?

• Nifedipine
• Terbutaline
• Potassium carbonate 2 / 4

• Calcium gluconate - ----Answers-----(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.

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?

• Total abdominal hysterectomy
• Observation and endometrial biopsy in 3 months
• Endometrial curettage followed by progesterone daily
• Oral progesterone days 16-25 of the month for 6 months and

repeat biopsy - ----Answers-----(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. 3 / 4

(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

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?

• Fetal hypoxia
• Head compression
• Cord compression
• Uteroplacental insufficiency - ----Answers-----(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.

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