Answer 20

20.  Choice B is the correct answer.  As a rule of thumb, gynecologic problems are typically better imaged with ultrasound than CT scanning.  Her pregnancy test is negative so a quantitive HCG would be low yield.  Endometrial biopsy would have a low yield in her age group and would not have pathology that would cause an adnexal mass.

Question 20

20.  Your patient is a 20 year old female that presents with left lower pelvic pain.  On physical exam there is no vaginal discharge but there is a palpable left adenexa mass.  She has a negative pregnancy test.  Which of the following is the best test to order?

A.  CT scan of Abdomen and Pelvis with 3 dose oral and IV contrast
B.  Pelvic ultrasound
C.  Quantitative HCG
D.  Endometrial biopsy

Answer 19

19.  Choice D is the correct answer.  Patients with thyroid disease can have some voice change but it is typically hoarse because of the recurrent laryngeal nerve being irritated that runs by the thyroid gland on the way to the larynx.  HCG and progesterone would be elevated and if elevated would not cause these physical findings.

Question 19

19.  A 54 year old female presents with increased facial hair, and a deep voice.  She is concerned because these are new findings for her.  Which of the following lab values would likely be elevated?

A.  Free T4
B.  HCG
C.  Progesterone
D.  Testosterone

Answer 18

18.  Choice C is the correct answer.  When there is lesions such as this, reexamining the patient after a couple cycles to see if it resolves is appropriate.  A return 2 week visit is not appropriate.  Exploratory laparoscopy would be appropriate if this does not resolve after a couple month cycles.  CT guided biopsy is not indicated with these lesions.

Question 18

18.  Your patient is a 26 year old female the present with left lower pelvic pain that has been going on for 1 week.  Physical exam reveals left adenexa tenderness.  Ultrasound reveals a complex ovarian cyst 4 x 4 cm.  Which of the following is the best management plan?

A. Follow up visit 2 weeks
B  Schedule patient for exploratory laparoscopy
C. Follow up visit in 2 months.
D. Schedule patient for a CT guided biopsy

Answer 17

17.  Choice D is the correct answer.  Choices A and B are not correct because with a beta HCG that high you should see an IUP on ultrasound.  Gestational trophoblastic disease has extremely high beta HCG and has some visible pathology on ultrasound.

Question 17

17.  Your patient is a 32 year old female that presents with beta HCG of 3143.  She is complaining of spotting and lower abdominal cramping.  She is unsure of her exact LMP. Her ultrasound reveals no definitive intrauterine pregnancy and her cervical os is closed.  Which of the following is her most likely diagnosis:

A.  Early intrauterine pregnancy not seen yet

B.  Completed miscarriage

C.  Gestational Trophoblastic Disease

D.  Ectopic pregnancy

Answer 16

16.  Choice B is the correct answer.  Women with mastitis can continue to breast feed if physically able.  Doxycycline is generally not considered appropriate for breast feeding women.  Clinically there is nothing suspicious for an abscess so incision drainage is not indicated.  

Question 16

16.  Your patient is a 28 year old female who present to your office 7 days post partum because of erythema and warmth to her left breast.  There is no nipple discharge and no induration or fluctuant areas.  Which of the following is the best management plan.

A.  Stop breast feeding
B.  Start Augmentin
C.  Start Doxycycline
D.  Recommend incision and drainage of the breast