Buku Prof Grabber Women’s Health

CASE 15.1

1. A. Study shows there is no significant difference in weight gain of women initiating oral
contraceptive pills vs placebo
2. E. all of the above
3. D. She can use OCP’s as it is hard to predict whether her headaches will be affected
4. A. if she starts taking the pill during the first 5 days of her menstrual period, no backup method
is needed
5. B. “This level of nausea and vomiting is very common, and there are several modifications and
over the counter medication that are safe”
6. E. all of the above
7. C. 1 hour glucose tolerance test
8. D. Group B streptococcus (GBS) culture for PCR

CASE 15.2

1. C. perform a digital vaginal examination

2. A. Begin an induction of labor
3. B. begin iv oxytoxin at 2 miliunits per minute
4. D. chorioamnionitis
5. C. Initiate broad spectrum antibiotics
6. C. baseline 165 beats per minute, with late decelerations
7. B. placental insufficiency
8. C. forceps or vacuum assisted vaginal delivery
9. A. endometritis

CASE 15.3

1. B. The need for cervical ripening agents for induction and helps to predict labor induction
success
2. C. She should undergo a nonstress test and ultrasound for amniotic fluid index
3. B. prolonged walking
4. A. iv oxytocin
5. B. baseline 150 beats per minute,reactive
6. A. epidural analgesia
7. B. baseline 160 beats per minutes, variable deceleration to the 90s
8. A. check the patient’s cervix
9. A. continue pushing
10. E. all of the above
11. D. respiratory distress syndrome
 12. A. Uterine atony
13. E. all of the above
14. E. all of the above
15. C. desire to be a punk rocker

QUICK QUIZZ:

1. B. D-isoimmunization (Rh Isoimunization)

CASE 15.4

1. C. a decreased risk of preterm birth

2. B. corticosteroid theraphy has been associated with and increased risk of neonatal infection
3. E. none of the above
4. C. obstetrical consult for cerclage placement

CASE 15.5

1. C. initiates GBS prophylaksis

QUICK QUIZZ

1. C. maternal history of preterm contractions with term birth

CASE 15.6

1. B. 20% to 30%
2. C. aspirin 81 mg daily
3. C. 1/150
4. F. all of the above
5. A. orders a 3 hours glucose tolerance test
6. B. set up diabetes teaching and a consult with nutricionist/dietician
7. D. repeating the ultrasound for growth in 4 weeks
8. B. obtaining a 24 hours urine for protein
9. A. gestational hypertensions
10. C. admit to labor and delivery for blood work and monitoring, with plans to move toward
delivery
11. D. all of the above
12. C. for 24 hours after delivery

CASE 15.7

1. E. either A or D is correct
2. C. systemic arterial pressure increase during first triemester, reaches peak iin mid pregnancy,
and remains at that level until labour
CASE 15.8

1. B. cyclic medroxyprogesterone 10 mg a day

2. C. depression
3. D. parathyroid disease

CASE 15.9

1. D. history of chlamydia infection

2. D. B and C
3. C. CA-125
4. B. Non steroid anti inflammatory drugs (NSAIDs)
5. E. all of the above
6. A. <1%

CASE 15.10

1. C. urine HCG
2. D. ectopic pregnancy
3. E. all of the above
4. B. she has previously been exposed to the D antigen and has developed antibodies
5. A. Threatened abortion
6. D. embryonic chromosomal abnormality
7. E. counseling and reassurance

CASE 15.11

1. C. Fetal ultrasound for growth and amniotic fluid index

2. B. maternal smoking
3. C. expectant management
4. B. Augmentation of labor
5. C. fundal pressure
6. B. adequate iron for premature newborns
7. A. stress incontinecia
8. B. obtain urinalissis followed by urin culture if abnormal
9. A. pelvic muscle exercise

CASE 15.12

1. B. she needs further diagnostic testing including colposcopy and possible biopsy
2. E. either A or B would be acceptable choices
3. D. LEEP or LASER ablation
4. B. about one-third of CIN III lesion spontaneously regress
 5. C. cervical ectopic pregnancy
6. B. She should return for pap smear plus HPV testing in 12 and 24 months
7. A. Repeat pap smear and co testing in another 12 months
8. D. Both A and B

CASE 15.13

1. E. none of the above diagnosis should be excluded based on the information available
2. C. Treat as an outpatient with antibiotics and schedule follow up for 36 to 48h
3. C. ceftriaxone 250 mg IM once plus doxycycline 100 mg PO BID for 14 days
4. E. all of the above
5. A. anovulation
6. D. colposcopy with cervical and endometrial biopsies
7. B. 66% increase in 48h
8. C. consultation with someone able to do a salpingectomy if necessary
9. C. she should be educated about ectopic pregnancy and miscarriage

CASE 15.14

1. A. Recommended against estrogen testing

2. B. There is no definitive test of menopause
3. D. decrease in stroke risk
4. D. Previous thromboembolic event
5. D. all of the above
6. C. Patient’s history and physical examination
7. E. all of the above

CASE 15.15

1. C. polycystic ovary disease

2. E. all of the above
3. A. smoking
4. E. arranging for definitive treatment eg hysterectomy)

CASE 15.16

1. C. Anovulation
2. A. prostaglandin release
3. B. Initiate combined hormonal contraception
4. E. all of the above
5. C. premenstrual syndrome
6. B. elevated LH to FSH (LH:FSH) ratio
7. D. Thiazid diuretics

CASE 15.17
 1. D. A and B
2. C. endometriosis
3. E. A or C
4. B. “You just cannot know for sure until you have tried to conceive”

QUICK QUIZZ:

1. A. Chlamydia and gonorrhea

2. C. pessary trial
3. C. expectant management with repeat ultrasound in 2 months
4. E. pelvic ultrasound
5. A. ovarian cancer
6. E. A and B

CASE 15.18

1. D. number of sexual partners the victim has had in her lifetime

2. E. all of the above
3. B “An examination is importab=nt for your health and in the event that this become criminal
case. The yield of the examination declines with time. Even if you don’t feel like prosecuting
now, you may decide to do so in the future, and the best evidence is gathered early”
4. B. HSV antibody testing

CASE 15.19

1. D. mildly elevate androgen

2. B. Trichomonas vaginalis infection
3. A. Flagyl (metronidazole) 2 gram orally in a single dose
4. E. all of the above
5. B. Gonnorhea and chlamydia testing

QUICK QUIZZ:

1. C. Lichen sclerosus
2. B. “given you use of warfarin, you should not use oral fluconazole”

CASE 15.20

1. E. conception while on oral contraceptives

2. D. Lupus anticoagulant and anticardiolipin anibody
3. C. 60% to 70 % chance of successful in next pregnancy

QUICK QUIZZ:

1. E. Your BMI is normal, your goal is to gain 30 lb

2. A. A progestine challenge