31-Final test 5th year Obstetrics and gynecology(1).pdf

31-Final test. 5th year. Obstetrics and gynecology Инструкция к тесту 31-Final test. 5th year. Obstetrics and gynecology 1 1 из 662 Which of the following is defined as the sum of stillbirths and neonatal deaths per 1000 total births?  Fetal death rate ...

31-Final test. 5th year. Obstetrics and gynecology Инструкция к тесту 31-Final test. 5th year. Obstetrics and gynecology 1 1 из 662 Which of the following is defined as the sum of stillbirths and neonatal deaths per 1000 total births?  Fetal death rate  Infant mortality rate  Perinatal mortality rate  Neonatal mortality rate 2 2 из 662 A patient presents with severe preeclampsia at 37 weeks’ gestation. Labor is induced and she spontaneously delivers a 3260-g neonate. In the delivery room she complains of a severe headache and suddenly collapses. She is unable to be resuscitated. How would the maternal death in such case be classified?  Perinatal death  Nonmaternal death  Direct (pregnancy-related) maternal death  Indirect maternal death 3 3 из 662 The perinatal period starts after delivery at 20 weeks’ gestation or older. When does it end?  7 days after birth  28 days after birth  6 weeks after birth  1 year after birth 4 4 из 662 Which of the following is an example of an indirect maternal death?  Septic shock following an abortion  Hemorrhage following uterine atony  Aspiration following an eclamptic seizure  Aortic rupture at 36 weeks’ gestation in a patient with Marfan syndrome 5 5 из 662 A 26-year-old woman is brought to the emergency department with abdominal pain and dizziness. On exam she is found to be pale and tachycardic. Her urine pregnancy test is positive and her hemoglobin is 5 g/dL. Bedside ultrasound reveals a left adnexal mass and free fluid. She is taken to the operating room for a ruptured ectopic pregnancy. While in the operating room she arrests and is unable to be resuscitated. How would her death be classified?  Perinatal death  Nonmaternal death  Indirect maternal death  Pregnancy-related death 6 6 из 662 A 30-year-old multigravida presents with ruptured membranes at term but without labor. Following induction with misoprostol, her labor progresses rapidly, and she spontaneously delivers a liveborn 3300-g neonate. Immediately after delivery, she complains of dyspnea. She becomes apneic and pulseless and is unable to be resuscitated. Photomicrographs from her autopsy reveal fetal squames (arrows) within the pulmonary vasculature. How would her death be classified?  Perinatal death  Nonmaternal death  Direct (pregnancy-related) maternal death  Indirect maternal death 7 7 из 662 A patient presents at 22 weeks’ gestation with spontaneous rupture of membranes and delivers a 489-g male infant who dies at 4 hours of life. Her last menstrual period and early sonographic evaluation confirm her gestational dating. All except which of the following definitions accurately apply to this delivery?  Abortus  Preterm neonate  Early neonatal death  Extremely low birthweight 8 8 из 662 Which of the following is defined as the number of maternal deaths that result from the reproductive process per 100,000 live births?  Perinatal mortality rate  Maternal mortality ratio  Direct (pregnancy-related) maternal death rate  Indirect maternal death rate  9 9 из 662 Most infant deaths occur in which of the following groups?  Low-birthweight infants  Infants of diabetic mothers  Infants with congenital anomalies  Infants with chromosome abnormalities 10 10 из 662 Which of the following is an example of a “near miss” case?  A postpartum patient who falls in the shower without injury  High spinal anesthesia resulting in intubation, admission to the intensive-care-unit, and a ventilator-associated pneumonia  Failure to give Rh immunoglobulin to a Rh-negative postpartum patient who ultimately has no change in antibody screen  A delay in sending the human immunodeficiency virus (HIV) screening test of a laboring patient who ultimately has a negative test result 11 11 из 662 Which of the following best describes the primary role of the Ob/Gyn hospitalist?  Assist other obstetricians in procedures  Be a backup for physicians taking calls from home  Care for hospitalized patients who have no primary doctor  Care for hospitalized obstetrical patients and help manage their emergencies 12 12 из 662 A 36-year-old G1 delivers an infant with a complex congenital heart defect. The death of the newborn at 5 days of life due to the congenital heart defect would be counted in which of the following rates?  Infant mortality rate  Perinatal mortality rate  Early neonatal death rate  All of the listed options 13 13 из 662 Which of the following is not a component of the perineal body?  Iliococcygeus muscle  Pubococcygeus muscle  Bulbospongiosus muscle  Superficial transverse perineal muscle 14 14 из 662 Which of the following muscles compose the levator ani muscle?  Puborectalis  Iliococcygeus  Pubococcygeus  All of the listed options 15 15 из 662 During a postpartum hysterectomy for intractable bleeding, a clamp is placed on the uterine artery near its insertion to the uterus. What is the relationship between the ureter and uterine artery at this point?  The ureter is 2 cm medial to the uterine artery at this location.  The ureter is 2 cm medial to the uterine artery and crosses under it.  The ureter is 2 cm lateral to the cervix and crosses over the uterine artery.  The ureter is 2 cm lateral to the cervix and crosses under the uterine artery. 16 16 из 662 The vascular supply of the uterus comes from which of the follow arteries?  Uterine artery  Internal pudendal artery  Middle sacral artery  Middle rectal artery 17 17 из 662 All the following arteries comes off the anterior division of the internal iliac artery, EXCEPT which?  Uterine artery  Obturator artery  Superior vesical artery  Superior gluteal artery 18 18 из 662 Which of the following is the correct anatomic progression of the fallopian tube from proximal to distal?  Isthmus, ampulla, infundibulum  Ampulla, infundibulum, isthmus  Infundibulum, ampulla, isthmus  Ampulla, isthmus, infundibulum 19 19 из 662 A cross-section of the extrauterine fallopian tube contains which of the following?  Myosalpinx  Mesosalpinx  Endosalpinx  All of the listed options 20 20 из 662 Which bones make up the pelvis?  Sacrum  Coccyx  Innominate  All of the listed options 21 21 из 662 Which plane is the plane of least pelvic dimensions?  The plane of the midpelvis  The plane of the pelvic inlet  The plane of the pelvic outlet  None of the listed options 22 22 из 662 The pelvic inlet is bounded by which of the following?  Posteriorly by the promontory  Laterally by the linea terminalis  Anteriorly by horizontal pubic rami  All of the listed options 23 23 из 662 Which of the following does NOT characterize the obstetric conjugate?  It cannot be directly measured.  It normally measures 11 cm or more.  It is the least clinically important diameter of the pelvic inlet.  It is the shortest distance from the sacral promontory and the symphysis pubis. 24 24 из 662 Which of the following is accurate regarding the midpelvis?  Contains the smallest pelvic diameter  Serves as the point to measure station  Is marked by the interspinous diameter  All of the listed options 25 25 из 662 A 22-year-old primigravida presents in active labor. She is 5 cm dilated and the fetal head is noted to be at -2 station. Which of the following is true?  The fetal head is engaged.  The biparietal diameter has reached the level of the midpelvis.  The biparietal diameter has reached the level of the pelvic inlet.  None of the listed options 26 26 из 662 A 22-year-old primigravida presents in active labor. She is 8 cm dilated and the fetal head is noted to be at 0 station. Which of the following is true?  The fetus is too big to fit through her pelvis.  Internal rotation of the fetal head to transverse should be occurring.  The top of the fetal head is noted at the level of the midpelvic interspinous diameter.  None of the listed options. 27 27 из 662 A 22-year-old primigravida presents in active labor. She is completely dilated and the fetal head is noted to be at +5 station. Which of the following is true?  The caput may be visualized at the level of the introitus.  The caput is now 5 cm distal to the midpelvic interspinous diameter.  The fetal head has most likely internally rotated into an occiput anterior presentation.  All of the listed options. 28 28 из 662 Which of the following accurately characterize Braxton Hicks contractions?  Are usually non-rhythmic  Have an intensity of 5–25 mmHg  Can be detected by bimanual examination  All the listed options 29 29 из 662 A 23-year-old presents for her initial prenatal care visit. She undergoes an ultrasound and the findings are shown below. What is the adnexal mass seen above?  Teratoma  Hydrosalpinx  Corpus luteum  Hemorrhagic cyst 30 30 из 662 A 32-year-old multigravida presents to triage complaining of increasing vaginal discharge for the last 24 hours. You perform a microscopic examination of the discharge and see the image pictured above under the slide. What it could be?  Bacterial vaginosis  Cervical shortening  Rupture of membranes  Normal physiologic discharge 31 31 из 662 The fetus gains the most weight proportionately during which time period in pregnancy?  10–20 weeks’ gestation  20–30 weeks’ gestation  30–40 weeks’ gestation  40–42 weeks’ gestation 32 32 из 662 Which of the following statements is true regarding glucose and insulin levels in pregnant and nonpregnant women?  Insulin levels decrease after meals in pregnancy.  Glucose levels decrease after meals in nonpregnant women.  Glucose concentrations increase after meals in pregnancy.  Insulin levels increase prior to meals in nonpregnant women. 33 33 из 662 Which of the following is a safeguard provided by pregnancy-induced hypervolemia?  Provides abundant nutrients and elements to support the rapidly growing fetus and placenta.  Meets the metabolic demands of the enlarged uterus and its greatly hypertrophied vascular system.  Protects the mother, and in turn the fetus, from deleterious effects of impaired venous return in the supine and erect positions.  All the listed options 34 34 из 662 When are maternal iron stores used in pregnancy?  First trimester  Second trimester  Third trimester  Latter half of pregnancy 35 35 из 662 Levels of which of the following coagulation factors are unchanged in pregnancy?  Protein C  Fibrinogen  Factor VII  Antithrombin III 36 36 из 662 What is the relationship between stroke volume and position in the pregnant woman when compared to the nonpregnant woman?  Compared to the nonpregnant state, stroke volume is increased when in the supine position at all gestational ages.  Compared to the nonpregnant state, stroke volume is increased when in the lateral position at all gestational ages.  At 26–30 weeks’ gestation, stroke volume in the supine position is equivalent to that of the nonpregnant woman in the lateral position.  All of the listed options 37 37 из 662 Which of the following statements regarding hemodynamic changes from the third trimester to the postpartum period is not accurate?  Heart rate decreases in the postpartum period.  Serum colloid oncotic pressure is lower during pregnancy.  Pulmonary capillary wedge pressure is higher during pregnancy.  Systemic vascular resistance decreases in the postpartum period. 38 38 из 662 Which of the following statements are true?  Angiotensinogen is produced in the maternal kidney.  Vascular refractoriness to angiotensin II may be estrogen related.  Refractoriness to angiotensin II is characteristic of mothers who develop preeclampsia.  None of the listed options 39 39 из 662 Which statement accurately describes the changes in respiratory physiology during pregnancy?  Respiratory rate increases.  Tidal volume remains the same.  Inspiratory capacity rises by 5–10%.  Functional residual capacity decreases by approximately 50%. 40 40 из 662 A 32-year-old multigravida presents to you at 8 weeks’ gestation. Her baseline serum creatinine is 1.0 mg/dL, and her blood pressure is 145/105 mmHg. Which test might you consider next?  Kidney ultrasound  50-gram glucose screen  24-hour total urine protein  Serum anti-double-stranded DNA 41 41 из 662 Which of the following statements is true regarding ureteral dilation in pregnancy?  Left-sided dilation is seen more often.  β-hCG is responsible for the ureteral dilation seen in pregnancy.  Unequal dilation results from right ureteral compression by the dextrorotated uterus.  None of the listed options 42 42 из 662 Concerning bladder function in pregnancy, which of the following is true?  Urethral length increases to compensate for decreased bladder capacity.  In primigravidas bladder pressure increases from 8 cm H2O to 20 cm H2O at term.  Maximal urethral pressure increases from 70 cm H2O to 93 cm H2O to maintain continence.  All of the listed options 43 43 из 662 Concerning the gastrointestinal tract during pregnancy, which of the following is correct?  Gastric emptying time increases during pregnancy.  Intraesophageal pressures are lower during pregnancy.  Lower esophageal sphincter tone is increased during pregnancy.  None of the listed options 44 44 из 662 During normal pregnancy, which of the following is true regarding gallbladder physiology and function?  Gallbladder contractility is increased  Decreased cholesterol saturation of bile  Impaired emptying and increased stasis  None of the listed options 45 45 из 662 Which of the following is true regarding the pituitary gland?  Oxytocin is secreted from the anterior pituitary gland.  Prolactin is secreted from the posterior pituitary gland.  Antidiuretic hormone is secreted from the anterior pituitary gland.  Oxytocin and antidiuretic hormone are secreted from the posterior pituitary gland. 46 46 из 662 Regarding the thyroid gland during pregnancy, which of the following is true?  The highest concentration of maternal free T4 is early in gestation.  Fetal concentration of thyroxine-binding globulin increases throughout pregnancy.  Maternal concentration of thyroid-stimulating hormone reaches a plateau by the mid-second trimester.  All the listed options 47 47 из 662 Which of the following is inaccurate concerning fetal and maternal skeletal metabolism?  All markers of bone turnover decrease during pregnancy.  Fetal skeletal mineralization requires approximately 30 grams of calcium.  Prevention of possible pregnancy-related maternal osteoporosis is difficult.  Greater maternal calcium absorption occurs and is mediated by elevated maternal 1,25-dihydroxyvitamin D concentrations. 48 48 из 662 Concerning the musculoskeletal system, which of the following is not true?  Most relaxation takes place during the second half of pregnancy.  Symphyseal separation greater than 1 cm may cause significant pain.  Progressive lordosis is a characteristic feature of normal pregnancy.  Sacroiliac, sacrococcygeal, and pubic joints have increased mobility during pregnancy. 49 49 из 662 Pregnancy-related memory decline is limited to which period in pregnancy?  First trimester  Second trimester  Third trimester  Postpartum 50 50 из 662 Which of the following is true regarding difficulties in sleep patterns in pregnancy?  Include difficulty awakening  Last up to 8 weeks postpartum  Begin as early as 6 weeks’ gestation  Are more common in multiparous women 51 51 из 662 What is the increased risk of mortality for women who do not receive prenatal care as compared to women who do?  Risk unchanged  Twofold risk  Fourfold risk  Fivefold risk 52 52 из 662 Which of the following is more common when women do not obtain prenatal care?  Stillbirth  Preterm birth  Neonatal death  All of the listed options 53 53 из 662 For a routine low-risk woman with no complaints, which laboratory test should not be offered as part of her first prenatal visit?  Hepatitis B testing  Chlamydia screening  Blood type and screen  Thyroid function testing 54 54 из 662 A 29-year-old G2P1 at 8 weeks’ gestation presents for her first prenatal care visit. She is 1.62 m tall and weighs 71 kg, making her body mass index 27.1 kg/m2. What amount of total weight gain should you recommend for her pregnancy?  0–4 kg  4–7 kg  7–11 kg  11–15 kg 55 55 из 662 For an obese woman, the risk of preeclampsia and cesarean delivery is lowest with what amount of gestational weight gain?  0–6 kg  5–9 kg  7–11 kg  11–15 kg 56 56 из 662 There is substantial evidence that severe undernutrition during pregnancy can result in a higher rate of which of the following?  Preterm birth  Perinatal mortality  Small-for-gestational-age infants  All of the listed options 57 57 из 662 At least how much elemental iron should be given as a supplement daily to a pregnant woman?  15 mg  27 mg  42 mg  60 mg 58 58 из 662 Maternal deficiency of vitamin D has been associated with which of the following complications in the offspring?  Anemia  Seizures  Jaundice  Congenital rickets 59 59 из 662 Which of the following statements regarding vaccinations in pregnancy is true?  All pregnant women should be offered influenza vaccine during the appropriate season.  The Tdap vaccine should be given to all pregnant women between 16 and 20 weeks’ gestation.  Varicella vaccine should be offered to all women who are exposed to chicken pox during pregnancy.  The measles-mumps-rubella vaccine should be given to all pregnant women who are not immune. 60 60 из 662 Sexual intercourse during pregnancy is associated with which of the following pregnancy complications?  Miscarriage  Preterm birth  Spontaneous rupture of membranes  None of the listed options 61 61 из 662 Fundal height measurements in centimeters correlate closely with gestational age between 20 and 34 weeks. Which of the following can introduce error into this measurement?  Obesity  Full bladder  Uterine leiomyomata  All of the listed options 62 62 из 662 Preconceptional folic acid supplementation can reduce the recurrence risk of having a child with a neural-tube defect by what percentage?  11%  26%  72%  90% 63 63 из 662 Preconceptional counseling has been shown to do which of the following?  Result in more intended pregnancies  Decrease the number of perinatal deaths  Decrease the number of infants born with birth defects  Improve pregnancy outcomes for women with preexisting medical conditions 64 64 из 662 Birth defects are responsible for what percentage of infant mortality?  2%  5%  10%  20% 65 65 из 662 What is the recommended daily dose of folic acid that all women who may become pregnant should take?  1 mg  4 mg  400 mg  None of the listed options 66 66 из 662 Which of the following are important aspects of reproductive history that aid in preconceptional counseling?  Length of prior labor  Prior child’s birthweight  History of preterm delivery  Prenatal screening results from prior pregnancy 67 67 из 662 Fetal risks related to maternal age include which of the following?  Aneuploidy  Preterm birth  Growth disorders  All of the listed options 68 68 из 662 After delivery, clearance of the amnionic fluid that fills the fetal lungs occurs via which of the following mechanisms?  Physical compression of the fetal thorax  Absorption of fluid into the neonatal pulmonary circulation  Absorption of fluid into the neonatal pulmonary lymphatic system  All of the listed option 69 69 из 662 A 26-year-old multigravida presents in spontaneous labor at 39 weeks 3 days. She had spontaneous rupture of membranes with clear amnionic fluid and delivered spontaneously with a category I fetal heart rate tracing. The neonate was vigorous and crying immediately after delivery. What is the next best step in the management of this newborn?  Bulb suctioning of oropharyngeal secretions  Cord clamping and transfer to the radiant warmer  Placement on maternal abdomen for drying and evaluation of tone, heart rate, and respiratory effort  Hold infant in fully supported prone position and deliver 3 gentle back thumps to aid in initial secretion clearance. 70 70 из 662 A 26-year-old multigravida presents in spontaneous labor at 39 weeks 3 days. She had spontaneous rupture of membranes with clear amnionic fluid and delivered spontaneously with a category I fetal heart rate tracing. The neonate was vigorous and crying immediately after delivery. In 5 minutes the newborn became apneic with a heart rate that was 90 beats per minute at 50 seconds of life. The following is most appropriately initiated?  Secretions are suctioned  Positive pressure ventilation is administered  Newborn is stimulated, and head placed in the sniffing position  All of the listed options 71 71 из 662 Which of the following statements are true regarding Apgar scores?  Apgar score assesses 5 characteristics and either 0 or 2 points are awarded.  Apgar score effectively assesses newborn health and effectiveness of resuscitation.  Five-minute Apgar score is predictive of neonatal survival in term but not preterm neonates.  In term neonates, Apgar score 1.5 cm is diagnostic.  Surgery is usually necessary for separation >3 cm.  Treatment is generally conservative and consists of rest and placement of a pelvic binder.  All of the listed options 215 215 из 662 Your patient presents for her 6-week follow-up visit after having a primary cesarean delivery for breech presentation. She is trying to breastfeed exclusively but reports issues with milk supply. What contraceptive option would you not recommend for this patient?  Progestin-only pills  Estrogen-progestin patch  Depot medroxyprogesterone  A levonorgestrel intrauterine device 216 216 из 662 What percentage of non-breastfeeding women develop fever from breast engorgement postpartum?  15%  25%  35%  55% 217 217 из 662 What is the most common etiology of persistent fevers after childbirth?  Atelectasis  Pyelonephritis  Breast engorgement  Genital tract infections 218 218 из 662 Which of the following is the single most significant risk factor for development of an uterine infection?  Route of delivery  Use of internal monitors  Artificial rupture of membranes  Group B streptococcus colonization 219 219 из 662 Which of the following is not a risk factor for developing an uterine infection?  Multiparity  Prolonged labor  Cesarean delivery  Placement of internal monitors 220 220 из 662 What organism has been implicated in late-onset, indolent metritis?  Proteus  Klebsiella  Chlamydia  Peptostreptococcus 221 221 из 662 What is the most important criterion for the diagnosis of postpartum metritis?  Fever  Leukocytosis  Foul-smelling lochia  Parametrial tenderness 222 222 из 662 Which of the following regimens is the gold standard for treatment of a pelvic infection following a cesarean delivery?  Meropenem  Vancomycin  Clindamycin and azitromicin  Clindamycin and gentamicin 223 223 из 662 Which of the following has not been shown to lower the risk for infection after cesarean delivery?  Spontaneous separation of the placenta  Chlorhexidine-alcohol skin preparation  Single-dose antibiotics prior to skin incision  Surgeons changing gloves after delivery of the placenta 224 224 из 662 In more than 90% of women, metritis responds to treatment with antibiotics within what period of time?  12–24 hours  24–36 hours  48–72 hours  72–96 hours 225 225 из 662 Which of the following is frequently the first sign/ symptom of peritonitis in a postpartum woman?  Diarrhea  Skin erythema  Adynamic ileus  Abdominal rigidity 226 226 из 662 What is the overall incidence of septic pelvic thrombophlebitis?  1/100  1/200  1/2000–1/3000  1/20,000–1/30,000 227 227 из 662 Which of the following is a risk factor for episiotomy dehiscence?  Smoking  Infection  Genital warts  All of the listed options 228 228 из 662 What is the case-fatality rate of toxic shock syndrome?  1–2%  5–6%  10–15%  20–25% 229 229 из 662 Which of the following is the best treatment for toxic shock syndrome?  Supportive care  Supportive care and antibiotics  Supportive care, antibiotics, and wound debridement if necessary  There is no necessary treatment as it will resolve on its own over time 230 230 из 662 What is the incidence of mastitis?  1%  3%  10%  15% 231 231 из 662 When is mastitis most likely to occur?  Postpartum day 1  Postpartum day 5  3–4 weeks postpartum  6–9 months postpartum 232 232 из 662 What percentage of women with mastitis develop an abscess?  1%  3%  10%  15% 233 233 из 662 Which of the following is NOT expected in cases of mastitis?  Fever  Chills  Breast firmness  Symptoms in both breasts 234 234 из 662 A 32-year-old G4P2 presents 3 weeks after undergoing a cesarean delivery for breech presentation. She has been exclusively breastfeeding and feeling well. She now complains of a 2-day history of fever, chills, and breast pain. She finds it difficult to feed the infant on the affected side. On exam, the breast is warm, red, and tender. You expect mastitis at the least, are not sure if there is an abscess. You obtain an ultrasound and the image is shown below. What is the best management plan?  Intravenous antibiotics, supportive care, suspend breast feeding on the affected side for 48–72 hours  Oral antibiotics, discontinuation of breast feeding on the affected side, follow up with OB/GYN next week  Intravenous antibiotics, drainage of abscess, culture, pumping or breast feeding continued for both breasts  Milk culture, discharge home with pain medication, encourage breast feeding on that side, antibiotics if the milk culture is positive 235 235 из 662 What percentage of pregnancies are complicated by hypertension?  2–3%  4–5%  5–10%  10–20% 236 236 из 662 A 21-year-old primigravida at 36 weeks’ gestation presents for her clinic visit and is noted to have a blood pressure of 148/88 mm Hg. A repeat blood pressure 30 minutes later is 146/92 mm Hg. Her blood pressures throughout pregnancy have been below 140/90 mm Hg. She denies any complaints, and urinalysis is negative for proteinuria. What is the most likely diagnosis?  Delta hypertension  Chronic hypertension  Preeclampsia syndrome  Gestational hypertension 237 237 из 662 What percentage of eclamptic seizures occur more than 48 hours after delivery?  2%  5%  10%  20% 238 238 из 662 A 28-year-old primigravida at 38 weeks’ gestation presents with complaint of contractions. Her blood pressure is noted to be 148/90 mm Hg and 152/96 mm Hg. She has a urine protein:creatinine ratio of 0.4, a creatinine of 1.04 mg/dL (baseline 0.48 mg/dL), normal AST and ALT, and platelet count of 110,000/μL. She denies any symptoms. What criteria for severe preeclampsia does this patient meet?  Proteinuria  Low platelets  Elevated creatinine  She does not meet criteria for severe preeclampsia. 239 239 из 662 Many conditions and factors are associated with an increased risk for preeclampsia. Which of the following factors results in the greatest relative risk for a diagnosis of preeclampsia in the current pregnancy?  Primigravida  Advanced maternal age  Systemic lupus erythematous  History of preeclampsia in a prior pregnancy 240 240 из 662 Which of the following is thought to play a significant role in the development of preeclampsia?  Genetic factors  Immunological factors  Abnormal trophoblastic invasion  All of the listed options 241 241 из 662 A 21-year-old primigravida presents at 36 weeks’ gestation with new-onset headache. Her blood pressure is 150/90 mm Hg, her serum creatinine is 0.8 mg/mL, AST is 32 U/L, and platelet count is 28,000/μL. Which of the following criteria for severe preeclampsia is met?  Hypertension  Liver dysfunction  Thrombocytopenia  Elevated serum creatinine 242 242 из 662 Which statement best describes renal perfusion and glomerular filtration rates in women with preeclampsia that has not yet progressed to severe disease?  Similar compared to normal pregnant values  Increased compared to normal pregnant values  Similar compared to normal nonpregnant values  Decreased compared to normal nonpregnant values 243 243 из 662 What proportion of maternal deaths can be attributed to hypertensive disorders in pregnancy?  1 in 2  1 in 6  1 in 10  1 in 20 244 244 из 662 What is the underlying etiology of the proteinuria seen with preeclampsia?  Increased capillary permeability  Increased renal artery resistance  Increased glomerular filtration rate  Increased systemic vascular resistance 245 245 из 662 Computed tomography image shows cerebral edema in a postpartum patient with hypertension, vision changes, and confusion. Which of the following interventions is least indicated for this patient  Mannitol  Dexamethasone  Antihypertensive medication  Intravenous immune globulin 246 246 из 662 Your patient is admitted to the hospital for evaluation of new-onset hypertension at 30 weeks’ gestation. Which of the following tests or evaluations is LEAST appropriate?  Maternal weight  Protein:creatinine ratio  Cell-free DNA testing for aneuploidy  Sonographic evaluation of fetal growth 247 247 из 662 Which of the following medical therapies has been associated with a modest decrease in the incidence of preeclampsia in women at increased risk?  Aspirin  Metformin  Enoxaparin  Heparin sulfate 248 248 из 662 A 42-year-old woman presents for prenatal care. She has a demanding professional career and reports she is unwilling to attend frequent prenatal visits at the end of pregnancy. You discourage this, explaining these visits are recommended for which of the following reasons?  To aid in the early detection of preeclampsia  To detect possible malpresentation and discuss delivery planning  To aid in the timely detection of fetal complications such as growth restriction or oligohydramnios  All of the listed options 249 249 из 662 What is the most important cause of maternal mortality worldwide?  Infection  Hemorrhage  Pulmonary embolism  None of the listed options 250 250 из 662 Which of the following statements is accurate concerning postpartum hemorrhage?  The blood loss at delivery approaches the volume of blood added during pregnancy.  Estimated blood loss reported is often less than the actual blood loss.  Postpartum hemorrhage is cumulative blood loss of >100 mL accompanied by symptoms and signs of hypovolemia.  None of the listed options 251 251 из 662 Causes of uterine atony include which of the following?  Obesity  Placenta previa  Multiple fetuses  Placental abruption 252 252 из 662 A 33-year-old G4P3 at 35 weeks’ gestation presents to labor and delivery with a small amount of vaginal bleeding. When you place her on the fetal monitor there is a severe fetal distess. An emergent cesarean delivery is performed. The 1- minute and 5-minute Apgars are 0 and 3, respectively. Which of the following would be the etiology?  Vasa previa  Placenta previa  Placental abruption  All of the listed options 253 253 из 662 Which of the following maneuvers should be performed in the setting of postpartum hemorrhage following a vaginal delivery?  Evaluate birth canal for lacerations  Evaluate the placenta for possible retained fragments  The uterus should be manually explored, and placental fragments removed  All of the listed options 254 254 из 662 During evaluation of postpartum hemorrhage following a vaginal delivery, which of the following maneuvers or medications might be used?  Bimanual uterine compression  Ergot alkaloids for patients with hypertension  Prostaglandine F2α in patients with mild asthma  All of the listed options 255 255 из 662 A 34-year-old G3P3 begins having brisk bright red bleeding following completion of a vaginal delivery. You give her carboprost tromethamine (Prostaglandine F2α) and perform bimanual uterine compression. What else should be immediately considered?  Call for help  Ask for urgent help from anesthesia  Place large-bore intravenous lines, order blood, and begin volume resuscitation  All of the listed options 256 256 из 662 A 34-year-old G3P3 begins having brisk bright red bleeding following completion of a vaginal delivery. You give her carboprost tromethamine (Prostaglandine F2α) and perform bimanual uterine compression. Despite on it the patient continues bleeding. Which of the following maneuvers might be employed?  Hysterectomy  Bakri balloon placement  Uterine compression sutures  All of the listed options 257 257 из 662 A 34-year-old G3P3 begins having brisk bright red bleeding following completion of a vaginal delivery. You give her carboprost tromethamine (Prostaglandine F2α) and perform bimanual uterine compression. Despite on it the patient continues bleeding. She undergoes a hysterectomy and 5 units of packed red blood cells are given, but bleeding continues. What is the most likely etiology of the bleeding?  Vaginal cuff bleeding  Dilutional coagulopathy  Lacerated internal iliac artery  Placental implantation on the omentum 258 258 из 662 What percentage of women have lacerations at the time of vaginal delivery?  50%  90%  80%  65% 259 259 из 662 Which maneuvers below should be performed when repairing a cervical laceration?  Operator grasps lips of cervix with ring forceps.  Second assistant can provide better exposure with vaginal wall retractors.  Assistant place downward pressure on the uterus to expose the cervix better for the operator.  All of the listed options 260 260 из 662 What is the appropriate management of vulvovaginal hematomas?  Surgical exploration in all cases  To prevent infection they should all undergo ultrasound guided drainage.  In a small hematoma, if pain is severe then ice packs and analgesia are appropriate.  If bleeding ceases, small to moderate-sized hematomas can be treated expectantly. 261 261 из 662 The following picture represents which of the following?  Molar gestation  Placenta accreta  Acute placental abruption  Partial placental abruption 262 262 из 662 Which of the following are risk factors for recurrent abruption?  Prior abruption  Low birthweight  Preterm rupture of membranes  None of the listed options 263 263 из 662 Your patient is a 22-year-old G2P1 at 36 weeks’ gestation with a history of prior abruption during a spontaneous vaginal delivery. Which of the following might be effective for preventing recurrence during this pregnancy?  Antepartum testing  Delivery at 38 weeks  Cesarean delivery at 38 weeks  Cesarean delivery at 39 weeks 264 264 из 662 Which of the following is true concerning placental abruption?  It may lead to a dilutional coagulopathy.  Concealed abruption forces thromboplastin into large veins draining the implantation site.  In most women with abruption severe enough to kill the fetus, the plasma fibrinogen level will be less than 150 mg/dL.  All of the listed options 265 265 из 662 What is depicted in the following picture?  Placenta previa  Placenta accreta  Couvelaire uterus  None of the listed options 266 266 из 662 How is a low-lying placenta defined?  The placenta is implanted in the lower uterine segment.  The placental edge covers the internal os, but not completely.  The placental edge does not cover the internal os but lies within a 1-cm wide perimeter.  The placental edge does not cover the internal os but lies within a 2-cm wide perimeter. 267 267 из 662 Which hemostatic surgical procedure is demonstrated in the picture above?  B-Lynch procedure  Uterine artery ligation  Vaginal artery ligation  Ovarian artery ligation 268 268 из 662 What is the definition of very low birthweight?  5000 mIU/mL  All the listed options 366 366 из 662 Incomplete eradication of an ectopic pregnancy allows continued growth of trophoblastic tissue. This leads to tubal rupture in up to what percentage of women?  1 percent  20 percent  40 percent  60 percent 367 367 из 662 Inappropriately rising serum β-human chorionic gonadotropin (hCG) levels indicate a dying pregnancy, but not its location. With a robust uterine pregnancy, serum β-hCG levels should increase by which of the following percentage ranges every 48 hours?  23 percent and 46 percent  53 percent and 66 percent  63 percent and 76 percent  73 percent and 86 percent 368 368 из 662 A 26-year-old multigravida presents with a serum β-human chorionic gonadotropin (hCG) level exceeding 2500 mIU/mL, vaginal bleeding, and abdominal pain. This laparoscopic photograph illustrates which of the following?  A right ovarian mass  An intrauterine pregnancy  A right interstitial pregnancy  A distended right tubal ampulla 369 369 из 662 For most hemodynamically stable women with a first-trimester cervical pregnancy, nonsurgical management with systemic methotrexate can be offered. Resolution and uterine preservation are achieved with methotrexate regimens for gestations less than 12 weeks in what percentage of cases?  61 percent  71 percent  81 percent  91 percent 370 370 из 662 During the first few days following methotrexate administration, up to what percentage of women experience abdominal pain that is controlled by mild analgesics?  5 percent  20 percent  50 percent  80 percent 371 371 из 662 A uterine pregnancy in conjunction with an extrauterine pregnancy is termed a heterotopic pregnancy and has an estimated incidence of 1 in 30,000 pregnancies. However, in pregnancies resulting from assisted reproductive technology, the heterotopic pregnancy rate approximates what percentage?  90 percent  9.0 percent  0.9 percent  0.09 percent 372 372 из 662 Criteria for the diagnosis of an ovarian ectopic pregnancy include which of the following?  The ipsilateral tube is incorporated into the pregnancy mass.  The ectopic pregnancy is connected by the broad ligament to the uterus.  Histologically, ovarian tissue can be demonstrated in the placental tissue.  All the listed options 373 373 из 662 A woman with known risk factors for extrauterine pregnancy presents with amenorrhea. Which of the following symptoms may accompany an ectopic pregnancy?  Breast tenderness  Nausea and vomiting  Vaginal bleeding with abdominal pain  All the listed options 374 374 из 662 A 24-year-old woman receives a single intramuscular dose of methotrexate followed by success full resolution of her ectopic pregnancy. She is eager to attempt pregnancy again. You recommend her to use contraception for at least 3 to 6 months before conceiving again. For up to how many months is methotrexate retained within human tissue?  2 months  4 months  8 months  16 months 375 375 из 662 Without intervention, an ectopic tubal pregnancy can lead to which of the following?  Tubal rupture  Spontaneous resolution  Expulsion of products of conception through the fimbriated end of the tube (tubal abortion)  All the listed options 376 376 из 662 What is the expected per cycle fecundability rate?  0.5 percent  5 percent  25 percent  85 percent 377 377 из 662 Regarding couples attempting pregnancy, what percentage of women are expected to have conceived at 1 year?  15 percent  30 percent  60 percent  85 percent 378 378 из 662 Which of the following assisted reproductive techniques is shown here?  Embryo biopsy  Assisted hatching  Oocyte in vitro maturation  Intracytoplasmic sperm injection (ICSI) 379 379 из 662 An infertile couple presents for evaluation. Neither partner has ever conceived a pregnancy. Both believe that the female partner alone is the source of their failure to achieve a pregnancy. It should be explained that infertility can be attributed to the male partner in approximately one third of cases and to both partners in approximately what percentage of cases?  1 percent  10 percent  33 percent  66 percent 380 380 из 662 Despite achieving ovulation in most patients, clomiphene citrate results in pregnancy rates of 50 percent or less. This disappointing pregnancy rate is attributed to which of the following?  Long drug half -life  Changes to cervical mucus quality  Antiestrogenic effects on the endometrium  All the listed options 381 381 из 662 A 28-year-old woman presents with primary infertility. She has no current health problems or history of serious illness, including pelvic inflammatory disease (PID). She has predictable, cyclic menses with mild dysmenorrhea, unchanged since menarche. Her healthy male partner has been evaluated and has a normal physical examination and semen analysis. What is your interpretation of the patient’s hysterosalpingogram as shown above?  Normal  Uterine didelphys  Bilateral hydrosalpinges  Unilateral proximal tubal blockage 382 382 из 662 Which of the following is the preferred surgical approach for ovarian endometriomas, usually via laparoscopy?  Ovarian wedge resection  Cyst drainage and ablation  Cyst wall excision by a stripping technique  Unilateral oophorectomy if the contralateral ovary appears normal 383 383 из 662 Which of the following is the best treatment for a woman with a significant decline in ovarian reserve?  Use of donor eggs  Clomiphene citrate ovulation induction  Exogenous gonadotropin ovulation induction  In vitro fertilization with intracytoplasmic sperm injection 384 384 из 662 Which of the following suggests ovulatory cycles?  Dysmenorrhea  Mittelschmerz  Moliminal symptoms  All the listed options 385 385 из 662 Which of the following tubal obstruction locations is LEAST amenable to surgical repair?  Isthmic  Interstitial  Ampullary  Fimbrial 386 386 из 662 Which of the following midluteal progesterone level values signify ovulation?  0.05 ng/mL  0.1 ng/mL  1.0 ng/mL  5.0 ng/mL 387 387 из 662 Compared with in vitro fertilization, advantages of bilateral tubal reanastomosis to reverse tubal occlusion from a prior sterilization procedure do NOT include which of the following?  Ability to conceive naturally  Negligible risk of ectopic pregnancy  Decreased risk of multifetal gestation  Avoidance of ovarian stimulation with exogenous hormonal therapy 388 388 из 662 As shown here, sonography is clinically most useful for the diagnosis of which of the following conditions that contributes to a significant percentage of infertility cases?  Anovulation  Sex cord-stromal tumors  Polycystic ovarian syndrome  Periovarian adhesive disease 389 389 из 662 Reduced secretion of which of the following hormones is most likely responsible for the rising serum follicle-stimulating hormone (FSH) level seen as a woman ages?  Activin  Inhibin B  Estradiol  Follistatin 390 390 из 662 A 19-year-old woman is admitted with her second bout of pelvic inflammatory disease (PID) in 18 months. She is counseled that she is at increased risk of infertility and ectopic pregnancy in the future. Despite this effort, she is likely to continue her risk-taking behaviors. What is the estimated tubal infertility rate after three episodes of PID?  0.4 percent  14 percent  34 percent  54 percent 391 391 из 662 Which of the following treatment options offers the best chance for intrauterine pregnancy in a patient with the following problem?  Fimbriectomy  Neosalpingostomy  Tubal reanastomosis  In vitro fertilization after bilateral salpingectomy 392 392 из 662 In reproductive-aged women, which of the following increases with the passage of time?  Fertility  Ovarian reserve  Risk of spontaneous abortion  Success of donor insemination 393 393 из 662 Infertility thought secondary to which of the following scenarios warrants intracytoplasmic sperm injection (ICSI)?  Chronic anovulation  Severe oligospermia  Diminished ovarian reserve in an older woman  Bilateral distal fallopian tube occlusion with hydrosalpinges 394 394 из 662 Which of the following is present in some gonadotropin preparations and provides the needed luteinizing hormone (LH) activity by virtue of its shared receptor with LH?  Inhibin  Activin  Follistatin  Human chorionic gonadotropin 395 395 из 662 Which of these statements regarding infertility is FALSE?  Women are affected more than twice as often as men.  Around 10 to 15 percent of the reproductive-aged population is infertile.  Early evaluation after only 6 months may be justied for certain medical conditions or for women aged 35 years or older.  Infertility generally is defined as the inability to achieve successful pregnancy after at least 12 months of regular, unprotected intercourse. 396 396 из 662 Which of the following statements regarding antimüllerian hormone level (AMH) is true?  AMH levels are increased in women with polycystic ovarian syndrome.  Compared with estradiol for follicle-stimulating hormone (FSH) levels, AMH levels correlate better with the number of ovarian primordial follicles.  AMH expression is strong in preantral follicles and weak in larger follicles.  All the statements are true. 397 397 из 662 A 32-year-old woman undergoes infertility evaluation after trying to conceive or 5 years. She has cyclic but heavy menses. Prior to this, she experienced one pregnancy that ended in a first-trimester spontaneous abortion. What uterine abnormality is suggested by her hysterosalpingogram?  Normal  Asherman syndrome  Submucous leiomyoma  Bilateral hydrosalpinges 398 398 из 662 Hysterosalpingography is LEAST helpful for detecting which of the following?  Tubal patency  Pelvic adhesions  Asherman syndrome  Congenital uterine anomalies 399 399 из 662 For the evaluation of ovarian function, which of the following laboratory tests is LEAST helpful?  Random inhibin B level  Cycle day 3 estradiol level  Random antimüllerian hormone level (AMH)  Cycle day 3 follicle-stimulating hormone (FSH) level 400 400 из 662 A 28-year-old nullipara who has been seeking pregnancy is diagnosed with polycystic ovarian syndrome (PCOS). She is generally healthy, but her body mass index (BMI) is in the obese range. Which of the following should be recommended as first-line management of her anovulation?  Gonadotropins  Clomiphene citrate  Weight loss and exercise  Insulin-sensitizing agents 401 401 из 662 Obesity increases the risk of which of the following pregnancy complications?  Birth defects  Cesarean delivery  Unexplained stillbirth  All the listed options 402 402 из 662 A very health-conscious patient is seeking pregnancy and asks about the best diet to follow at this time. She is overwhelmed by all the advice available from friends, books, and magazines. Which of the following nutritional strategies is most strongly recommended for women attempting pregnancy?  High protein diet  Dietary antioxidants  Folic acid supplementation  Complex carbohydrate restriction 403 403 из 662 The photomicrograph of an air-dried sample of cervical mucus demonstrates the effect of high amounts of which of the following hormones?  Inhibin  Estrogen  Progesterone  Follicle-stimulating hormone (FSH) 404 404 из 662 A 28-year-old woman with polycystic ovarian syndrome (PCOS) and infertility asks about the potential use of metformin to help achieve pregnancy. She can be counseled that current evidence LEAST supports which of the following benefits of metformin therapy in women with PCOS?  Improved live-birth rate  Improved menstrual cyclicity  Higher frequency of spontaneous ovulation  Increased ovulatory response to clomiphene citrate therapy 405 405 из 662 Of infertility causes, which of the following is most likely encountered?  Unexplained  Male factors  Tubal disease  Ovulatory dysfunction 406 406 из 662 If not already up to date as a part of routine wellwoman care, which of the following should be completed during the initial infertility evaluation?  Determine rubella immunity status  Screen for cervical cancer  Screen for Neisseria gonorrhoeae and Chlamydia trachomatis  All the listed options 407 407 из 662 Which of the following assisted reproductive technologies, typically is used to treat male actor infertility, is shown here?  Embryo biopsy  Intracytoplasmic sperm injection (ICSI)  Oocyte in vitro maturation  Assisted hatching 408 408 из 662 Which of the following is NOT true of basal body temperature testing to identify ovulation in adult women?  It can be an insensitive test in many women.  With ovulation, the temperature rises from 0.4° to 0.8°.  Once the temperature rises, a patient should expect ovulation during the next 48 hours.  It is an inexpensive and easy test for ovulation monitoring. 409 409 из 662 Which of the following complication is more common in pregnancies resulting from assisted reproductive technologies compared with spontaneously conceived pregnancies?  Cesarean delivery  Placental abruption  Gestational diabetes  All the listed options 410 410 из 662 Which of the following statements regarding the management of uterine factors in infertile women is supported by evidence from a randomized trial?  Endometrial polypectomy increases pregnancy rates.  Myomectomy of intramural myomas increases pregnancy rates.  Asherman syndrome can be reversed with highdose estrogen therapy alone.  None of the above 411 411 из 662 A 30-year-old nulligravida has been trying to conceive for the last 2 years. She has no medical problems. She consumes five alcoholic drinks weekly, smokes half a pack of cigarettes daily. She describes herself as a heavy coffee drinker. She works in a dry-cleaning facility. Which of the following exposures is LEAST likely affecting her fertility?  Alcohol  Caffeine  Cigarettes  Dry cleaning fluid exposure 412 412 из 662 In women with inadequate cervical mucus quantity or quality as a suspected contributor to infertility, what is the most reasonable approach to achieving pregnancy?  Cryotherapy  Ovulation induction  Intrauterine insemination  Flax seed oil supplementation 413 413 из 662 In general, infertility evaluation is initiated after a couple fails to conceive after 1 year of unprotected intercourse of reasonable frequency. When should earlier evaluation be considered?  Woman older than 35 years  History of chronic anovulatory cycles  Prior severe pelvic inflammatory disease (PID)  All the listed options 414 414 из 662 Which of the following statements is true regarding thyroid dysfunction and infertility?  Subclinical hypothyroidism is not associated with ovarian dysfunction.  There is no relationship between infertility and overt thyroid dysfunction.  If infertile women seeking pregnancy, treatment of any degree of hypothyroidism is advisable.  Thyroid-stimulating hormone levels are elevated in more than half of women with infertility. 415 415 из 662 Which of the following is true of luteal phase endometrial biopsy?  It shows high intra- and interobserver reliability.  It does not reliably distinguish fertile women from infertile women.  An out-of-phase biopsy result predicts an increased risk of future early pregnancy loss should conception occur.  Its performance on day 21 of a menstrual cycle is considered a standard component of an infertility evaluation. 416 416 из 662 Which of the following uterine measurements typifies those of the adult, nonpregnant woman?  5 cm length, 7 cm width at fundus  7 cm length, 5 cm width at fundus  7 cm length, 10 cm width at fundus  10 cm length, 5 cm width at fundus 417 417 из 662 The uterine cervix begins caudal to the uterine isthmus, consists primarily of fibrous tissue and a smaller amount of smooth muscle, and is approximately how many centimeters in length?  1-2  2-3  3-4  5-6 418 418 из 662 The main support of the uterus and cervix is provided by the levator ani muscles and the connective tissue that attaches the walls of the outer cervix to the pelvic walls. The connective tissue that attaches lateral and posterior to the uterus and cervix is called the parametria and consists of which of the following?  Cardinal ligaments  Uterosacral ligaments  Transverse cervical ligaments  All the listed options 419 419 из 662 The broad ligaments are double layers of peritoneum that extend from the lateral walls of the uterus to the pelvic walls. Within these two layers lie which of the following?  Fallopian tubes  Round ligaments  Ovarian ligaments  All the listed options 420 420 из 662 The blood supply to the uterine corpus generally arises from which of the following two arteries?  Renal and ovarian  Renal and uterine  Uterine and ovarian  External iliac and vaginal 421 421 из 662 The uterine artery approaches the uterus in the area of transition between the corpus and the cervix known as the uterine isthmus. In this area, the uterine artery courses over which of the following important structures?  Ureter  Round ligament  Fallopian tube  Uterosacral ligament 422 422 из 662 Which of the following is true regarding the ovarian vessels?  Both ovarian arteries arise from the aorta.  Both ovarian veins drain into the inferior vena cava.  Right and left ovarian arteries arise from the right renal artery and aorta, respectively.  Right and left ovarian veins drain into the right renal vein and inferior vena cava, respectively 423 423 из 662 The fallopian tube is a hollow structure that measures 7 to 12 cm in length and has four identifiable portions. Which portion has the smallest diameter?  Isthmic portion  Ampullary portion  Fimbriated portion  Interstitial portion 424 424 из 662 The fallopian tube receives its blood supply through its mesosalpinx from several branches of which artery?  Ovarian  Uterine  Fallopian  None of the above 425 425 из 662 The walls of the vagina consist of three layers. Adjacent to the vaginal lumen, the first layer consists of which of the following?  Smooth muscle  Collagen and elastin  Nonkeratinized squamous epithelium overlying a lamina propria  None of the above 426 426 из 662 Which of the following statements regarding the pathophysiology of leiomyomas is true? Typical leiomyoma histology is shown in these low- and high-power photomicrographs.  Each leiomyoma is derived from multiple progenitor myocytes.  Mitotic activity in their elongated smooth-musclebundles is common.  Leiomyomas possess a distinct autonomy romtheir surrounding myometrium.  Necrosis and degeneration develop in requently inleiomyomas because o their abundant and wellorganizedblood supply. 427 427 из 662 Compared with normal myometrial cells, leiomyoma cells have which of the following mechanism to create a hyperestrogenic environment requisite for myoma growth and maintenance?  They convert less estradiol to estrone  They contain a greater density of estrogen receptors  They contain higher levels of cytochrome P450 aromatase, which converts androgens to estrogen  All the listed options 428 428 из 662 Which of the following factors decreases the risk for leiomyoma development?  Early menarche  Cigarette smoking  Elevated body mass index  Polycystic ovarian syndrome 429 429 из 662 Leiomyomas carry a higher progesterone receptor density compared with the surrounding myometrium.As a result, all of the following statements regarding responses of leiomyomas to hormones are true EXCEPT:  Higher doses of medroxyprogesterone acetate are associated with leiomyoma growth  Hormone replacement therapy in postmenopausal women can stimulate leiomyoma growth  Antiprogestin agents, such as mifepristone and ulipristal acetate, cause leiomyoma growth  In women treated with gonadotropin-releasing agonists, leiomyomas typically decrease in size 430 430 из 662 Which of the following statements regarding factors associated with leiomyoma development is FALSE?  Higher rates of leiomyomas are linked with pregnancy  Leiomyomas are more common in African–American women  Gene mutations play a key role in leiomyoma development  In reproductive-aged women, the risk of leiomyoma development increases with age 431 431 из 662 What type of leiomyoma is shown in this sonographic image?  Intramural  Subserosal  Submucosal, type 0  Submucosal, type 1 432 432 из 662 Which of the following terms regarding leiomyomatosis is correctly paired with its defnition?  Benign metastasizing leiomyomas — venous dissemination of leiomyomas  Intravenous leiomyomatosis — extension of leiomyomas into uterine and other pelvic arteries  Disseminated peritoneal leiomyomatosis — leiomyomas that appear as multiple small peritoneal nodules within the abdominal cavity  All the listed options 433 433 из 662 Which symptom of leiomyomas is NOT correctly paired with its common pathophysiology?  Asymptomatic — prolapsing fibroid  Menorrhagia — dilatation of venules  Pelvic pressure — mechanical compression  Acute pelvic pain — leiomyoma degeneration 434 434 из 662 Leiomyomas account for 1 to 3 percent of infertility cases. Which of the following describes the putative mechanism by which leiomyomas may disrupt fertility?  Occlusion of tubal ostia  Disruption of normal uterine contractions  Disruption of implantation secondary to distortion of the endometrial cavity and/or endometrial inflammatory and vascular changes  All the listed options 435 435 из 662 Rare complications of leiomyomas include all of the following EXCEPT:  Leiomyomatosis  Cystic degeneration  Pseudo-Meigs syndrome  Myomatous erythrocytosis syndrome 436 436 из 662 Cystic degeneration, shown here, is one possible sonographic feature of leiomyomas. Which of the following is another possible finding?  Round hypoechoic mass  Hypoechoic mass with echogenic foci  Discrete borders with acoustic shadowing  All the listed options 437 437 из 662 A 40-year-old woman presents with complaints of heavy menstrual bleeding. Transvaginal sonography of the uterus reveals a heterogeneous central endometrial echo (shown above). Which of the following would be LEAST helpful to further clarify the diagnosis?  Hysteroscopy  Computed tomography  Magnetic resonance imaging (MRI)  Saline infusion sonography with three-dimensional (3-D) imaging 438 438 из 662 A 45-year-old woman complains of worsening heavy menstrual bleeding. This was previously treated with nonsteroidal antiinflammatory drugs (NSAIDs). She has no other medical problems. Three-dimensional sonographic evaluation reveals the type 0 submucosal leiomyoma shown here. All of the following are suitable next choices for medical treatment in this patient EXCEPT:  Combination oral contraceptives  Depot medroxyprogesterone acetate  Gonadotropin-releasing hormone agonist  Levonorgestrel-containing intrauterine system 439 439 из 662 Which of the following statements describes a limitation of antiprogestin use for leiomyoma treatment?  Almost half of patients complain of vasomotor symptoms  The antiprogestational effects expose the endometrium to unopposed estrogen  Mifepristone is manufactured in a dose well above that needed for leiomyoma therapy  All the listed options 440 440 из 662 Which of the following is a proposed mechanism of action of gonadotropin-releasing hormone (GnRH) agonists on leiomyomas?  GnRH agonists downregulate estrogen and progesterone receptors on the leiomyomas themselves  GnRH agonists upregulate receptors on ovarian gonadotropes, thereby increasing estrogen and progesterone effects  GnRH agonists downregulate receptors on pituitary gonadotropes, thereby suppressing estrogen and progesterone levels  None of the listed options 441 441 из 662 A 47-year-old woman presents with complaints of heavy menstrual bleeding, dysmenorrhea, and anemia. Evaluation confirms that her condition is secondary to intramural leiomyomas. After thorough discussion of the various medical and surgical options, she wishes to proceed with gonadotropin-releasing hormone (GnRH) agonist treatment. Which of the following statements is important to include in counseling before initiating this therapy?  Treatment can result in loss of trabecular bone, which may not be recouped following therapy discontinuation  Side effects of GnRH agonists include vasomotor symptoms, libido changes, and vaginal dryness that may promote dyspareunia  Anticipated clinical benefits are reduced leiomyoma volume and diminished bleeding and pain. However, once therapy is stopped, leiomyomas regrow and regain pretreatment sizes within 3 to 4 months  All the listed options 442 442 из 662 Which of the following statements is true regarding “add-back therapy” to complement gonadotropin releasing hormone (GnRH) agonist treatment?  Add-back therapy is typically begun immediately with GnRH agonist initiation  Add-back therapy includes estrogen combined with a progestin in a preparation equivalent to that found in high-dose combination oral contraceptives  The goal of add-back therapy is to counter side effects of GnRH agonist treatment without mitigating the shrinking action on leiomyoma volume  None of the listed options 443 443 из 662 Relative contraindications to uterine artery embolization include all of the following EXCEPT:  Desire for future fertility  Pedunculated submucosal leiomyomas  Concurrent gonadotropin-releasing hormone(GnRH) use  History of treated (resolved) Neisseria gonorrhoeae or Chlamydia trachomatis infection 444 444 из 662 Compared with hysterectomy, uterine artery embolizationis associated with which of the following?  Longer hospitalization  Postembolization syndrome  Equivalent time frame for return to work  Higher 24-hour postprocedural pain scores 445 445 из 662 Frequent complications associated with uterine artery embolization include which of the following?  Groin hematoma  Leiomyoma tissue passage  Prolonged vaginal discharge  All the listed options 446 446 из 662 A 35-year-old nulligravida presents for counseling regarding uterine artery embolization (UAE). Her heavy menstrual bleeding due to uterine leiomyomas has been refractory to all attempts at medical management.She desires future fertility. Which of the following complications of pregnancy is she at increased risk for after UAE?  Miscarriage  Cesarean delivery  Postpartum hemorrhage  All of the above 447 447 из 662 All of the following statements regarding magnetic resonance imaging-guided focused ultrasound therapy (MRgFUS) are true EXCEPT:  Long-term data regarding the duration of symptom relief are limited  Less than 10 percent of women seek alternative treatments for their symptoms by 12 months following MRgFUS  This technique ocuses ultrasound energy to a degree that heats targeted leiomyomas to incite necrosis  Contraindications include abdominal wall scars,contraindications to magnetic resonance imaging, uterine size greater than 24 weeks, and desire for future fertility. 448 448 из 662 Laparoscopic myomectomy, compared with open myomectomy, is characterized by which of the following?  More febrile morbidity  Less adhesion formation  Improved pregnancy rates  Equivalent hospital stays 449 449 из 662 When used as the sole technique for myoma-related bleeding, which of the following surgical therapies is least effective?  Myomectomy  Hysterectomy  Endometrial ablation  Hysteroscopic resection of submucous leiomyomas 450 450 из 662 As shown here, with endometriosis, which of the following is ectopically located?  Myometrial cells  Ectocervical cells  Endometrial glands and stroma  Endocervical glands and stroma 451 451 из 662 Compared with the general population, the prevalence of endometriosis is higher in women with which of the following characteristics?  Pelvic pain  Infertility  Affected family member  All the listed options 452 452 из 662 Which of the following is a more favored theory toexplain the development of endometriosis?  Lymphatic spread  Coelomic metaplasia  Retrograde menstruation  Abnormal differentiation of müllerian remnants 453 453 из 662 A 19-year-old nulligravida presents with worsening dysmenorrhea and chronic pelvic pain during the lastyear. Transvaginal sonography is completed and shows a unicomuate uterus and an obstracted cavitary rudimentary horn, as shown here. Of other müllerian anomalies, which of the following is LEAST likely topose a similar risk for endometriosis development?  Imperforate hymen  Bicornuate uterus  Transverse vaginal septum  Obstructed hemivagina ipsilateral renal agenesis (OHVIRA) 454 454 из 662 Of the following locations, where is endometriosis LEAST likely to be found?  Pleura  Ureter  Rectovaginal septum  Posterior-cul-de sac peritoneum 455 455 из 662 Of the following locations, where is endometriosis MOST likely to be found?  Pleura  Ureter  Rectovaginal septum  Posterior-cul-de sac peritoneum 456 456 из 662 An enzyme important in creating a unique estrogenic environment within endometiiotic implants includes which of the following?  Aromatase  17 α-hydroxylase  11 β-hydroxylase  17 β -hydroxysteroid dehydrogenase type 2 457 457 из 662 Which of the following is a potent inducer of aromatase and is thought to create a feed-forward loop to potentiate the estrogenic environment of endometriotic implants?  Prostaglandin E2  Matrix metalloproteinase 3  Cyclooxygenase type 2 inhibitor  17 β-hydroxysteroid dehydrogenase type 2 458 458 из 662 Which of the following is the focus of the classification system developed by the American Society for Reproductive Medicine?  Pelvic pain severity  Degree of infertility  Anatomic extent of endometriosis  All the listed options 459 459 из 662 At the time of laparoscopy, this patient was noted to have endometriotic surface lesions limited to the locations shown here. According to the American Society for Reproductive Medicine classification, which of the following stages is assigned?  Stage I  Stage II  Stage III  Stage IV 460 460 из 662 At the time of laparoscopy, your patient was noted to only have bilateral adnexal cysts. Incision of one of the surgical specimens is seen here. Prior to laparoscopy, the ovarian cysts were measured by sonography and found to be 4 cm on the right and 7 cm on the left. According to the American Society for Reproductive Medicine classification, this degree of endometriosis would be assigned which stage?  Stage I  Stage II  Stage III  Stage IV 461 461 из 662 Of the following, which is the more likely complaint from a woman with endometriosis?  Dysuria  Dyschezia  Dyspareunia  Anterior abdominal wall pain 462 462 из 662 When evaluating a woman with endometriosis, which of the following gynecologic conditions may appropriately be considered in the differential diagnosis?  Adenomyosis  Interstitial cystitis  Chronic tubo-ovarian abscess  All the listed options 463 463 из 662 Which of the following is the most likely etiology for infertility in a woman with endometriosis?  Tubal obstruction  Implantation defect  Ovulatory dysfunction  Poor embryo development 464 464 из 662 Of deep infiltrating lesions involving the bowel, which of the following sites is more commonly affected?  Cecum  Appendix  Small bowel  Rectosigmoid colon 465 465 из 662 A 24-year-old woman with endometriosis diagnosed laparoscopically during late adolescence complains of worsening dysmenorrhea, dyspareunia, dysuria, and urinary urgency. Each of several urineanalyses and urinecultures has been negative for infection. Which of the following would be the LEAST suitable to further evaluate this patient?  Cystoscopy  Computed tomography  Transvaginal sonography  Magnetic resonance imaging 466 466 из 662 Which of the following manifestations is LEAST likely to be encountered during the physical examination of a patient with endometriosis?  Fixed, immobile uterus during bimanual examination  Uterosacral ligament nodularity during bimanual examination  Exophytic, fungating cervical lesion during speculum examination  Single, firm nodule palpated at a point along the length of a prior Pfannenstiel incision 467 467 из 662 Which of the following is true regarding laboratory testing during evaluation of suspected endometriosis?  It should rarely be performed  It identifies most cases of endometriosis  It is used mainly to exclude other conditions  Of tests, elevated cancer antigen 125 (CA125) levels are pathognomonic for endometriosis. 468 468 из 662 Sonographically, endometriomas are typically described by which of the following?  Solid with intracystic blood flow  Solid with diffuse internal low-level echoes  Cystic with focal hyperechoic internal echoes  Cystic with diffuse internal low-level echoes 469 469 из 662 As demonstrated in the pelvic sonogram here, endometriomas often have an appearance similar to which of the following?  Tubo-ovarian abscess  Pedunculated leiomyoma  Mature cystic teratoma  Hemorrhagic corpus luteum cyst 470 470 из 662 Which of the following peritoneal implant colorings most commonly correlates with histologic findings of endometriosis?  Red  Blue  Black  Clear 471 471 из 662 A 22-year-old nulligravida undergoes diagnostic laparoscopy for dysmenorrhea and chronic pelvic pain. The extent of her endometriosis is shown here, and these lesions are ablated. She desires future fertility but is not currently seeking conception. Which of the following is the most appropriate postoperative treatment?  Androgens  Aromatase inhibitors  Combination oral contraceptives  Gonadotropin-releasing hormone antagonist 472 472 из 662 Which of the following combination oral contraceptive formulations is most effective for endometriosis management?  Monophasic  Multiphasic  Low dose (20 pg ethinylestradiol)  All are equally effective. 473 473 из 662 Which of the following progestins is a suitable option to treat a woman recently diagnosed with stage I endometriosis who has associated pain but is not currently seeking conception?  Norethindrone acetate  Depot medroxyprogesterone acetate  Levonorgestrel-releasing intrauterine system  All are suitable options. 474 474 из 662 Which of the following is a suitable gonadotropin-releasing hormone agonist choice for treatment of endometriosis?  Leuprolide acetate as a 11.25-mg. 3-month intra-muscular injection  Nafarelin as a 200-mg twice daily nasal spray  Goserelin as a 10.8-mg, 3-month subcutaneous implant  All the listed options 475 475 из 662 A 25-year-old nulligravida with stage II endometriosis refractory to initial medical options is now pain free after administration of a gonadotropin-releasing hormone agonist 1 month ago. However, she now complains of poor sleep due to vasomotor symptoms, decreased libido, and dyspareunia secondar y to vaginal dryness. Which of the following agents taken orally daily might be LEAST effective for this patient?  Fluoxetine  Norethindrone  Norethindrone plus conjugated equine estrogen  Medroxyprogesterone acetate plus transdermal estradiol 476 476 из 662 Which of the following are suitable times to begin add-back therapy during the course of gonadotropin-releasing hormone agonist treatment?  At 1 month  At 6 months  At initiation of therapy  Each one is suitable 477 477 из 662 All of the following are side effects of aromatase inhibitors EXCEPT:  Hyperglycemia  Vaginal atrophy  Vasomotor symptoms  Ovarian cyst formation 478 478 из 662 All of the following are side effects of danazol EXCEPT:  Hirsutism  Voice deepening  Breast hypertrophy  Vasomotor symptoms 479 479 из 662 Stage I endometriosis is found at the time of diagnostic laparoscopy. Which of the following surgical treatments of eudometriotic implants is suitable to achieve symptom relief?  Excision  Laser ablation  Electrosurgical ablation  All are suitable 480 480 из 662 With deeply infiltrating endometriosis, which of the following surgical approaches may most likely benefit the patient?  Laser ablation  Radical excision  Bipolar electrosurgical ablation  Monopolar electrosurgical ablation 481 481 из 662 For surgical treatment of endometriomas, which of the following approaches is superior in lowering endometrioma recurrence rates?  Drainage  Cystectomy  Cyst wall ablation  None is superior 482 482 из 662 Which of the following statements is true regarding presacral neurectomy?  It effectively treats lateral adnexal pain.  It is a procedure that excises the uterosacral ligaments.  Postoperative side effects may include constipation and voiding dysfunction.  It should be recommended to most women with endometriosis undergoing surgery. 483 483 из 662 A 35-year-old women is scheduled to undergo laparoscopic hysterectomy for endometriosis refractory to multiple medical management regimens. Which of the following is a correct counseling point regarding concurrent bilateral salpingo- oophorectomy (BSO)?  Choosing BSO eliminates recurrent pain.  Choosing BSO eliminates reoperation rates.  Ovaries should routinely be removed during hysterectomy for endometriosis.  Her ovaries maybe retained if normal appearing and if her anticipated hypoestrogenic effects outweigh persistent pain and reoperation risks. 484 484 из 662 Which of the following is a concern with the use of estrogen replacement therapy following bilateral salpingo- oophorectomy for endometriosis?  Recurrence of endometriotic lesions  Persistence of endometriotic lesions  Cancer development within endometriotic lesions  All the listed options 485 485 из 662 Since widespread introduction of the Papanicolaou (Pap) test in the 1950s, cervical cancer screening has reduced the incidence and mortality rate from invasive cervical cancer by more than what percentage?  50 percent  60 percent  70 percent  90 percent 486 486 из 662 In the lower genital tract, the term intraepithelial neoplasia refers to squamous epithelial lesions that are potential precursors of invasive cancer. In the case of cervical intraepithelial neoplasia (CIN), what term applies when abnormal cells involve the full thickness of the squamous epithelium?  CIN 1  CIN 2  CIN 3  Carcinoma in situ (CIS) 487 487 из 662 The location of the cervical squamocolumnar junction (SCJ) varies with age and hormonal status. As shown in the image above, the SCJ tends to evert outward onto the ectocervix during which of the following conditions?  Menopause  Pregnancy  Prolonged lactation  Long-term progestin-only contraceptive use 488 488 из 662 All of the following are true statements regarding the cervix transformation zone (TZ) EXCEPT:  Nearly all cervical neoplasia develops within the TZ  Squamous metaplasia occurring within the TZ is abnormal  The TZ lies between the original squamous epithelium and columnar epithelium  The location and size of the TZ change through the process of squamous metaplasia. 489 489 из 662 L1 and L2 are two "late" genes of the human papillomavirus (HPV) genome. These genes encode proteins responsible for which of the following?  Capsid construction  Regulatory functions  DNA synthesis and replication  Conformational changes aiding entry into the hostcell 490 490 из 662 Clinically, human papillomavirus (HPV) types are classified as high risk (HR) or low risk (LR) based upon then oncogenic potential. Which two HR HPV types together account for approximately 70 percent of cervical cancers worldwide?  6 and 11  11 and 45  16 and 18  18 and 31 491 491 из 662 A 20-year-old nulligravida complains of occasional pelvic pain and intermittent vaginal discharge. She is also concerned about possible exposure to sexually transmitted infections. Which of the following is the most common sexually transmitted disease?  Chlamydial infection  Gonorrhea  Trichomoniasis  Genital human papillomavirus infection 492 492 из 662 Which of the following is the LEAST common outcome of cervical human papillomavirus infection?  Latent infection  Subclinical infection  High-grade dysplasia or cancer  Cervical intraepithelial neoplasia (CIN) 493 493 из 662 A 40-year-old woman has been in a mutually monogamous relationship for 20 years. She is concerned that her recent Pap test result was reported as atypical squamous cells of undetermined significance (ASC-US). Concurrent human papillomavirus (HPV) infection is reliably diagnosed by which of the following?  Cytology  Histology  Colposcopy  HPV nucleic acid testing 494 494 из 662 Appropriate clinical uses for high-risk human papillomavirus (HPV) testing include which of the following?  Surveillance after treatment of cervical neoplasia  Cotesting (cytology plus HPV testing) as screeningfor women 30 years or older  Triage or surveillance of certain abnormal cervicalcytology results or untreated cervical intraepithelialneoplasia (CIN)  All the listed options 495 495 из 662 Indications to treat human papillomavirus (HPV)-related lower genital tract disease include all of the following EXCEPT:  Invasive cancer  Latent HPV infection  Symptomatic genital warts  High-grade intraepithelial neoplasia 496 496 из 662 Which of the following is true of the prophylactic human papillomavirus (HPV) vaccines currently available?  All three use HPV type-specific virus-like particles to induce immunity  They require one initial dose followed by a booster dose 2 years later  They are theoretically protective against the HPV types that account for 40 percent of cervical cancers  All three are approved for the prevention of anogenitaland oropharyngeal neoplasia. 497 497 из 662 Gardasil, a quadrivalent vaccine against human papillomavirus (HPV) types 6, 11, 16, and 18, has the potential to prevent malignancies of which of the following body sites?  Cervix  Anal canal  Oropharynx  All the listed options 498 498 из 662 Risk of cervical intraepithelial neoplasia (CIN) is most strongly related to persistent genital high-risk human papillomavirus infection plus which of the following?  Tobacco use  Increasing age  Increasing parity  Increasing number of sexual partners 499 499 из 662 Of women diagnosed with cervical cancer, approximately what percentage have nerer been screened?  10 percent  30 percent  50 percent  70 percent 500 500 из 662 The risk of untreated cervical intraepithelial neoplasia (CIN) 3 lesions progressing over 30 years to invasive cancer approximates what percentage?  10 percent  20 percent  30 percent  50 percent 501 501 из 662 A 22-year-old woman with a low-grade squamous intraepithelial lesion (LSIL) Pap result is subsequently diagnosed with cervical intraepithelial neoplasia (CIN) 2 by colposcopy-directed biopsy. Colposcopy (as shown) is satisfactory and the endocervical curettage is negative for dysplasia or cancer. She is given the option of undergoing treatment or observation and is counseled that CIN 2 may spontaneously regress without treatment. Approximately what percentage of CIN 2 shows spontaneous regression within 2 years in young, healthy women?  10 percent  30 percent  60 percent  90 percent 502 502 из 662 Which of the following statements is true regarding conventional glass slide versus liquid-based cytology for cervical cancer screening according to current guidelines?  Both are equally acceptable for screening  They are now replaced by primary human papillomavirus (HPV) screening  Liquid-based cytology is more sensitive for screening  Conventional glass slide cytology is obsolete and should not be used 503 503 из 662 Which of the following is true regarding the clinical performance of the Pap test?  Higher sensitivity than specificity  Higher specificity than sensitivity  Equally low sensitivity and specificity  Equally high sensitivity and specificity 504 504 из 662 Based on current guidelines, how often should a 52-year-old woman undergo cervical cancer cytology screening if she is at average risk for this cancer and her three previous Pap test results were negative?  Annually  Every 2 years  Every 3 years  Every 5 years 505 505 из 662 If all Pap tests to date have been negative and performed at recommended intervals, cervical cancer screening discontinuation would be acceptable for which of the following women?  A 42-year-old woman with prior hysterectomy for leiomyomas  A 72-year-old woman in good health with one prior sexual partner and one new sexual partner for 6 months  A 55-year-old woman with metastatic breast cancer refusing further therapeutic cancer interventions  All of them are reasonable candidates fordiscontinuation of cervical cancer screening. 506 506 из 662 Your patient is a healthy 38-year-old woman who underwent a total hysterectomy 1 year ago for benign pathology. She has no prior history of abnormal Pap tests or lower genital tract neoplasia. She smokes cigarettes and has a new sexual partner. Her physical examination is without abnormalities. Which of the following strategies for prevention of lower genital tract neoplasia is indicated?  Obtain vaginal cytology every 3 years  Vaccinate against high-risk human papillomavirus (HPV) infection  Obtain vaginal cytology and HPV DNA testing every 3 years  Discontinue screening for neoplasia with Pap tests or HPV DNA testing but recommend smoking cessation 507 507 из 662 A 42-year-old patient with normal, cyclic menses is referred for colposcopy following an atypical glandular cells Pap test result. Your initial evaluation of this patient should include which of the following?  Colposcopy  Endometrial biopsy  Endocervical sampling  All the listed options 508 508 из 662 Short-term deferral of colposcopy may be considered for which of the following conditions?  Severe mucopurulent cervicitis  Mechanical heart valve anticoagulation  Unscheduled vaginal bleeding on the day of examination  Last menstrual period began 20 days ago, negative urine pregnancy test, condoms used for contraception 509 509 из 662 A 32-year-old woman presents for evaluation of an abnormal Pap test result. The image of her cervix before (A) and after (B) application of 5-percent acetic acid does NOT demonstrate which of the following?  Acetowhite change  Columnar epithelium  Squamous epithelium  Unsatisfactory colposcopy 510 510 из 662 During colposcopy and lesion grading, terms used to describe abnormal vascular patterns may include which of the following?  Mosaicism  Punctation  Atypical vessel(s)  All the listed options 511 511 из 662 Major clinical guidelines currently recommend endocervical sampling at the time of colposcopy in which of the following situations?  Adequate colposcopy, no ectocenical lesion identified  Initial evaluation of high-grade squamous or atypical glandular cytology results  Surveillance after conization for adenocarcinoma in situ in women seeking fertility preservation  All the listed options 512 512 из 662 A 45-year-old woman presents for evaluation of a high-grade squamous intraepithelial lesion (HSIL) Pap test result. Colposcopy is inadequate due to incomplete visualization of the squamocolumnar junction (SCJ). Cervical biopsy shows cervical intraepithelial neoplasia (CIN) 3, and CIN 2 is found in the endocervical curettage specimen. Which of the following is the most appropriate procedure for further management?  Cryosurgery  Hysterectomy  Loop excision  Laser ablation 513 513 из 662 A 55-year-old patient undergoes a conization procedure for cervical intraepithelial neoplasia (CIN 3)/carcinoma in situ (CIS). Appropriate post excision surveillance over the subsequent 2 to 3 years reveals no recurrence. Which of the following screening schedules is most appropriate for her beyond this posttreatment surveillance?  Discontinue screening  Annual screening until age 75 then may discontinue  Routine screening until age 65 then may discontinue  Routine screening for at least 20 years even if screening extends beyond age 65 514 514 из 662 Which human papillomavirus (HPV) subtype is most strongly associated with adenocarcinoma of the cervix?  HPV 6  HPV 16  HPV 18  HPV 31 515 515 из 662 Which of the following is true regarding smoking and cervical cancer risk?  Smoking may alter viral oncoprotein expression  Passive smoking increases the risk of cervical cancer  Women who smoke are less likely to clear high-risk human papillomavirus (HPV) infection  All the listed options 516 516 из 662 Which of the following statements regarding cervical cancer risk factors is FALSE?  Cervical cancer is an acquired immune deficiency syndrome (AIDS)-defining illness  Transplant recipients have an increased risk of cervical cancer  In general, women who have an autoimmune disease and take immunosuppressant therapy do not have an increased ride of cervical cancer  Combination oral contraceptives are associated with an increased risk of cervical cancer due to the higher number of sexual partners in users. 517 517 из 662 Which histologic subtype of cervical carcinoma is represented in this micrograph? Arrows point to keratin pearls.  Melanoma  Adenocarcinoma  Squamous cell carcinoma  Neuroendocrine carcinoma 518 518 из 662 Which of the following should NOT be used for hemostasis in cases of life-threatening hemorrhage from cervical cancer?  Lugol solution  Emergent radiation  Uterine artery embolization  Monsel (ferric subsulfate) solution 519 519 из 662 In patients with stage I cervical cancer, what percentage of Pap tests are read as consistent with cancer?  5 to 10 percent  10 to 20 percent  30 to 50 percent  60 to 80 percent 520 520 из 662 A woman presents for a routine health maintenance visit. The following is visualized during speculum examination. What is the most appropriate next step?  Perform a Pap test  Perform a cervical biopsy  Refer to a gynecologic oncologist  Obtain abdominopelvic computed tomography 521