NSG6430 MedUQuestions

Case 1 – Self-Assessment

Question

A 34-year-old woman who has no past medical problems nor is
currently taking any medications comes into your office because she noticed a
tender lump in her left breast starting approximately one month ago. She is worried because she has an aunt who
had breast cancer that was BRCA positive.
Her periods have been regular since they started at the age of 12 and
occur every 32 days. She is currently
menstruating. She has three children
aged 12, 9, and 4. On exam, her BMI is
32 and her other vital signs are stable.
On breast exam, you note a mobile rubbery mass of approximately 1 x 1cm
and with regular borders that is tender to palpation. You appreciate no axillary adenopathy. The rest of her physical exam is
unremarkable. Of the information
provided, which of the following places this patient at increased risk for
breast cancer?

Single Choice Answer:

A Age

B Weight

C Parity
history

D Family
history of cancer

E Age
of menarche

Question

A 64-year-old woman
who is overweight with well-controlled hypertension comes to your office
complaining of a lump in her breast that she noticed while showering. She denies any pain, tenderness, or skin
changes. A pertinent review of systems
is negative. Menarche began at the age
of 10. Her first child was born when she
was 29 and she had her second and last child at the age of 33. She experienced menopause at the age of
44. Her mother died of colon cancer when
she was 65 and her father passed away from metastatic prostate cancer at the
age of 70. She has no history of tobacco
use ever and occasionally drinks a glass of wine with dinner. Her BMI is 34. Which of the information provided thus far
puts the patient at decreased risk for breast cancer?

Single Choice Answer:

A Age

B Weight

C Age
at first birth

D Age
at menarche

E Age
at menopause

Question

A 63-year old woman
comes into your office for her annual preventive exam. She has hypertension and type 2
diabetes. She is not sexually active and
experienced menopause at the age of 52.
Her blood pressure is 125/83 and her physical exam otherwise is within
normal limits. You recommend influenza
and zoster vaccination. Her last
colonoscopy was 8 years ago and her last mammogram one year ago was
normal. She has never had an abnormal
Pap smear. At the age of 45 she had a
total hysterectomy for fibroids. You
tell her she does not require a Pap smear today because:

Single Choice Answer:

A She
has never had an abnormal Pap smear

B She
is not sexually active

C She had a total
hysterectomy for fibroids

D She
is 63 years old

E She
experienced menopause more than 10 years ago

Question

A 47-year-old woman comes into your office for a health care
maintenance exam. She has hypertension
and type 2 diabetes. She is not sexually
active and has not yet experienced menopause.
There is no family history of cancer.
Her blood pressure is 118/78, her BMI is 34 and the remainder of her
physical exam is within normal limits.
Her vaccinations are up-to-date, she has a PAP smear today and will have
labs drawn. According to USPSTF, which
of the following is the best recommendation to give her concerning mammography?

Single Choice Answer:

A Should
have started at age 40 and every year thereafter

B Should
have started at age 40 and every 2 years thereafter

C Start
at age 50 and every year thereafter

D Start
at age 50 and every 2 years thereafter

E Screening
mammography is not recommended at this time

Question

A 27-year-old woman comes into your office because she heard
from her friend about a vaccination against cervical cancer and would like
one. She has no medical problems and has
had a Mirena IUD for three years. She
has an allergy to latex and penicillin.
She began having sex at the age of 18 and is currently sexually active
with one partner. She occasionally uses
condoms. She smokes half a pack of
cigarettes per day. Her mother had
endometrial cancer several years ago and had a total hysterectomy. Why is the patient not a good candidate for
the Gardasil vaccination?

Single Choice Answer:

A Age

B Sexual
activity

C Mirena
IUD

D Allergy
to penicillin

E Family
history of endometrial cancer

F Tobacco
use

Case 12 – Self-Assessment

Question

A 33-year-old G0P0 female presents to your clinic for her
first prenatal visit. Her home pregnancy test was positive, she has been
experiencing mild nausea for two weeks. Her last normal menstrual period was
six weeks ago. Her initial prenatal visit should include:

Single Choice Answer:

A Quad
screen

B Abdominal
ultrasound

C Complete
metabolic panel

D Complete
blood count

Question

A 32-year-old female presents at your office for a
preconception health visit. She is a
G2P2, both deliveries were vaginal. Her
first child was born with a neural tube defect.
According to the USPSTF, what doseage of folate should this patient take
daily before she gets pregnant?

Single Choice Answer:

A 1
mg

B 4
mg

C 400
mcg

D 800
mcg

Question

A 24-year-old African American G1P0 at 14 weeks presents
with vaginal bleeding and abdominal cramping. On examination her vital signs
are: blood pressure 120/75 mmHg, pulse rate 74/minute, temperature 98.4 degrees
F taken orally, respiratory rate 18/minute, and oxygen saturation 99% on room
air. On pelvic examination, there is a
small amount of blood in the vagina, the cervical os is open, and there is no
cervical or adnexal tenderness noted. On
pelvic ultrasound, an intrauterine gestational sac with a yolk sac is
seen. What is her diagnosis?

Single Choice Answer:

A Complete
abortion

B Threatened
abortion

C Missed
abortion

D Inevitable
abortion

Question

A 25-year-old caucasian female presents with vaginal
bleeding and cramping. Her last normal
menstrual period was six weeks ago. The
patient’s vital signs are stable. On
speculum exam of the vagina, there is no bleeding from the cervix. A quantitative beta-human chorionic
gonadotropin (beta-hCG) level is 1492 mIU/ml.
The patient is sent home and told to return to in 48 hours. Her beta-hCG on the return visit is 3000
mIU/ml. What is the appropriate next
step in the management of this patient?

Single Choice Answer:

A Surgery
for ectopic pregnancy

B Methotrexate
for ectopic pregnancy

C Ultrasound
to confirm intrauterine pregnancy

D Dilation
and currettage

Question

A 23-year-old heterosexual Caucasian G0P0 female presents to
your office with abdominal pain, fever and vaginal discharge. The discharge has
an abnormal odor. She denies new or multiple sex partners. On pelvic exam,
there is cervical motion tenderness and adnexal pain during the bimanual exam.
A cervical culture is positive for chlamydia trachomatis. What risk factor for
chlamyida infection is present in this patient?

Single Choice Answer:

A Sexual
orientation

B Ethnicity

C Age

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