QUESTION: 141

A 24-year-old nullipara is being evaluated for infertility. On pelvic examination, she has a single cervix. A diagnostic laparoscopy shows a double uterine fundus. Which of the following is the most likely diagnosis of her uterine anomaly?

septate uterus
unicornuate uterus
bicornuate uterus
didelphic uterus
a diethylstilbestrol (DES) exposed uterus

Answer(s): C

Explanation:

Asingle cavity uterus forms from fusion of paired Müllerian ducts followed by dissolution of the fused medial walls. Uterine anomalies can be divided into five distinct categories: A. failure of formation of one or both Müllerian ducts (unicornuate uterus or absent uterus, respectively); B. failure of fusion of the Müllerian ducts (didelphic uterus, with two cervixes and two vaginal canals separated by a longitudinal septum); C.
partial fusion of the Müllerian ducts (bicornuate uterus); D. failure of dissolution of the fused medial walls of the Müllerian ducts (septate uterus); and E. DES exposed uterus. Afetus exposed to DES (or any estrogen) in the first trimester will often develop a T-shaped uterine cavity. The pathophysiology of this abnormality is unknown. In this patient, a single cervix and a double uterine fundus indicate a bicornuate uterus.

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QUESTION: 142

A 58-year-old G6P4Ab2 diabetic woman who weighs 122.6 kg (270 lb) has her first episode of vaginal bleeding in 5 years. Her physician performs an outpatient operative hysteroscopy and dilatation and curettage (D&C). Which of the following is an indication for the procedure and the most likely diagnosis?

endometrial cancer because of her high parity
endometrial cancer because of her obesity
cervical cancer because of her age
cervical cancer because of her diabetes
ovarian cancer because of her obesity

Answer(s): B

Explanation:

Obesity, advanced age, and hepatic disease are associated with an increased risk of endometrial adenocarcinoma. While postmenopausal bleeding is most commonly caused by atrophic changes in the genital tract, cancer must be considered. Cervical cytology and examination of endometrial histology are absolutely indicated. The risk of endometrial cancer is increased approximately threefold in diabetic women, and obese women have a three- to fourfold increased risk. High parity is a risk factor for cervical cancer; low parity is a risk factor for ovarian and endometrial cancer. Postmenopausal bleeding is a sign of ovarian cancer only if the malignancy secretes estrogen to stimulate the endometrium. An office endometrial biopsy has a sensitivity of about
90%. If postmenopausal bleeding persists, a D&C with hysteroscopy should be done. AD&C alone samples about 50% of the endometrium. For this reason, many gynecologists are performing a hysteroscopy and directed endometrial biopsy in addition to a D&C.

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QUESTION: 143

A pregnant woman is being followed by a nephrologist for chronic glomerulonephritis. Which of the following findings is normal at 28 weeks' gestation?

blood pressure of 132/86 mmHg
blood urea nitrogen (BUN) of 21 mg/100 mL
serum creatinine of 1.1 mg/100 mL
glomerular filtration rate (GFR) of 130 mL/min
glycosuria with a plasma glucose of 130 mg/100 mL

Answer(s): D

Explanation:

Blood pressure tends to drop slightly in normal pregnancy. This woman's blood pressure of 132/86 mmHg is definitely higher than would be expected and suggests the possibility of chronic hypertension. Because the GFR in pregnancy increases normally by as much as 50% to a peak of approximately 160 mL/min, serum creatinine and BUN should be less than 0.9 and 13 mg/100 mL, respectively. The observed values in this patient are elevated or pregnancy. The renal threshold for glucose normally decreases in pregnancy.
Therefore, glycosuria does not always mean diabetes in pregnancy. Several plasma glucose measurements should be obtained in pregnant women with glycosuria to correlate urinary and plasma glucose levels.

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QUESTION: 144

A 25-year-old woman has a positive cervical culture for Neisseria gonorrhoeae. She has had at least two positive cultures for gonorrhea treated in the past. She is afebrile and has no symptoms. The incidence of penicillin-resistant gonorrhea in some areas of the United States is currently as great as 10%. Because of this, the recommended treatment for gonorrhea includes which of the following?

125 mg intramuscular ceftriaxone as a single dose
1 g spectinomycin
2 g ampicillin orally as a single dose
2 g intramuscular cefoxitin
2 g metronidazole as a single dose

Answer(s): A

Explanation:

The current treatment guideline from the Centers for Disease Control and Prevention for uncomplicated gonococcal infections is ceftriaxone 125 mg IM one time. Cefixime 400 mg orally is an alternative. Each is given as a single dose. Importantly, the quinolone class, for example, ciprofloxacin is no longer considered appropriate treatment for gonococcal infections due to drug resistance. To the chosen drug is added azithromycin, 1 g orally, or doxycycline, 100 mg orally twice daily for 7 days. The second drug is added to treat C. trachomatis, which is present in almost 50% of women with gonorrhea. Sexual partners should be treated at the same time

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Free USMLE STEP2 Exam Questions (page: 104)

QUESTION: 141

Explanation:

QUESTION: 142

Explanation:

QUESTION: 143

Explanation:

QUESTION: 144

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