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Free STEP2 Exam Braindumps (page: 43)

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PDF with 738 Questions

A 22-year-old woman and her 24-year-old partner have been attempting to conceive for 12 months. They have sexual intercourse two to three times per week and use no contraception or coital lubricants. She has never been pregnant and her husband has fathered no pregnancies. She has no history to suggest damage to her Fallopian tubes and her menses occur at 28- to 31-day intervals. What is the probability of conception per ovulation in normally fertile couples?

  1. 5%
  2. 10%
  3. 20%
  4. 35%
  5. 50%

Answer(s): C

Explanation:

Fecundability is the ability to achieve a pregnancy, and the rate per ovulation in couples with no impediment to fertility is approximately 2025%. This figure is reduced as the woman enters her early 30s, if sexual intercourse occurs fewer than one to two times per week, or if the couple use coital lubricants in the periovulatory part of her menstrual cycle. Using the 20% fecundability rate, 20 of 100 couples will achieve a pregnancy in the first menstrual cycle of effort. In the second cycle, 20% of the remaining 80 couples will achieve a pregnancy, that is 16 women. This is a cumulative pregnancy rate of 36%. Twenty percent of the remaining 64 women will conceive in the third cycle, approximately 13 women. The cumulative conception rate after three cycles is approximately 49%. Continuing this calculation, 9095% of normally fertile couples will achieve a pregnancy within 12 ovulations. Based on this calculation, infertility is defined as the inability to conceive after 12 ovulatory cycles.



A 22-year-old woman and her 24-year-old partner have been attempting to conceive for 12 months. They have sexual intercourse two to three times per week and use no contraception or coital lubricants. She has never been pregnant and her husband has fathered no pregnancies. She has no history to suggest damage to her Fallopian tubes and her menses occur at 28- to 31-day intervals.

The statistic in question 166 is fecundability. Fecundity is defined as the probability of having a liveborn child per ovulation. What is the fecundity of normally fertile couples?

  1. 5%
  2. 10%
  3. 20%
  4. 35%
  5. 50%

Answer(s): B

Explanation:

While the probability of conception per ovulation is approximately 20%, about 50% of all conceptions in humans end as a pregnancy loss. Of this percentage, 35% of pregnancies end so early that women never realize they conceived. The remaining 15% are recognized pregnancy losses, most in the first trimester.
Stated otherwise, only 10% of women who conceive will have a liveborn child (50% of the 20% conception rate per ovulation). Fecundity in the future (probability of having a liveborn child) is not reduced after a single pregnancy loss.



A 46-year-old G3P3 woman has had postcoital spotting for 6 months. On pelvic examination, she has a fungating, exophytic lesion arising from her cervix that is approximately 2 cm in diameter. Biopsy of this lesion is interpreted as invasive squamous cell carcinoma of the cervix. There is no evidence of extension of the cancer onto the vagina. The parametria are indurated on bimanual examination, though not to the pelvic sidewall. CT scan of her pelvis and abdomen discloses enlarged paraaortic lymph nodes and metastatic lesions in the parenchyma of her liver.

Which of the following is the FIGO stage of her cancer?

  1. IA
  2. IB
  3. IIB
  4. IIIB
  5. IVB

Answer(s): C

Explanation:

Cervical cancer is currently the only female reproductive tract cancer staged clinically according to FIGO standards. FIGO also requires that the clinical staging be based on technologies generally available worldwide, including third world countries. For this reason, lymphangiography, angiography, CT or MRI scans, laparoscopy, or hysteroscopy are not permitted to stage cervical cancer. Stage I cancer is confined to the cervix. Stage IA is microscopic cancer without a visible lesion. Stage IB is macroscopic cancer visible to the eye. Stage IB is further subdivided into stage IB1 (clinically visible lesion 4.0 cm or less in greatest dimension) and stage IB2 (clinically visible lesion more than 4.0 cm in greatest dimension). Stages IIIV have spread beyond the cervix. Stage IIB is lateral spread into the parametria, but not extending to the pelvic sidewall. Because of the presence of abnormal paraaortic lymph nodes and hepatic changes consistent with metastases, she is actually a stage IVB.



A 46-year-old G3P3 woman has had postcoital spotting for 6 months. On pelvic examination, she has a fungating, exophytic lesion arising from her cervix that is approximately 2 cm in diameter. Biopsy of this lesion is interpreted as invasive squamous cell carcinoma of the cervix. There is no evidence of extension of the cancer onto the vagina. The parametria are indurated on bimanual examination, though not to the pelvic sidewall. CT scan of her pelvis and abdomen discloses enlarged paraaortic lymph nodes and metastatic lesions in the parenchyma of her liver. This woman's childbearing is complete. She is a healthy woman who is close to ideal body weight, exercises regularly, and does not smoke. Which of the following is the most appropriate treatment of this woman?

  1. TAH-BSO
  2. radical hysterectomy with pelvic and paraaortic lymph node dissection
  3. pelvic exenteration
  4. multiagent chemotherapy
  5. combined brachytherapy and external radiation therapy

Answer(s): E

Explanation:

Although this 46-year-old woman is staged as a IIB, she should be treated as a stage IVBbecause of the findings on CT scan. Methods of staging that are similar allow institutions to compare results of treatment without having to account for different staging procedures and criteria. Asimple TAH-BSO is appropriate therapy only for women with carcinoma in situ of the cervix (CIN III, stage 0). Women with stage I or IIA may be treated with radical hysterectomy or with radiation therapy. Beyond stage IIA, only radiation therapy is acceptable. A pelvic exenteration is indicated when there is a central recurrence after maximal dose radiation therapy. Platinum-based chemotherapy has been used for women with metastases or recurrence after radiation therapy. It is considered palliative. Also, some suggest that a lymphadenectomy be performed before the start of radiation. Recently, several have used chemotherapy as primary therapy for bulk disease. There are no randomized-controlled trials to document that chemotherapy is superior to surgery or radiation.






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