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women's health

Practice targeted AMC-style multiple-choice questions on women's health.

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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 58-year-old asymptomatic woman undergoes a screening mammogram. The image is shown. Which of the following is the MOST appropriate next step in the management of this patient?

A. MRI of the breast
B. Reassurance and routine screening in 1 year
C. Ultrasound of the breast
D. Excisional biopsy
E. Stereotactic core biopsy
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Ovarian Cyst
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 32-year-old woman presents to the ED with acute lower abdominal pain and nausea. She reports her last menstrual period was 6 weeks ago, and home pregnancy test was negative yesterday. Vitals are stable. A CT scan of the abdomen and pelvis is performed, the relevant image is shown. What is the MOST appropriate next step in management?

A. Oral contraceptive pills
B. Follow-up ultrasound in 6-8 weeks
C. Laparoscopic cystectomy
D. Serum CA-125 level
E. Immediate laparotomy
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Clinical aspects of mammary Paget's disease occurred on the thoracic wall where simple mastectomy was performed some years before.
Image by Monica Giovannini, Carmelo D'Atri, Quirino Piubello, Annamaria Molino CC BY-SA 2.0 · Source

A 72-year-old woman, status post mastectomy, presents with a lesion. What is the MOST appropriate initial diagnostic test?

A. Patch testing
B. Skin biopsy
C. Wood's lamp examination
D. KOH examination
E. Fungal culture
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Ovarian Cyst
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 45-year-old woman presents with a 3-month history of increasing abdominal bloating and occasional pelvic discomfort. She reports normal menstrual cycles and no weight loss or changes in bowel habits. Physical examination is unremarkable except for mild abdominal distension. Routine blood tests, including CA-125, are within normal limits. A CT scan of the pelvis is performed, with a relevant axial image shown. Considering the clinical presentation, the normal CA-125 level, and the findings demonstrated in the image, what is the MOST appropriate next step in the management of this patient?

A. Reassurance and discharge with advice to return if symptoms worsen.
B. Referral to a gynaecological oncologist for further assessment.
C. Repeat CT scan in 3 months to monitor size and characteristics.
D. Laparoscopic cystectomy for definitive diagnosis and treatment.
E. Initiate a trial of oral contraceptive pills to reduce cyst size.
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A 32-year-old woman, currently 28 weeks pregnant, presents to the antenatal clinic for a routine check-up. She has a history of gestational diabetes mellitus (GDM) diagnosed at 24 weeks of gestation. Her current treatment includes dietary modifications and regular blood glucose monitoring. Her recent fasting blood glucose levels have been consistently between 5.5 and 6.0 mmol/L, and her postprandial levels are between 7.5 and 8.0 mmol/L. She reports feeling well and has no symptoms of hypoglycemia. Her obstetric history includes one previous pregnancy complicated by GDM, which was managed with insulin. Her current pregnancy is otherwise uncomplicated. What is the most appropriate next step in the management of her gestational diabetes?

A. Increase dietary carbohydrate intake
B. Start metformin therapy
C. Schedule an early induction of labor
D. Initiate insulin therapy
E. Continue current management and monitor closely
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 62-year-old woman presents for routine mammography. She has no palpable lumps or skin changes. Her previous mammogram two years ago was normal. The current mammogram is shown. What is the MOST appropriate next step in management?

A. Excisional biopsy
B. Ultrasound of the breast
C. Reassurance and routine screening in 2 years
D. Stereotactic core biopsy
E. MRI of the breast
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 58-year-old woman attends a routine mammography screening. She reports no palpable lumps, pain, or nipple discharge. Her family history is unremarkable. The image shows the findings of the current mammogram. What is the MOST appropriate next step in the management of this patient?

A. Reassurance and routine screening in 1 year
B. Excisional biopsy
C. MRI of the breast
D. Ultrasound of the breast
E. Stereotactic core biopsy
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A 45-year-old woman with a suspicious breast mass on mammography undergoes a biopsy, which confirms invasive ductal carcinoma. She is referred to an oncologist for further management. What is the next step in her management?

A. Order a PET scan.
B. Refer for radiation therapy.
C. Perform a sentinel lymph node biopsy.
D. Start chemotherapy.
E. Start hormonal therapy.
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 55-year-old woman presents for her routine biennial screening mammogram. She denies any breast lumps, pain, or nipple discharge. Her past medical history is notable only for well-controlled hypothyroidism. There is no family history of breast or ovarian cancer. Physical examination reveals no palpable abnormalities. The provided image is a magnified view from the craniocaudal projection of the left breast. Considering the clinical context and the findings demonstrated, what is the most appropriate immediate next step in the management of this patient?

A. Stereotactic core needle biopsy of the area
B. Perform a diagnostic ultrasound of the breast
C. Repeat screening mammography in 12 months
D. Refer for immediate surgical excision
E. Order genetic testing for BRCA1/BRCA2 mutations
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 62-year-old woman presents for routine screening mammography. She has no palpable lumps or skin changes. Her mother was diagnosed with breast cancer at age 68. The provided image is from her mammogram. What is the MOST appropriate next step in management?

A. MRI of the breast
B. Ultrasound of the breast
C. Reassurance and routine screening in one year
D. Stereotactic core biopsy
E. Excisional biopsy
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 62-year-old woman presents for her routine mammogram. She has no personal or family history of breast cancer. She denies any breast pain, nipple discharge, or palpable lumps. Clinical breast exam is unremarkable. Review of her prior mammograms shows stable, scattered fibroglandular densities. The current mammogram is shown. What is the MOST appropriate next step in management?

A. MRI of the breast
B. Stereotactic core biopsy
C. Reassurance and routine screening in 1 year
D. Ultrasound of the breast
E. Excisional biopsy
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A 28-year-old woman presents with a palpable lump in her left breast, noticed two weeks ago. It feels smooth, mobile, and non-tender. No family history of breast cancer. On examination, a 2cm, firm, mobile mass is noted. Considering Australian guidelines for a palpable breast lump in this age group, what is the most appropriate initial investigation?

A. MRI breast
B. Core biopsy
C. Mammography
D. Ultrasound scan
E. Fine needle aspiration cytology
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 58-year-old woman presents for her scheduled screening mammogram. She reports no breast lumps, pain, or nipple discharge. Her past medical history includes well-controlled hypertension and osteoarthritis. She has no known family history of breast or ovarian cancer. Physical examination reveals no palpable abnormalities in either breast or axillae. The mammogram is performed, and the image provided is a detail from the craniocaudal view of the left breast. Considering the clinical presentation and the findings demonstrated in the provided image, what is the most appropriate immediate next step in the management of this patient?

A. Repeat mammography in 6 months
B. Ultrasound of the breast
C. Excisional biopsy
D. Referral for genetic counselling and testing
E. Stereotactic core biopsy of the suspicious area
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A 32-year-old woman, G1P1, presents to her general practitioner at 34 weeks gestation complaining of a new, intensely itchy rash. The rash started on her abdomen around the umbilicus and has now spread to her thighs and buttocks. On examination, there are erythematous papules and plaques, some with vesicles, located within the striae distensae of her abdomen. She denies any personal or family history of eczema or other skin conditions. She is otherwise well, with normal blood pressure and no proteinuria. Fetal movements are normal. Which of the following is the most appropriate initial management?

A. Oral corticosteroids
B. Topical corticosteroids and emollients
C. Referral to a dermatologist for biopsy
D. Induction of labour
E. Oral antihistamines alone
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A 28-year-old woman presents with a palpable lump in her left breast, noticed two weeks ago. It is slightly tender, especially before her period. On examination, it is mobile, firm, and about 2 cm. No skin changes or nipple discharge. What is the most appropriate initial investigation?

A. Ultrasound of the breast
B. Observation and review in 3 months
C. MRI of the breast
D. Fine needle aspiration cytology (FNAC)
E. Mammography
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 62-year-old woman attends her routine mammogram. She has no palpable lumps or skin changes. Her previous mammograms have been normal. The provided image is from the current study. Which of the following is the MOST appropriate next step in management?

A. Stereotactic core biopsy
B. Excisional biopsy
C. Reassurance and routine screening in 2 years
D. Ultrasound of the breast
E. MRI of the breast
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Ovarian Cyst
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 28-year-old woman presents with pelvic pain that started suddenly 2 days ago. Her periods are regular. She denies fever or vomiting. The shown CT was performed. What is the MOST likely diagnosis?

A. Ruptured ovarian cyst
B. Ovarian torsion
C. Appendicitis
D. Pelvic inflammatory disease
E. Ectopic pregnancy
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Ovarian Cyst
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 32-year-old woman presents to the ED with acute lower abdominal pain. She reports nausea but denies fever or vaginal bleeding. Her last menstrual period was 3 weeks ago. A CT scan of the abdomen and pelvis is performed, the relevant image is shown. What is the MOST appropriate next step in management?

A. Laparoscopic cystectomy
B. Expectant management with analgesia
C. CA-125 level
D. Immediate laparotomy
E. Oral contraceptive pills
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A 25-year-old woman presents to the clinic with a 3-day history of dysuria, increased urinary frequency, and urgency. She denies fever, flank pain, or vaginal discharge. She is sexually active and uses oral contraceptives. On examination, she is afebrile and her vital signs are stable. Urinalysis shows pyuria and bacteriuria. What is the most appropriate treatment?

A. Trimethoprim-sulfamethoxazole
B. Ciprofloxacin
C. Ceftriaxone
D. Amoxicillin
E. Nitrofurantoin
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 65-year-old asymptomatic woman undergoes a screening mammogram. The image shows the findings. Her previous mammograms have been unremarkable. What is the MOST appropriate next step in the management of this patient?

A. Stereotactic core biopsy
B. MRI of the breast
C. Excisional biopsy
D. Ultrasound of the breast
E. Reassurance and routine screening in 1 year
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 55-year-old woman with no palpable breast lumps presents for a routine screening mammogram. The image is shown. What is the MOST appropriate next step?

A. Stereotactic core biopsy
B. Ultrasound of the breast
C. Reassurance and routine follow-up in 1 year
D. Excisional biopsy
E. MRI of the breast
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A 42-year-old woman presents with a new, firm, mobile lump in her left breast, noticed two weeks ago. She is otherwise well. What is the most appropriate initial investigation?

A. Fine needle aspiration cytology (FNAC) of the lump
B. Reassurance and review in 3 months
C. Ultrasound of the breast only
D. Core biopsy of the lump
E. Mammogram and ultrasound of the breast
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A 52-year-old woman presents to her GP with a palpable lump in her right breast. She reports no pain, nipple discharge, or skin changes. She has no family history of breast cancer. On examination, the lump is firm, non-tender, and mobile. There is no axillary lymphadenopathy. What is the most appropriate initial investigation?

A. Breast ultrasound
B. Mammography
C. Fine-needle aspiration (FNA)
D. MRI of the breast
E. Core biopsy
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 55-year-old woman undergoes routine screening mammography. She is asymptomatic with no personal or family history of breast cancer. Physical examination is unremarkable. The provided image is a magnified view from the craniocaudal projection of the right breast. Based on the findings demonstrated, what is the most appropriate immediate next step in the management of this patient?

A. Stereotactic core needle biopsy of the area.
B. Order genetic testing for BRCA1/BRCA2 mutations.
C. Proceed directly to surgical excision.
D. Repeat screening mammography in 12 months.
E. Perform a diagnostic ultrasound of the breast.
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 62-year-old woman presents for her routine mammogram. She has no personal or family history of breast cancer. She denies any breast pain, nipple discharge, or palpable lumps. Clinical breast exam is unremarkable. Her previous mammograms have been negative. The current mammogram reveals findings as shown in the image. What is the MOST appropriate next step in management?

A. Ultrasound-guided core biopsy
B. MRI of the breast
C. Stereotactic core biopsy
D. Excisional biopsy
E. Reassurance and routine screening mammography in 1 year
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Ovarian Cyst
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 28-year-old female presents to the ED with acute onset right lower quadrant pain. She reports nausea and vomiting. Her last menstrual period was 6 weeks ago, and she denies any vaginal bleeding. She is hemodynamically stable. A CT scan of the abdomen and pelvis is performed, with a relevant image shown. What is the MOST appropriate next step in the management of this patient?

A. Emergency hysterectomy
B. Laparoscopic cystectomy
C. Administration of broad-spectrum antibiotics
D. Initiate anticoagulation therapy
E. Expectant management with analgesia
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A 28-year-old woman using a combined oral contraceptive pill is prescribed carbamazepine for newly diagnosed epilepsy. What is the most appropriate advice regarding her ongoing contraception?

A. Switch to a standard dose progestogen-only pill.
B. Stop the carbamazepine and consult her neurologist.
C. Switch to a non-hormonal method or depot medroxyprogesterone acetate.
D. Continue the combined pill and use condoms for 7 days.
E. Double the dose of her current combined oral contraceptive pill.
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A 45-year-old woman presents to her GP with a 6-month history of irregular menstrual cycles and hot flashes. She also reports mood swings and difficulty sleeping. Her last menstrual period was 3 months ago. What is the most likely diagnosis?

A. Hypothyroidism
B. Hyperthyroidism
C. Perimenopause
D. Polycystic ovary syndrome (PCOS)
E. Premature ovarian insufficiency
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Ovarian Cyst
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 28-year-old female presents to the ED with acute onset right lower quadrant pain. She reports nausea and vomiting. Her last menstrual period was 6 weeks ago, and she denies any vaginal bleeding. She is hemodynamically stable. A CT scan of the abdomen and pelvis is performed, with a relevant image shown. What is the MOST appropriate next step in the management of this patient?

A. Laparoscopic cystectomy
B. Immediate laparotomy
C. Expectant management with analgesia
D. Oral contraceptive pills
E. Serum CA-125 level
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A 25-year-old man and a 23-year-old woman, newlyweds, are planning a 3-week trip to South America. The woman is not on oral contraceptives and wants to conceive. They are concerned about Zika. What advice can you provide?

A. Start OCP now and avoid unprotected sex for 3 months post-trip.
B. No need to delay pregnancy; just use mosquito repellent.
C. The Zika vaccine is available and recommended.
D. Defer pregnancy for 2 weeks post-trip.
E. Defer pregnancy for 6 months post-trip.
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A 32-year-old woman presents to the clinic with a 6-month history of irregular menstrual cycles and excessive facial hair growth. She has gained 5 kg over the past year and reports difficulty losing weight despite regular exercise. On examination, she has acne and hirsutism. Her BMI is 28 kg/m². Blood tests reveal elevated testosterone levels and normal TSH and prolactin levels. What is the most likely diagnosis?

A. Androgen-secreting ovarian tumor
B. Polycystic ovary syndrome (PCOS)
C. Congenital adrenal hyperplasia
D. Hypothyroidism
E. Cushing's syndrome
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A 28-year-old woman presents to her GP with a 3-month history of amenorrhea. She reports occasional headaches and galactorrhea. She is not on any medications and has no significant past medical history. On examination, her vital signs are normal, and there are no visual field defects. A pregnancy test is negative. What is the most appropriate initial investigation?

A. MRI of the brain
B. Serum prolactin level
C. Thyroid function tests
D. FSH and LH levels
E. Pelvic ultrasound
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A 35-year-old woman with a family history of BRCA1-associated breast cancer is considering genetic testing. She is asymptomatic and has no personal history of cancer. What is the MOST appropriate initial step in her management?

A. Ordering a BRCA1/2 gene mutation analysis
B. Prescribing prophylactic tamoxifen
C. Suggesting prophylactic bilateral mastectomy
D. Recommending annual mammography starting at age 25
E. Referral to a clinical geneticist or genetic counselor for pre-test counseling and risk assessment
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Ovarian Cyst
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 32-year-old woman presents to her general practitioner with a 6-month history of worsening dysmenorrhea and pelvic pain, particularly on the left side. She reports no fever, weight loss, or abnormal vaginal bleeding. Her last menstrual period was 2 weeks ago and was normal. Physical examination reveals mild left adnexal tenderness. A CT scan of the pelvis was performed, the relevant image is shown. Given the clinical context and the imaging findings, what is the MOST appropriate next step in management?

A. Refer for diagnostic laparoscopy
B. Prescribe NSAIDs and schedule a follow-up appointment in 3 months
C. Initiate combined oral contraceptive pill
D. Repeat pelvic ultrasound in 6-12 weeks
E. Order serum CA-125 levels
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A 50-year-old woman with a breast lump undergoes a mammogram, which shows microcalcifications. A core biopsy confirms ductal carcinoma in situ (DCIS). What is the most appropriate next step?

A. Start chemotherapy.
B. Perform a mastectomy.
C. Observe with repeat imaging in 6 months.
D. Perform a lumpectomy with radiation.
E. Start tamoxifen.
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A 28-year-old woman presents to the emergency department with sudden onset of severe right lower abdominal pain. She reports nausea but no vomiting. Her last menstrual period was two weeks ago, and she is not sexually active. On examination, she has tenderness in the right lower quadrant with guarding. Her vital signs are stable. A pelvic ultrasound shows a 5 cm cyst on the right ovary with free fluid in the pelvis. What is the most likely diagnosis?

A. Ovarian torsion
B. Ectopic pregnancy
C. Ruptured ovarian cyst
D. Pelvic inflammatory disease
E. Appendicitis
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A 35-year-old woman presents with a 2cm, firm, mobile lump in her left breast, noticed two weeks ago. She is otherwise well. What is the most appropriate initial investigation?

A. Core biopsy
B. Mammography
C. Fine needle aspiration cytology (FNAC)
D. Reassurance and review in 3 months
E. Ultrasound of the breast
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A 30-year-old woman attends her first antenatal visit at 28 weeks gestation. She has no significant medical history and received her last tetanus booster 10 years ago. She is otherwise well. According to Australian guidelines, which vaccination is most specifically recommended for administration during this gestational period?

A. Hepatitis B vaccine
B. Influenza vaccine
C. Measles-mumps-rubella (MMR) vaccine
D. Varicella vaccine
E. Diphtheria-tetanus-acellular pertussis (dTpa)
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A 52-year-old woman presents to her general practitioner with concerns about irregular menstrual bleeding over the past six months. She has a history of obesity, with a BMI of 32 kg/m², and was recently diagnosed with type 2 diabetes mellitus. She reports that her periods have been irregular for the past few years, often skipping months. She is not currently on any hormone replacement therapy. On examination, she has no signs of hirsutism or virilization. Her blood pressure is 140/85 mmHg, and her fasting blood glucose level is 8.5 mmol/L. Which of the following groups of women is most at risk for developing endometrial hyperplasia?

A. Women with a history of smoking and low BMI
B. Women with obesity and chronic anovulation
C. Women on combined oral contraceptive pills
D. Women who have undergone hysterectomy
E. Women with a history of regular menstrual cycles
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 58-year-old woman attends a routine mammography screening. She reports no palpable lumps, pain, or nipple discharge. Her family history is unremarkable. The current mammogram reveals new findings compared to her prior images from the last 5 years. The image is shown. What is the MOST appropriate next step?

A. Reassurance and repeat mammogram in 1 year
B. MRI of the breast
C. Excisional biopsy
D. Stereotactic core biopsy
E. Ultrasound of the breast
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Ovarian Cyst
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 35-year-old female presents with chronic pelvic pain. The provided CT was performed. What is the MOST appropriate initial management?

A. Laparoscopic cystectomy
B. CA-125 level
C. Trial of oral contraceptives
D. Observation with repeat imaging in 6 weeks
E. Immediate laparotomy
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Ovarian Cyst
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 28-year-old woman presents with pelvic pain that started suddenly 2 days ago. Her periods are irregular. She denies fever or vomiting. The shown CT was performed. What is the MOST likely diagnosis?

A. Tubo-ovarian abscess
B. Ovarian torsion
C. Ectopic pregnancy
D. Hemorrhagic ovarian cyst
E. Appendicitis
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A 28-year-old woman presents to the emergency department with sudden onset of severe right lower abdominal pain. She reports nausea and vomiting but denies fever or urinary symptoms. Her last menstrual period was two weeks ago, and she is sexually active. On examination, she has tenderness in the right lower quadrant with guarding. A pelvic ultrasound reveals a 5 cm right ovarian cyst with free fluid in the pelvis. What is the most likely diagnosis?

A. Pelvic inflammatory disease
B. Ruptured ovarian cyst
C. Ovarian torsion
D. Ectopic pregnancy
E. Appendicitis
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A 35-year-old woman with a strong family history of breast cancer (mother and sister diagnosed before age 40) is concerned about her risk. What is the most appropriate genetic testing for this patient?

A. HER2/neu testing
B. KRAS mutation testing
C. p53 mutation testing
D. Estrogen receptor testing
E. BRCA1/BRCA2 mutation testing
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 62-year-old woman presents for routine mammography. The image is shown. What is the MOST appropriate next step?

A. Reassurance and routine screening
B. Stereotactic core biopsy
C. Ultrasound of the breast
D. MRI of the breast
E. Excisional biopsy
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A 28-year-old woman presents to the emergency department with severe lower abdominal pain and vaginal bleeding. She is 8 weeks pregnant by last menstrual period. She reports no fever or chills. On examination, her blood pressure is 100/60 mmHg, heart rate is 110 bpm, and she appears pale and diaphoretic. Abdominal examination reveals tenderness in the lower quadrants without rebound tenderness or guarding. A pelvic examination shows a closed cervical os with moderate bleeding. A bedside transvaginal ultrasound reveals an empty uterus. Which of the following is the most appropriate next step in management?

A. Administer methotrexate
B. Perform an exploratory laparotomy
C. Administer anti-D immunoglobulin
D. Observe and repeat ultrasound in 48 hours
E. Perform a dilation and curettage
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A 32-year-old woman presents to the emergency department with severe right lower quadrant abdominal pain, nausea, and vomiting. She reports her last menstrual period was 6 weeks ago. On examination, she has tenderness and guarding in the right lower quadrant. A urine pregnancy test is positive. What is the most appropriate next step in management?

A. Prescribe analgesics and discharge
B. Schedule an exploratory laparotomy
C. Perform a transvaginal ultrasound
D. Administer methotrexate
E. Order a CT scan of the abdomen
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Ovarian Cyst
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 32-year-old woman presents with pelvic pain and bloating. Her periods are regular. An abdominal CT scan is performed. Based on the image, what is the MOST appropriate next step in management?

A. Oral contraceptive pills
B. CA-125 level
C. Repeat imaging in 6-12 weeks
D. Laparoscopic cystectomy
E. Referral to gynaecological oncology
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Ovarian Cyst
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 31-year-old woman presents with pelvic pain and bloating for 3 months. Her periods are regular. Pelvic exam reveals mild adnexal tenderness. A CT scan is performed, with a relevant image shown. What is the MOST appropriate next step?

A. CA-125 level
B. Reassurance and follow-up in 6-12 months
C. Immediate laparotomy
D. Oral contraceptive pills
E. Laparoscopic cystectomy
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A 32-year-old woman presents to her general practitioner six weeks postpartum with distressing obsessive thoughts about accidentally harming her newborn. She reports spending excessive time checking on the baby and cleaning the nursery, which interferes with her ability to rest and care for herself. She denies any intent to harm her child and feels ashamed of these thoughts. Her past medical history is unremarkable, and she has no history of psychiatric disorders. On examination, she appears anxious but is cooperative and oriented. Which of the following is the most appropriate initial management strategy for her condition?

A. Cognitive-behavioral therapy (CBT) with exposure and response prevention
B. Reassurance and monitoring without immediate intervention
C. Referral to a psychiatrist for further evaluation
D. Initiation of selective serotonin reuptake inhibitor (SSRI) therapy
E. Prescribing benzodiazepines for immediate anxiety relief
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