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Answer all the questions
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I have all 55 questions extracted. Given the large number of questions and my budget constraints, I'll answer them all directly from medical knowledge. These are across gynecology, nephrology, respiratory medicine, and gastroenterology.
Here are the answers to all 55 questions:
MULTIPLE CHOICE ANSWERS
1. Most common benign ovarian neoplasm in reproductive age (tissue from all 3 germ layers)
Answer: Mature cystic teratoma (dermoid cyst) - derived from all three embryonic germ layers.
2. First-line pharmacologic agent for ovulation induction in PCOS women seeking pregnancy
Answer: b. Letrozole - an aromatase inhibitor, now preferred over clomiphene citrate per ACOG/ASRM guidelines.
3. Most common histological and clinical subtype of uterine fibroids by anatomical location
Answer: Intramural fibroids (located within the myometrium) are the most common subtype.
4. Moderate persistent asthma is when:
Answer: FEV1 or PEF 60-80% predicted with variability >30% - corresponds to moderate persistent classification.
5. What is NOT a characteristic feature of nephrotic syndrome?
Answer: c. Hypolipidemia - Nephrotic syndrome causes HYPERlipidemia (not hypolipidemia), due to increased hepatic lipoprotein synthesis.
6. Ectopic endometrial glands and stroma within the myometrium with globally enlarged uterus
Answer: Adenomyosis
7. Ovarian cyst filled with thick, chocolate-colored old blood - precise medical term:
Answer: Endometrioma (chocolate cyst)
8. Endocrine finding classically observed in untreated PCOS:
Answer: b. Elevated LH with normal or low FSH (elevated LH:FSH ratio, typically >2:1 or >3:1), along with elevated androgens.
9. Primary support structure of the uterus and upper vagina, attenuation leads to apical prolapse:
Answer: Cardinal (transverse cervical) ligament / Uterosacral ligaments - the cardinal and uterosacral ligament complex provides the primary apical support. The Arcuate option in the choices refers to the arcuate line, not the correct answer. The answer is Cardinal ligament (also called Mackenrodt's ligament).
10. Classic appearance of deep infiltrating endometriosis on diagnostic laparoscopy:
Answer: Powder-burn lesions (dark blue/black or brown nodular lesions), also described as "gunshot" lesions on the peritoneum.
11. Type of fibroid most strongly linked to heavy menstrual bleeding (menorrhagia) and severe anemia:
Answer: Submucosal fibroid - distorts the endometrial cavity and causes the heaviest bleeding.
12. Classification of pyelonephritis according to period:
Answer: a. Primary, b. Acute, c. Chronic renal insufficiency, d. Period of partial remission - Classification by period includes: Active period, Period of partial clinical remission, Period of full clinical and laboratory remission.
13. Fixed, retroverted uterus on bimanual pelvic examination suggests:
Answer: b. Pelvic adhesions / endometriosis - a fixed retroverted uterus is abnormal and suggests adhesions from endometriosis, PID, or previous surgery (not a normal variant).
14. Risk factor for COPD:
Answer: b. Persistent non-atopic wheezer - persistent non-atopic wheezing in childhood is associated with COPD development, often linked to early airway damage.
15. Standard examination position for routine gynaecological evaluations and Pap smears:
Answer: b. Dorsal lithotomy position
16. Most common physical finding on auscultation of the chest in asthma:
Answer: Expiratory wheeze (high-pitched polyphonic wheeze, heard predominantly on expiration).
17. Congenital uterine anomaly from complete failure of fusion of both Müllerian ducts:
Answer: Uterus didelphys (two separate uteri, two cervices) - complete failure of fusion produces didelphys. Uterus septatus results from failure of resorption of the midline septum after fusion.
18. Ovarian tumor in a 65-year-old with dense fibrous stroma and nests of transitional epithelium:
Answer: Brenner tumor (also called transitional cell tumor of the ovary) - characterized by transitional epithelium (Walthard cell nests) embedded in dense fibrous stroma.
19. Membranous nephropathy is the type of:
Answer: a. Idiopathic nephrotic syndrome - membranous nephropathy is the most common cause of nephrotic syndrome in adults and is classified as idiopathic (primary) or secondary.
20. 26-year-old with acute left-sided lower abdominal pain, vaginal spotting, positive pregnancy test:
Answer: Ectopic pregnancy (most likely left tubal ectopic pregnancy - this is a classic presentation).
21. "Autoinflammatory" Rheumatologic Disease:
Answer: b. Chronic Recurrent Multifocal Osteomyelitis (CRMO/CNO) - CRMO is a classic autoinflammatory bone disease in children.
22. What is true about secretory diarrhea?
Answer: b. Interferes with reabsorption - Secretory diarrhea is caused by active secretion of electrolytes/fluid into the gut lumen OR inhibition of normal absorption. It persists with fasting and the osmotic gap is normal (<50 mOsm/kg).
23. Age of manifestation of minimal change nephrotic syndrome:
Answer: a. 2-6 years - Minimal change disease is the most common cause of nephrotic syndrome in children, peak onset ages 2-6 years.
24. What is true about osmotic diarrhea?
Answer: b. Usually coupled with decrease in absorption - Osmotic diarrhea results from poorly absorbed osmotically active solutes in the gut lumen, which retain water. It stops with fasting. The osmotic gap is increased (>125 mOsm/kg).
25. Clinical manifestation of acute bronchitis:
Answer: a. Within 7-8 days the cough becomes productive - Acute bronchitis typically starts with a dry cough that becomes productive after several days; it is most often preceded by an upper respiratory tract infection.
26. Primary non-surgical mechanical device for symptomatic pelvic organ prolapse in poor surgical candidates:
Answer: Pessary (vaginal pessary)
27. Type of dysmenorrhea with painful menstruation in absence of identifiable pelvic pathology, beginning shortly before or with menses:
Answer: Primary dysmenorrhea - caused by prostaglandin-mediated uterine contractions, no underlying pelvic pathology.
28. Renal clinical manifestation of pyelonephritis:
Answer: b. Slight hematuria - The renal clinical manifestation is hematuria (microscopic/slight). Syndrome of intoxication (fever, chills, malaise) and pain syndrome are systemic/local manifestations. Dysuria is a lower urinary tract symptom.
29. Fallopian tube that is blocked and distended with clear fluid in chronic PID:
Answer: Hydrosalpinx - a blocked fallopian tube filled with clear serous fluid (as opposed to pyosalpinx which is pus-filled).
30. Definitive surgical treatment for symptomatic uterine fibroids in a woman who has completed childbearing:
Answer: Hysterectomy - definitive, permanent cure for fibroids.
31. Classification of pyelonephritis according to course:
Answer: b. Primary, b. Chronic - By course: Primary (no underlying urological abnormality) vs. Secondary (associated with structural/functional abnormality); also Acute vs. Chronic by course.
32. Environmental potential risk factor of asthma that is NOT:
Answer: a. Race/Ethnicity - Race/ethnicity is a host (non-modifiable) risk factor, not an environmental one.
33. What is NOT a risk factor for acute bronchiolitis?
Answer: c. Preponderance of Females - Acute bronchiolitis (RSV bronchiolitis) actually has a male preponderance. Being female is NOT a risk factor.
34. Lung function of persistent atopic wheezer at birth:
Answer: a. Normal - Persistent atopic wheezers have normal lung function at birth; their lung function declines over time due to allergic airway inflammation.
35. Environmental potential risk factor of asthma:
Answer: All of the above (a. Occupational sensitizer, b. Air pollution, c. Respiratory infections) - all three are recognized environmental risk factors for asthma.
36. Embryological structure giving rise to fallopian tubes, uterus, and upper vagina:
Answer: b. Paramesonephric (Müllerian) ducts - The Wolffian (mesonephric) ducts give rise to male reproductive structures.
37. Mild intermittent asthma is when:
Answer: FEV1 or PEF ≥80% predicted with variability <20%, symptoms ≤2 days/week.
38. What is true about osmotic diarrhea?
Answer: b. Interferes with reabsorption / decreased absorption - osmotic diarrhea is due to decreased/impaired absorption of solutes causing osmotic retention of water in the gut. It stops with fasting.
39. Classification of pyelonephritis according to renal function:
Answer: c. With disorders of renal function (or without disorders) - Classification by renal function: with impaired renal function vs. without impaired renal function.
40. Most common anatomical site for ectopic pregnancy implantation:
Answer: c. Ampulla of the fallopian tube - >70% of ectopic pregnancies implant in the ampullary portion of the fallopian tube.
41. Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome - matching clinical presentation:
Answer: Primary amenorrhea with absent uterus and upper vagina, normal female karyotype (46,XX), normal secondary sexual characteristics (normal ovarian function), and a blind-ending or absent vaginal canal.
42. Type of surgery carrying the highest risk for post-operative pelvic adhesions:
Answer: Colorectal/bowel surgery or myomectomy - among gynecological surgeries, myomectomy carries the highest risk; among all surgeries, bowel/colorectal surgery is associated with the most adhesions.
43. Asthma is characterized by (all that apply):
Answer: a. Airway inflammation, b. Airflow restriction, c. Airway hyperresponsiveness - Asthma is defined as a chronic inflammatory disorder with variable airflow obstruction and bronchial hyperresponsiveness.
44. Pathophysiology of late acute asthma:
Answer: a. These changes cause bronchial hyperresponsiveness and obstruction - Late-phase asthma reaction involves inflammatory cell infiltration (eosinophils, T-cells), cytokine release, causing sustained airway inflammation, hyperresponsiveness, and obstruction persisting 4-12 hours after the trigger.
45. Under FIGO PALM-COEIN classification for AUB, structural etiology:
Answer: b. Ovulatory dysfunction is NOT structural (it's under COEIN). The structural etiologies are PALM: Polyp, Adenomyosis, Leiomyoma, Malignancy/hyperplasia. Coagulopathy (AUB-C) is also non-structural. A Polyp or Leiomyoma would be the structural answer.
46. Long-term sequela uniquely linked to chronic PID due to fallopian tube scarring:
Answer: Ectopic pregnancy - tubal scarring from chronic PID increases ectopic pregnancy risk. Also causes infertility (tubal factor infertility).
47. How is chronic pelvic pain (CPP) structurally defined in clinical gynecology:
Answer: CPP is defined as non-cyclic pelvic pain of ≥6 months duration, severe enough to cause functional disability or require medical care, localized to the pelvis, anterior abdominal wall, lower back, or buttocks.
48. Hoover sign in a wheezing child - what it is NOT:
Answer: b. Normal diaphragm movement - Hoover sign reflects paradoxical inward movement of the lower chest during inspiration, caused by a flattened diaphragm pulling the lower ribs inward (seen in hyperinflation). Normal diaphragm movement is NOT a feature of Hoover sign.
49. Contraction of gallbladder in hypertonic dyskinesia by ultrasound:
Answer: a. More than 2/3 of the previous volume - In hypertonic (hyperkinetic) gallbladder dyskinesia, the gallbladder contracts excessively, ejecting more than 2/3 of its volume.
50. Complication of pneumonia that is NOT:
Answer: b. Pneumothorax (Pneumotorax) - while empyema and atelectasis are recognized complications of pneumonia, spontaneous pneumothorax is not a typical direct complication of community-acquired pneumonia (though it can occur with certain organisms like Staph aureus or PCP).
51. Infectious etiological factor of acute glomerulonephritis:
Answer: b. Streptococcal - Post-streptococcal glomerulonephritis (PSGN) caused by Group A beta-hemolytic Streptococcus is the classic infectious cause of acute GN.
52. Benign ovarian tumor associated with Meigs syndrome (tumor + ascites + pleural effusion):
Answer: Ovarian fibroma - Meigs syndrome classically consists of ovarian fibroma + ascites + right-sided pleural effusion.
53. Type of benign degeneration most frequent in uterine fibroids during pregnancy:
Answer: Red (carneous) degeneration - caused by venous thrombosis and hemorrhagic infarction during rapid growth in pregnancy (outpacing blood supply).
54. Incubation period of Rotavirus:
Answer: b. <24 hrs - Actually the incubation period of Rotavirus is approximately 1-3 days (24-72 hours). The most accurate answer among the choices is c. <72 hrs.
55. Anatomical structure directly visualized at the upper apex of the vagina on routine speculum examination:
Answer: The cervix (uterine cervix) - the cervix is visualized at the upper apex (vault) of the vagina during speculum examination.
Summary Table
| Q | Answer |
|---|---|
| 1 | Mature cystic teratoma (dermoid cyst) |
| 2 | b. Letrozole |
| 3 | Intramural fibroids |
| 4 | FEV1/PEF 60-80% predicted |
| 5 | c. Hypolipidemia (it's HYPERlipidemia in nephrotic syndrome) |
| 6 | Adenomyosis |
| 7 | Endometrioma |
| 8 | Elevated LH, low/normal FSH (elevated LH:FSH ratio) |
| 9 | Cardinal (Mackenrodt's) ligament |
| 10 | Powder-burn (blue/black) lesions |
| 11 | Submucosal fibroid |
| 12 | Active / Partial remission / Full remission periods |
| 13 | Pelvic adhesions (endometriosis/PID) |
| 14 | b. Persistent non-atopic wheezer |
| 15 | b. Dorsal lithotomy position |
| 16 | Expiratory wheeze |
| 17 | Uterus didelphys |
| 18 | Brenner tumor |
| 19 | a. Idiopathic nephrotic syndrome |
| 20 | Ectopic pregnancy |
| 21 | b. CRMO/CNO |
| 22 | Persists with fasting, normal osmotic gap |
| 23 | a. 2-6 years |
| 24 | b. Decreased absorption, stops with fasting |
| 25 | a. Cough becomes productive by 7-8 days |
| 26 | Pessary |
| 27 | Primary dysmenorrhea |
| 28 | b. Slight hematuria |
| 29 | Hydrosalpinx |
| 30 | Hysterectomy |
| 31 | Primary vs. Secondary / Acute vs. Chronic |
| 32 | a. Race/Ethnicity (host factor, not environmental) |
| 33 | c. Preponderance of Females (males predominate) |
| 34 | a. Normal |
| 35 | All: Occupational sensitizer, Air pollution, Respiratory infections |
| 36 | b. Paramesonephric (Müllerian) ducts |
| 37 | FEV1/PEF ≥80%, variability <20% |
| 38 | Stops with fasting, high osmotic gap |
| 39 | c. With/without disorders of renal function |
| 40 | c. Ampulla of fallopian tube |
| 41 | Primary amenorrhea, absent uterus/vagina, normal 46,XX karyotype |
| 42 | Bowel/colorectal surgery (or myomectomy among gyn procedures) |
| 43 | a+b+c: Inflammation + airflow restriction + hyperresponsiveness |
| 44 | Bronchial hyperresponsiveness and sustained obstruction |
| 45 | PALM = structural (Polyp, Adenomyosis, Leiomyoma, Malignancy) |
| 46 | Ectopic pregnancy / tubal factor infertility |
| 47 | Non-cyclic pain ≥6 months |
| 48 | b. Normal diaphragm movement (Hoover = paradoxical movement) |
| 49 | a. >2/3 of previous volume |
| 50 | Pneumothorax is not a typical complication |
| 51 | b. Streptococcal (PSGN) |
| 52 | Ovarian fibroma |
| 53 | Red (carneous) degeneration |
| 54 | c. <72 hrs (1-3 days incubation) |
| 55 | The cervix |
Answer all the questions me tuoned in video
analyse_media
I have all 23 questions. Here are the answers:
ANSWERS TO ALL 23 QUESTIONS
Question 1 - Infectious causes of pneumonia are:
Answer: d. Microorganisms
Pneumonia caused by microorganisms (bacteria, viruses, fungi, parasites) is classified as infectious pneumonia. Options a, b, and c (aspiration of food, foreign bodies, radiation) cause non-infectious/chemical pneumonia.
Question 2 - Woman with symptomatic fibroids, no desire for future fertility. Minimally invasive treatment?
Answer: b. Uterine Artery Embolization (UAE)
UAE is a well-established, minimally invasive, uterus-preserving (but fertility-compromising) procedure that cuts off blood supply to fibroids. IVF is for fertility, cerclage prevents miscarriage/preterm birth, antibiotics treat infection, and hormonal contraception alone does not treat fibroids definitively.
Question 3 - 28-year-old with thin gray discharge, fishy odor worse after intercourse, pH 5.5, clue cells on microscopy?
Answer: c. Bacterial Vaginosis (BV)
Classic BV triad: elevated vaginal pH (>4.5), fishy (amine) odor especially after intercourse, and clue cells (epithelial cells coated with bacteria) on wet prep. Candidiasis causes thick white discharge + itching; Trichomoniasis causes frothy yellow-green discharge; pH 5.5 rules out candidiasis (pH <4.5).
Question 4 - CDC recommended outpatient regimen for PID:
Answer: b. Ceftriaxone IM + Doxycycline PO ± Metronidazole
This is the standard CDC outpatient PID regimen: a single IM dose of Ceftriaxone 500 mg, plus Doxycycline 100 mg PO BID x 14 days, with or without Metronidazole 500 mg PO BID x 14 days (to cover anaerobes and BV).
Question 5 - Definition of chronic glomerulonephritis?
Answer: a.
The correct definition is option a: "The condition is characterized by irreversible and progressive glomerular and tubulointerstitial fibrosis, leading to reduced GFR and retention of uremic toxins. If disease progression is not halted with therapy, the result is CKD, ESRD, and cardiovascular disease."
Option b is incorrect because it states disease progression "is halted with therapy" - which contradicts the definition of a condition progressing to ESRD.
Question 6 - Complication during labor in women with fibroids:
Answer: b. Malpresentation and dystocia
Large fibroids can mechanically obstruct the birth canal, prevent normal fetal descent, and cause abnormal fetal lie/malpresentation (e.g., transverse, breech), resulting in dystocia (obstructed or dysfunctional labor).
Question 7 - Common risk factor for PID:
Answer: c. Multiple sexual partners
Multiple sexual partners is the most significant behavioral risk factor for PID, as it increases exposure to sexually transmitted pathogens (Neisseria gonorrhoeae, Chlamydia trachomatis). Oral contraceptives actually offer some protection (thickened cervical mucus). Nulliparity and late menarche are not major risk factors.
Question 8 - Woman with fibroids: urinary frequency and constipation are caused by:
Answer: b. Pressure effects of large fibroids
Large fibroids, particularly subserosal or broad ligament fibroids, exert mechanical pressure on adjacent pelvic organs - the bladder (causing urinary frequency/urgency) and the rectum/sigmoid (causing constipation and bloating).
Question 9 - "Autoinflammatory" Rheumatologic Disease:
Answer: c. Periodic Fever Syndromes
Autoinflammatory diseases involve dysregulation of the innate immune system without autoantibodies or antigen-specific T cells. Classic examples include Periodic Fever Syndromes (PFAPA, FMF, CAPS, TRAPS) and CRMO/CNO. Juvenile Dermatomyositis (a) is an autoimmune disease; SLE (b) is autoimmune with autoantibodies.
Question 10 - What is true about secretory diarrhea?
Answer: b. Interferes with reabsorption of water
Secretory diarrhea is caused by active secretion of electrolytes and water into the gut lumen OR impaired reabsorption of water - it persists even with fasting, and the osmotic gap is normal (<50 mOsm/kg). Options a, c, and d describe osmotic diarrhea (poorly absorbed solutes, stops with fasting).
Question 11 - Predominant feature of the clinical history in Asthma:
Answer: a. Episodic shortness of breath, particularly at night, often accompanied by cough
While wheezing, breathlessness, and chest tightness are all features of asthma, the predominant/hallmark clinical history is episodic (recurrent) dyspnea - especially nocturnal - with cough. This pattern of episodic, reversible symptoms is what distinguishes asthma from other chronic airway diseases.
Question 12 - Contraction of the gallbladder in HYPOtonic dyskinesia by ultrasound:
Answer: b. Less than 1/2 of the previous volume
In HYPOtonic (hypokinetic) gallbladder dyskinesia, the gallbladder contracts poorly - ejecting less than 1/2 of its volume (ejection fraction <40%). This is in contrast to HYPERtonic (hyperkinetic) dyskinesia where the gallbladder contracts excessively (>2/3 of volume). Note: this is the reverse of the previous exam's Q49, which asked about HYPERtonic - that answer was >2/3.
Question 13 - Woman with painful grouped vesicles on vulva that ulcerate. Best diagnostic test:
Answer: c. PCR from lesion
Genital herpes (HSV-1 or HSV-2) classically presents with painful grouped vesicles that ulcerate. PCR (polymerase chain reaction) from the lesion/swab is the gold standard diagnostic test - most sensitive and specific. Viral culture was previously standard but is less sensitive. Pap smear, Gram stain, and Amsel criteria are not appropriate for diagnosing herpes.
Question 14 - Connective Tissue Disease that is NOT:
Answer: d. Periodic Fever Syndromes
Periodic Fever Syndromes (e.g., FMF, CAPS) are autoinflammatory, NOT connective tissue diseases. The classic CTDs include SLE, juvenile dermatomyositis, mixed connective tissue disease, scleroderma, Sjögren's syndrome, and polymyositis. This pairs with Q9 - autoinflammatory vs. autoimmune/CTD distinction.
Question 15 - Key finding on bimanual examination in PID:
Answer: a. Cervical Motion Tenderness (CMT)
CMT ("chandelier sign") is the hallmark physical finding of PID on bimanual examination - pain elicited by moving the cervix side to side. It reflects peritoneal irritation from pelvic infection. Along with uterine tenderness and adnexal tenderness, CMT forms the minimum clinical criteria for PID diagnosis (CDC).
Question 16 - Triggering factor of Asthma:
Answer: c. Strong emotional expressions
Triggers are factors that precipitate asthma attacks in already-sensitized individuals. Emotional stress/strong emotional expressions (laughing, crying) can trigger bronchospasm via neurogenic mechanisms. Genetic predisposition (a) and atopy (b) are risk factors (predisposing factors), not triggers.
Question 17 - Common symptom of endometriosis in adolescents:
Answer: b. Dysmenorrhea
Dysmenorrhea (painful periods) - particularly severe, progressive, and poorly responsive to NSAIDs - is the most common presenting symptom of endometriosis in adolescents and young women. It is often dismissed as "normal period pain," contributing to the diagnostic delay of ~8 years (see Q22).
Question 18 - Finding that best differentiates vulvovaginal candidiasis from bacterial vaginosis:
Answer: b. Vaginal itching and vulvar erythema
Vulvovaginal candidiasis (VVC) characteristically causes intense vulvar itching, burning, and erythema with a thick white "cottage cheese" discharge. BV typically causes no inflammation - no itching, no erythema. This inflammatory pattern (pruritus + erythema) is the key differentiating feature.
Question 19 - Most useful diagnostic procedure for genital tuberculosis:
Answer: b. Endometrial biopsy
Endometrial biopsy with histopathology (showing caseating granulomas) and culture for Mycobacterium tuberculosis is the most useful diagnostic procedure for genital TB, which primarily affects the endometrium and fallopian tubes. PCR on endometrial tissue is also highly sensitive.
Question 20 - 30-year-old woman with infertility, amenorrhea, chronic pelvic pain, night sweats, tubal fibrosis on ultrasound:
Answer: b. Genital Tuberculosis
This is a classic presentation of genital TB: young woman with infertility + amenorrhea + constitutional symptoms (night sweats) + tubal fibrosis/calcification on imaging. TB is the leading cause of tubal factor infertility in endemic regions. Endometriosis doesn't cause night sweats or tubal fibrosis; acute gonococcal PID is acute, not chronic with constitutional symptoms.
Question 21 - Clinical diagnosis of Asthma supported by historical signs - which is NOT a historical sign?
Answer: e. Hyperinflated chest
Hyperinflated chest (barrel chest) is a physical examination/clinical sign, not a historical (symptom history) sign. Breathlessness (a), wheezing (b), chest tightness (c), and cough (d) are all symptoms reported in the patient's history. Hyperinflation is found on physical examination or chest X-ray.
Question 22 - Average delay in diagnosis of endometriosis from symptom onset:
Answer: c. 8.3 years (approximately 7-10 years, most cited figure is ~8 years)
Multiple studies consistently report an average diagnostic delay of approximately 7-10 years (the most commonly cited figure is 8.3 years) from symptom onset to confirmed diagnosis of endometriosis, due to symptom normalization, lack of awareness, and requirement for surgical confirmation.
Question 23 - Viral cause of gastroenteritis that is NOT viral:
Answer: a. E. coli
E. coli (Escherichia coli) is a bacterium, not a virus. Calicivirus/Norwalk virus (b), Enteric Adenovirus (c), and Astrovirus (d) are all true viral causes of gastroenteritis.
Quick Summary Table
| Q | Correct Answer |
|---|---|
| 1 | d. Microorganisms |
| 2 | b. Uterine Artery Embolization |
| 3 | c. Bacterial Vaginosis |
| 4 | b. Ceftriaxone IM + Doxycycline PO ± Metronidazole |
| 5 | a. (irreversible, progressive, NOT halted = leads to ESRD) |
| 6 | b. Malpresentation and dystocia |
| 7 | c. Multiple sexual partners |
| 8 | b. Pressure effects of large fibroids |
| 9 | c. Periodic Fever Syndromes |
| 10 | b. Interferes with reabsorption of water |
| 11 | a. Episodic SOB, especially nocturnal, with cough |
| 12 | b. Less than 1/2 of the previous volume |
| 13 | c. PCR from lesion |
| 14 | d. Periodic Fever Syndromes |
| 15 | a. Cervical Motion Tenderness |
| 16 | c. Strong emotional expressions |
| 17 | b. Dysmenorrhea |
| 18 | b. Vaginal itching and vulvar erythema |
| 19 | b. Endometrial biopsy |
| 20 | b. Genital Tuberculosis |
| 21 | e. Hyperinflated chest (physical sign, not historical) |
| 22 | c. 8.3 years |
| 23 | a. E. coli (bacterium, not a virus) |
IMG_8594.jpg
Ans
Answer: c. Vulvovaginal candidiasis
Reasoning - classic diagnostic triad:
| Feature | This Patient | Candidiasis | BV | Trichomonas |
|---|---|---|---|---|
| Discharge | Thick, white ("cottage cheese") | ✅ Thick white, curdy | Thin, gray, fishy | Frothy, yellow-green |
| Vaginal pH | Normal (3.8-4.5) | ✅ Normal | Elevated >4.5 | Elevated >4.5 |
| KOH microscopy | Pseudohyphae | ✅ Pseudohyphae/budding yeast | Clue cells | Motile trichomonads |
| Key symptom | Severe itching + vulvar erythema | ✅ Pruritus + erythema | No inflammation | Variable |
Why the others are wrong:
- a. Bacterial vaginosis - thin gray discharge, fishy odor, elevated pH, clue cells on wet prep - NO itching/erythema
- b. Trichomoniasis - frothy yellow-green discharge, elevated pH, motile flagellated protozoa on wet prep - strawberry cervix
- d. Gonococcal cervicitis - mucopurulent cervical discharge, cervical friability, no pseudohyphae
- e. Syphilis - painless chancre (primary) or diffuse rash (secondary), not vaginal discharge with pseudohyphae
The image also shows the selected answer is c (the filled circle is next to option c), which is correct.
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