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Question 1221Question →

Match each patient's clinical profile with the most appropriate contraceptive method based on the World Health Organization Medical Eligibility Criteria (WHO MEC) and specific non-contraceptive benefits.

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Items

A 24-year-old woman with a history of oligomenorrhea, severe acne, and bothersome facial hair growth who desires contraception.
A 37-year-old woman who smokes a pack of cigarettes daily, has regular menses, and requests a long-acting, hormone-free contraceptive method.
A 31-year-old woman with a history of unprovoked deep vein thrombosis who currently experiences severe, heavy menstrual bleeding causing anemia.
A 22-year-old woman with sickle cell disease experiencing frequent vaso-occlusive pain crises who struggles to remember taking daily medications.

Matches

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Answer

The patient with hyperandrogenism matches with Combined oral contraceptive pills; the older smoker matches with the Copper intrauterine device; the patient with a prior DVT and heavy bleeding matches with the Levonorgestrel-releasing intrauterine device; and the patient with sickle cell disease matches with Depot medroxyprogesterone acetate.
Contraceptive selection must prioritize patient safety by avoiding methods with WHO MEC Category 4 contraindications (such as estrogen in women >35 who smoke or have a history of unprovoked thromboembolism) while leveraging the non-contraceptive benefits of specific methods (such as reduced sickling crises with DMPA, reduced bleeding with LNG-IUD, and reduced hyperandrogenism with COCs).

Step-by-Step Solution

1
Analyze the contraindications for the 37-year-old smoker and the 31-year-old with a prior deep vein thrombosis.
Both patients have absolute contraindications to estrogen (WHO MEC Category 4). The smoker requires a hormone-free method, making the copper intrauterine device ideal. The patient with the prior DVT has heavy menstrual bleeding, which is best treated with the levonorgestrel-releasing intrauterine device.
Estrogen increases the risk of cardiovascular events and thromboembolism.
2
Evaluate the non-contraceptive benefits required for the 24-year-old with hyperandrogenism and the 22-year-old with sickle cell disease.
The patient with hyperandrogenism and oligomenorrhea (PCOS) benefits most from combined oral contraceptive pills. The patient with sickle cell disease benefits most from depot medroxyprogesterone acetate.
Combined oral contraceptives decrease free testosterone levels to treat acne and hirsutism. Depot medroxyprogesterone acetate is uniquely known to reduce sickle cell pain crises and does not require daily adherence.

Key Concept

Selection of contraception based on Medical Eligibility Criteria (WHO MEC) and specific non-contraceptive benefits.
Estimated Time:1m 30s
Question 1222Question →

Match each prenatal screening test or prophylactic intervention with its appropriate clinical indication and temporal timing during an uncomplicated pregnancy.

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Items

Syphilis, HIV, and Hepatitis B screening
Chlamydia and Gonorrhea screening
Early 50-g oral glucose challenge test
Administration of Tdap vaccine

Matches

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Answer

Syphilis, HIV, and Hepatitis B screening is universally recommended at the initial visit. Chlamydia and Gonorrhea screening is indicated at the initial visit for patients <25 or those who are high-risk. Early glucose screening is for patients with pregestational diabetes risk factors. The Tdap vaccine is universally recommended between 27 and 36 weeks.
The established standard of prenatal care requires stratifying interventions by gestational age and patient risk profile. Syphilis, HIV, and Hep B are universal initial screens. Chlamydia/Gonorrhea and early GCT are initial screens reserved for specific risk groups. Finally, Tdap is a universal intervention delayed until 27-36 weeks to optimize neonatal immunity.

Step-by-Step Solution

1
Identify the criteria for universal versus risk-based screening at the first prenatal visit.
Syphilis, HIV, and Hepatitis B are universal screens; Chlamydia/Gonorrhea and early glucose testing are risk-based screens.
To correctly allocate first-trimester screening modalities based on national obstetric guidelines.
2
Differentiate the specific risk factors for the targeted first-trimester screenings.
Age <25 dictates Chlamydia/Gonorrhea screening, whereas metabolic risk factors (e.g., obesity) dictate early glucose screening.
To precisely match the targeted tests to their respective clinical indications.
3
Determine the correct gestational timing for prophylactic interventions.
The Tdap vaccine is administered at 27-36 weeks rather than the first visit.
To match the intervention to its optimal temporal window for fetal benefit.

Key Concept

Routine prenatal care involves a combination of universal infectious disease screening at the initial visit, targeted risk-based screening for specific populations, and temporally optimized prophylactic interventions such as the Tdap vaccine in the late second or third trimester.
Question 1223Question →

Match each of the following major obstetric emergencies during labor and the puerperium with its classic physical examination or clinical presentation.

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Items

Uterine atony
Genital tract laceration
Retained placental fragments
Uterine inversion
Uterine rupture

Matches

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Answer

Uterine atony matches with a soft, boggy uterus; Genital tract laceration matches with a firm uterus and continuous trickle of blood; Retained placental fragments matches with missing cotyledons; Uterine inversion matches with a vaginal mass and unpalpable abdominal fundus; Uterine rupture matches with sudden pain and regression of fetal station.
Each obstetric emergency has a distinct and classic clinical presentation. Uterine atony is characterized by a soft, boggy uterus. Genital tract lacerations present with a firm uterus but continued bleeding. Retained placenta is identified by missing cotyledons on inspection. Uterine inversion presents with an unpalpable abdominal fundus and a vaginal mass. Uterine rupture is classically associated with sudden pain, cessation of contractions, and loss of fetal station.

Step-by-Step Solution

1
Identify the clinical presentation of uterine atony.
A soft, boggy, enlarged uterus with profuse hemorrhage.
The failure of the myometrium to contract prevents spiral artery compression, which is the primary mechanism of postpartum hemostasis.
2
Identify the clinical presentation of a genital tract laceration.
A firm, well-contracted uterus with a steady trickle of bright red blood.
The bleeding originates from the birth canal rather than the placental bed, so the uterus maintains its normal firm tone.
3
Identify the clinical presentation of retained placental fragments.
A firm uterus with continued bleeding and missing cotyledons on placental inspection.
Adherent or retained tissue prevents complete focal contraction, and the visual defect in the delivered placenta is the hallmark diagnostic finding.
4
Identify the clinical presentation of uterine inversion.
A smooth vaginal mass with an unpalpable abdominal fundus.
The fundus collapses inside out into the birth canal, leaving a palpable void in the lower abdomen.
5
Identify the clinical presentation of uterine rupture.
Sudden tearing pain, cessation of contractions, and regression of fetal station.
A complete myometrial wall tear allows the fetus to exit into the peritoneal cavity, halting labor forces and fetal descent.

Key Concept

Clinical presentation and physical examination findings of severe intrapartum and postpartum obstetric emergencies.
Question 1224Question →

Review the following patient scenarios involving complex medical histories. Select the most appropriate contraceptive method for each patient based on the World Health Organization Medical Eligibility Criteria (WHO MEC) and clinical efficacy.

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Items

A 34-year-old G2P2 with systemic lupus erythematosus and a positive lupus anticoagulant. Vital signs are normal. She desires long-term, reversible contraception but has a history of an unprovoked deep vein thrombosis.
A 26-year-old nulligravida with a BMI of 31 kg/m², prior Roux-en-Y gastric bypass surgery, and a known bicornuate uterus. Pelvic exam confirms normal adnexa. She seeks highly effective, maintenance-free contraception.
A 38-year-old G3P3 who smokes one pack of cigarettes daily. Blood pressure is 128/82 mmHg. She reports debilitating monthly pelvic pain during menses and seeks reliable pregnancy prevention.
A 29-year-old nulligravida presenting 72 hours after unprotected intercourse. Exam reveals mucopurulent cervical discharge and cervical motion tenderness. Vital signs: T 37.8°C, HR 90. She urgently requests emergency pregnancy prevention.

Matches

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Answer

The copper IUD is matched to the patient with SLE and antiphospholipid antibodies. The etonogestrel implant is matched to the patient with gastric bypass and a bicornuate uterus. The LNG-IUD is matched to the smoker over 35 with dysmenorrhea. Oral ulipristal acetate is matched to the patient needing emergency contraception with active cervicitis.
Each clinical scenario contains specific medical conditions that dictate the safety and efficacy of contraceptive methods according to the WHO Medical Eligibility Criteria. Matching requires identifying the absolute contraindications (MEC 4) or relative contraindications (MEC 3) in each vignette to isolate the single most appropriate method.

Step-by-Step Solution

1
Evaluate the patient with SLE, positive lupus anticoagulant, and history of DVT.
Identify that both estrogen and progestin-containing methods present unacceptable thromboembolic risks in this highly hypercoagulable state.
This rules out implants, oral pills, and hormone-releasing IUDs, leaving the non-hormonal Copper IUD as the safest choice.
2
Evaluate the patient with a Roux-en-Y gastric bypass and a bicornuate uterus.
Identify that oral absorption is compromised and the uterine cavity is structurally abnormal.
This rules out oral contraceptive pills (due to malabsorption) and all intrauterine devices (due to cavity distortion), leaving the Etonogestrel subdermal implant.
3
Evaluate the 38-year-old smoker with severe dysmenorrhea.
Identify that combined hormonal contraceptives are contraindicated due to age over 35 and heavy smoking.
The Levonorgestrel-releasing IUD provides excellent contraception without cardiovascular risk and directly treats the heavy bleeding and pain associated with dysmenorrhea.
4
Evaluate the patient requiring emergency contraception who has signs of acute pelvic inflammatory disease (PID).
Identify that intrauterine device insertion is contraindicated during an active pelvic infection.
Because it has been 72 hours, Oral ulipristal acetate is chosen over levonorgestrel as it maintains higher efficacy up to 120 hours.

Key Concept

Application of the WHO Medical Eligibility Criteria (MEC) for Contraceptive Use in complex medical scenarios
Question 1225Question →

Match the following clinical and laboratory findings of female genital tract infections to their most appropriate first-line pharmacotherapy and partner management strategy.

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Items

Thin, homogenous, grayish-white vaginal discharge; pH 5.55.5; wet mount shows stippled epithelial cells with obscured borders.
Profuse, yellow-green, frothy vaginal discharge; punctate cervical hemorrhages; wet mount shows motile, flagellated protozoa.
Intense vulvar pruritus; thick, white, curdy vaginal discharge; vaginal pH 4.24.2; KOH prep reveals budding yeast and pseudohyphae.
Mucopurulent cervical discharge; easily induced cervical bleeding (friability); positive nucleic acid amplification test (NAAT) for an obligate intracellular bacterium.

Matches

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Answer

Bacterial vaginosis is treated with a 7-day course of metronidazole without partner treatment. Trichomoniasis requires a 7-day course of metronidazole with partner treatment. Vulvovaginal candidiasis is treated with a single dose of fluconazole without partner treatment. Chlamydia requires a 7-day course of doxycycline with partner treatment.
Each clinical scenario presents pathognomonic features of a specific gynecologic infection, which dictates both the choice of pharmacotherapy and the need for partner management. Bacterial vaginosis (clue cells, high pH) and trichomoniasis (motile protozoa) both utilize oral metronidazole, but only trichomoniasis requires partner treatment. Vulvovaginal candidiasis (normal pH, pseudohyphae) is treated with fluconazole without partner treatment. Chlamydia (mucopurulent cervicitis, positive NAAT) is treated with doxycycline and requires partner treatment.

Step-by-Step Solution

1
Analyze the clinical presentation and diagnostic findings for each patient to identify the etiologic pathogen.
The pathogens are identified as Gardnerella vaginalis (bacterial vaginosis), Trichomonas vaginalis, Candida albicans, and Chlamydia trachomatis, respectively.
Accurate diagnosis based on discharge characteristics, pH, and microscopy is the prerequisite for selecting the correct antimicrobial therapy.
2
Select the guideline-concordant antimicrobial agent and regimen for each infection.
BV and Trichomoniasis (in women) require 7 days of oral metronidazole. Candidiasis requires a single dose of fluconazole. Chlamydia requires 7 days of doxycycline.
Following current CDC STI guidelines ensures optimal eradication and minimizes treatment failure.
3
Determine if concurrent treatment of sexual partners is necessary.
Partner treatment is indicated for STIs (Trichomoniasis and Chlamydia) but not for dysbiosis or opportunistic fungal overgrowth (BV and Candidiasis).
Treating partners for STIs prevents reinfection and halts community transmission.

Key Concept

Diagnosis and management of common gynecologic infections, including indications for concurrent partner treatment.
Estimated Time:1m 30s
Question 1226Question →

Match each clinical presentation during routine prenatal care with its most appropriate next step in management based on standard obstetric protocols.

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Items

At 28 weeks gestation, a 27-year-old O-negative patient (second pregnancy, one prior delivery) presents with an anti-D antibody titer of 1:32.
An asymptomatic Group B Streptococcus bacteriuria was treated at 12 weeks gestation in a 25-year-old primigravida, who is now presenting for her 36-week evaluation.
During a 16-week prenatal visit, a 31-year-old patient (G3P2) is noted to have a maternal serum alpha-fetoprotein result of 3.2 multiples of the median.
Following a 50-g glucose challenge test at 26 weeks gestation, a 32-year-old nulliparous patient receives a plasma glucose result of 158 mg/dL.
Ultrasound assessment at 11 weeks for a 29-year-old pregnant patient reveals a notably enlarged fetal nuchal translucency of 3.8 mm.

Matches

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Answer

The correct matches align each specific screening abnormality with its next indicated step: Rh sensitization requires monitoring fetal MCA Doppler rather than administering RhoGAM; GBS bacteriuria mandates intrapartum prophylaxis without late screening; elevated MSAFP requires a targeted anatomy ultrasound; a positive 1-hour glucose screen requires a 3-hour glucose tolerance test; and an enlarged nuchal translucency warrants offering invasive diagnostic genetic testing.
Each correct pair directly reflects evidence-based guidelines for prenatal care, successfully matching a specific maternal or fetal screening result with the standardized next clinical step to confirm a diagnosis, monitor for complications, or provide prophylaxis.

Step-by-Step Solution

1
Evaluate the Rh status and antibody titer.
The titer of 1:32 indicates established alloimmunization (threshold is >1:16).
Recognizing established alloimmunization prevents inappropriate administration of RhoGAM and directs management toward monitoring for fetal anemia.
2
Analyze the history of GBS bacteriuria.
GBS bacteriuria early in pregnancy guarantees intrapartum prophylaxis.
Heavy colonization early in pregnancy predicts heavy colonization at delivery, so third-trimester screening is bypassed in favor of empiric treatment.
3
Assess the MSAFP elevation.
MSAFP > 2.5 MoM is abnormal and requires structural evaluation.
High alpha-fetoprotein levels are strongly associated with neural tube defects, which are best evaluated next via a comprehensive ultrasound.
4
Interpret the 1-hour glucose challenge result.
A value of 158 mg/dL is abnormal but below the direct diagnostic threshold (>200 mg/dL).
Standard two-step screening protocols require a 3-hour glucose tolerance test to confirm gestational diabetes after a positive 1-hour challenge.
5
Determine the management for an enlarged nuchal translucency.
An NT of 3.8 mm is a structural anomaly requiring diagnostic testing.
While non-invasive screening exists, significant structural findings warrant direct invasive testing (CVS/amniocentesis) for comprehensive microarray analysis.

Key Concept

Standard obstetric protocols dictate specific next steps for abnormal routine prenatal screening tests across all trimesters, focusing on distinguishing between when further screening versus definitive diagnosis or intervention is required.
Question 1227Question →

Match each of the following definitive histopathologic or mucosal biopsy findings to the corresponding pediatric gastrointestinal disorder it most accurately diagnoses.

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Items

Absence of parasympathetic ganglion cells in the submucosal and myenteric plexuses with prominent hypertrophied nerve trunks
Duodenal mucosa demonstrating villous atrophy, crypt hyperplasia, and significantly increased intraepithelial lymphocytes
Esophageal squamous epithelium showing greater than 15 eosinophils per high-power field and basal zone hyperplasia
Distal ileal outpouching tissue demonstrating the presence of heterotopic gastric oxyntic mucosa
Small bowel enterocytes exhibiting prominent clear cytoplasmic lipid vacuoles due to impaired chylomicron assembly

Matches

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Answer

The accurate pairs are: absent ganglion cells with Hirschsprung disease, duodenal villous atrophy with Celiac disease, >15 eosinophils/hpf with Eosinophilic esophagitis, heterotopic gastric mucosa with Meckel diverticulum, and clear lipid vacuoles with Abetalipoproteinemia.
Each histopathologic description provided represents the definitive diagnostic biopsy finding for a specific pediatric gastrointestinal disorder. Recognizing these pathognomonic cellular and structural changes is essential for confirming clinical suspicion when imaging or serology is insufficient.

Step-by-Step Solution

1
Analyze the histopathologic finding of absent ganglion cells and hypertrophied nerves.
Identified as the pathognomonic finding for Hirschsprung disease.
Neural crest cell migration failure leaves the distal colon aganglionic, requiring a rectal suction biopsy to assess the submucosal (Meissner) plexus.
2
Analyze the finding of villous atrophy and intraepithelial lymphocytosis.
Correlated with Celiac disease.
This represents the classic immune-mediated mucosal damage seen in the duodenum upon gluten exposure.
3
Analyze the presence of >15 eosinophils per high-power field in esophageal tissue.
Matched to Eosinophilic esophagitis.
This is the precise histologic diagnostic criterion for distinguishing this allergic condition from severe gastroesophageal reflux disease.
4
Analyze the finding of heterotopic gastric mucosa in an ileal outpouching.
Identified as Meckel diverticulum.
Failure of the omphalomesenteric duct to obliterate can leave an outpouching that frequently contains ectopic gastric mucosa.
5
Analyze the presence of enterocytes stuffed with clear lipid vacuoles.
Linked to Abetalipoproteinemia.
Deficiency in the microsomal triglyceride transfer protein (MTP) prevents chylomicron formation, trapping lipids within the intestinal epithelium.

Key Concept

Histopathologic diagnosis of pediatric gastrointestinal disorders
Estimated Time:2m 0s
Question 1228Question →

Match the characteristic histopathologic finding with the most likely associated gynecologic neoplasm.

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Items

Call-Exner bodies (small fluid-filled spaces between tumor cells)
Schiller-Duval bodies (glomerulus-like structures)
Reinke crystals (eosinophilic cytoplasmic inclusions)
Psammoma bodies (concentric, lamellated calcifications)
Hobnail cells (bulbous nuclei protruding into the lumen)

Matches

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Answer

Call-Exner bodies match with Granulosa cell tumor; Schiller-Duval bodies match with Yolk sac tumor; Reinke crystals match with Sertoli-Leydig cell tumor; Psammoma bodies match with Serous ovarian carcinoma; Hobnail cells match with Clear cell ovarian carcinoma.
Each histopathologic finding is classically associated with its matched neoplasm: Call-Exner bodies with granulosa cell tumors, Schiller-Duval bodies with yolk sac tumors, Reinke crystals with Sertoli-Leydig cell tumors, Psammoma bodies with serous carcinomas, and Hobnail cells with clear cell carcinomas.

Step-by-Step Solution

1
Analyze each histopathologic description provided in the left column.
Identify specific cellular and structural patterns unique to certain ovarian and gynecologic tumors.
Histopathology remains the definitive diagnostic step for classifying ovarian masses and dictating subsequent management.
2
Correlate the classic microscopic findings with their corresponding neoplasms based on histogenetic origin (epithelial, germ cell, or sex cord-stromal).
Call-Exner (Granulosa), Schiller-Duval (Yolk sac), Reinke crystals (Sertoli-Leydig), Psammoma bodies (Serous), Hobnail cells (Clear cell).
These are high-yield, pathognomonic associations required for diagnostic categorization in gynecologic oncology.

Key Concept

Histopathologic diagnosis of ovarian neoplasms
Question 1229Question →

Match each clinical presentation of an obstetric complication to its most likely etiology.

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Items

A 30-year-old G3P2 at 38 weeks gestation with a history of classical myomectomy. Vitals: BP 100/60 mm Hg, HR 110/min. She experiences sudden tearing abdominal pain, loss of fetal station, and abrupt cessation of uterine contractions. Fetal tracing shows sudden bradycardia.
A 34-year-old G2P1 at 36 weeks gestation. Vitals: BP 165/110 mm Hg, HR 98/min. She develops a rigid, exquisitely tender uterus, frequent low-amplitude contractions, and dark vaginal bleeding. Fetal tracing shows recurrent late decelerations.
A 28-year-old G1P0 at 39 weeks gestation with known velamentous cord insertion. Vitals: BP 115/75 mm Hg, HR 85/min. She experiences painless vaginal bleeding immediately after amniotomy. Fetal tracing shows an acute drop in fetal heart rate to 75/min with loss of variability.
A 32-year-old G4P3 at 37 weeks gestation with three prior cesarean deliveries. Vitals: BP 120/80 mm Hg, HR 88/min. She presents with new-onset, painless, bright red vaginal bleeding. Fetal tracing is reactive with a baseline of 140/min and moderate variability.

Matches

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Answer

The presentations match as follows: classical myomectomy history with loss of station is uterine rupture; severe hypertension with rigid uterus is placental abruption; bleeding after amniotomy with fetal bradycardia is vasa previa; and painless bleeding with prior cesareans is placenta previa.
Each scenario maps to distinct pathophysiologic processes: Uterine rupture presents with anatomical disruption (loss of station); abruption involves retroplacental bleeding causing uterine tetany; vasa previa involves torn fetal vessels causing rapid fetal exsanguination; and placenta previa involves exposed maternal vessels bleeding painlessly.

Step-by-Step Solution

1
Evaluate the first vignette for key diagnostic signs.
Identified prior classical incision, sudden pain, loss of station, and cessation of contractions as diagnostic for uterine rupture.
Classical incisions carry the highest risk for rupture, and loss of station occurs when the fetus extrudes into the abdominal cavity.
2
Evaluate the second vignette, focusing on maternal vitals and uterine tone.
Matched severe hypertension, rigid/tender uterus, and dark bleeding to placental abruption.
Hypertensive disorders cause abnormal decidual vasculature, leading to premature placental separation and retroplacental hematoma (hypertonic uterus).
3
Analyze the third vignette's sequence of events and fetal heart rate.
Linked velamentous cord insertion, amniotomy, and immediate fetal bradycardia to vasa previa.
Fetal vessels crossing the membranes are torn during amniotomy, leading to rapid fetal exsanguination and profound bradycardia.
4
Assess the fourth vignette's bleeding characteristics and risk factors.
Correlated painless, bright red bleeding and prior cesarean deliveries with placenta previa.
Prior cesareans predispose to low placental implantation, which bleeds painlessly as the lower uterine segment develops.

Key Concept

Differentiating third-trimester bleeding requires analyzing pain (present in abruption/rupture, absent in previa/vasa previa), uterine tone (rigid in abruption), fetal station changes (rupture), and timing of bleeding relative to membrane rupture (vasa previa).
Question 1230Question →

Match each patient's clinical profile with the most appropriate contraceptive method based on the World Health Organization Medical Eligibility Criteria (WHO MEC) and non-contraceptive benefits.

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Items

A 33-year-old woman with a history of estrogen-receptor positive breast cancer treated successfully 2 years ago, seeking a highly effective, long-acting contraceptive.
A 37-year-old woman who smokes a pack of cigarettes daily and requests a convenient contraceptive method, but strongly prefers not to have a device placed in her uterus.
A 26-year-old woman with a history of unprovoked deep vein thrombosis who suffers from heavy menstrual bleeding and dysmenorrhea.
A 22-year-old woman with moderate acne, hirsutism, and irregular, infrequent menses seeking contraception and symptom management.

Matches

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Answer

Patient 1 (breast cancer history) matches with the Copper intrauterine device. Patient 2 (smoker over 35 refusing IUD) matches with the Etonogestrel implant. Patient 3 (history of DVT with heavy menses) matches with the Levonorgestrel-releasing intrauterine device. Patient 4 (hyperandrogenism and irregular menses) matches with Combined oral contraceptive pills.
Each correct match strictly adheres to the WHO MEC guidelines while maximizing non-contraceptive benefits. All hormonal methods are absolutely contraindicated in active or recent breast cancer (MEC 4), requiring the hormone-free copper IUD. Estrogen is contraindicated in smokers over 35 and patients with a history of DVT (MEC 4), necessitating progestin-only methods; the etonogestrel implant respects the smoker's preference to avoid IUDs, while the levonorgestrel IUD provides targeted treatment for the DVT patient's heavy menstrual bleeding. Finally, combined oral contraceptives are the preferred first-line therapy for managing the hyperandrogenism and cycle irregularity characteristic of suspected polycystic ovary syndrome.

Step-by-Step Solution

1
Analyze each patient's medical history for absolute contraindications to estrogen.
Breast cancer, smoking over age 35, and a history of unprovoked deep vein thrombosis are all absolute contraindications (MEC Category 4) to estrogen-containing methods.
Identifying estrogen contraindications immediately eliminates combined hormonal methods for three of the four patients.
2
Evaluate absolute contraindications to progestin.
A history of breast cancer is also a Category 4 contraindication to progestin-only methods. Therefore, the patient with breast cancer must receive a hormone-free method.
Hormone-dependent cancers preclude the use of any exogenous hormonal contraception.
3
Match the remaining patients with the most appropriate method based on their specific preferences and needed non-contraceptive benefits.
The smoker over 35 refuses IUDs, making the progestin-only implant the best choice. The patient with a history of DVT has heavy bleeding, making the levonorgestrel IUD ideal for targeted symptom relief. The patient with suspected PCOS needs androgen suppression, making combined oral contraceptives optimal.
Tailoring contraception requires balancing patient safety, individual preferences, and the ability of certain methods to manage comorbid symptoms.

Key Concept

Application of the WHO Medical Eligibility Criteria (MEC) for contraceptive use and recognizing non-contraceptive benefits of specific contraceptive methods.
Estimated Time:1m 30s
Question 1231Question →

Match each gestational age milestone during an uncomplicated pregnancy with the most appropriate routine prenatal screening or intervention recommended by standard obstetric guidelines.

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Items

Initial prenatal visit (typically 8-10 weeks gestation)
15 to 22 weeks gestation
24 to 28 weeks gestation
36 to 37 6/7 weeks gestation

Matches

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Answer

The initial prenatal visit corresponds to baseline infectious and immunologic screening (ABO/Rh, HIV, RPR, Hepatitis B, Rubella). The 15-22 weeks interval corresponds to the maternal serum quad screen and fetal anatomic survey. The 24-28 weeks interval corresponds to the glucose challenge test and potential anti-D immune globulin administration. The 36-37 6/7 weeks interval corresponds to Group B Streptococcus rectovaginal screening.
Each gestational milestone in an uncomplicated pregnancy aligns with specific physiological changes and developmental stages. The first visit focuses on baseline labs (blood type, HIV, RPR, Hep B, Rubella). The mid-second trimester (15-22 weeks) is designated for structural and neural tube defect screening via quad screen and ultrasound, as organogenesis is complete. The late second trimester (24-28 weeks) targets peak insulin resistance with the glucose challenge test and addresses Rh alloimmunization risk. Finally, the late third trimester (36-37 6/7 weeks) requires GBS screening to guide intrapartum prophylaxis because maternal colonization is transient and must be assessed close to delivery.

Step-by-Step Solution

1
Identify the primary objectives of the first trimester prenatal visit.
Baseline laboratory testing is required to identify infectious diseases (HIV, syphilis, hepatitis B), immunologic status (rubella, varicella), and maternal blood type (ABO/Rh) to prevent vertical transmission and alloimmunization.
Early detection allows for timely intervention (e.g., antiretroviral therapy, penicillin) to optimize maternal and fetal outcomes.
2
Determine the screening focus of the mid-second trimester (15-22 weeks).
This period is targeted for neural tube defect screening (via maternal serum alpha-fetoprotein or quad screen) and the comprehensive fetal anatomic ultrasound (typically 18-22 weeks).
Fetal structures are sufficiently developed by this stage to evaluate organogenesis and placental location.
3
Recall the late second trimester (24-28 weeks) milestones.
Universal screening for gestational diabetes with a 50-g glucose challenge test is performed. Repeat antibody screening and prophylactic anti-D immune globulin are given to Rh(D)-negative patients.
Placental hormone-induced insulin resistance peaks late in the second trimester, making it the optimal time to detect gestational diabetes. Prophylactic anti-D prevents alloimmunization during the third trimester.
4
Identify the standard late third trimester (36-37 6/7 weeks) intervention.
Universal rectovaginal screening for Group B Streptococcus (GBS) is conducted.
Screening within 5 weeks of expected delivery provides the highest negative predictive value for GBS colonization, guiding intrapartum antibiotic prophylaxis to prevent neonatal sepsis.

Key Concept

Routine prenatal care requires specific screening modalities tied strictly to gestational age to identify and mitigate maternal, fetal, and neonatal risks at their optimal physiological windows.
Question 1232Question →

Match each intrapartum fetal heart rate (FHR) abnormality with its primary underlying physiologic or pathophysiologic mechanism.

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Items

Early decelerations
Variable decelerations
Late decelerations
Sinusoidal pattern
Prolonged deceleration

Matches

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Answer

Early decelerations match with fetal head compression. Variable decelerations match with umbilical cord compression. Late decelerations match with uteroplacental insufficiency. Sinusoidal patterns match with severe fetal anemia. Prolonged decelerations match with acute, sustained oxygenation disruption.
Accurate interpretation of fetal heart rate monitoring requires linking the visible pattern to its physiologic cause. Early decelerations align perfectly with contractions due to head compression. Variable decelerations are abrupt, reflecting the sudden mechanical nature of cord compression. Late decelerations are delayed, reflecting the time it takes for a contraction to restrict blood flow enough to trigger fetal chemoreceptors. Sinusoidal patterns reflect a loss of the normal autonomic baseline control, seen in severe anemia. Prolonged decelerations represent a sustained hypoxic insult.

Step-by-Step Solution

1
Analyze the morphologic characteristics (abrupt vs. gradual, timing relative to contractions) of each fetal heart rate pattern.
Differentiate between early, late, and variable decelerations based on their onset, nadir, and relationship to the uterine contraction cycle.
The precise timing and shape of the deceleration directly point to the underlying autonomic reflex or hypoxic mechanism.
2
Correlate unique or extended patterns (sinusoidal, prolonged) with their specific severe or acute pathophysiologic states.
Identify that a smooth undulating wave indicates anemia or severe hypoxia, while a deceleration lasting over 2 minutes indicates a sustained and potentially catastrophic hypoxic event.
These specific patterns represent severe compromise rather than transient, expected responses to individual contractions.

Key Concept

Fetal heart rate deceleration mechanisms
Estimated Time:1m 30s
Question 1233Question →

Evaluate the following histologic, cytogenetic, and clinical descriptions. Pair each specific finding with its corresponding pediatric hematologic or oncologic diagnosis.

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Items

Bone marrow aspirate reveals greater than 20% lymphoblasts that express terminal deoxynucleotidyl transferase (TdT) and CD10, with a t(12;21) translocation.
Biopsy of a rapidly enlarging facial mass demonstrates sheets of medium-sized lymphocytes, a high mitotic index, scattered macrophages, and a t(8;14) translocation.
Bone marrow evaluation shows greater than 20% myeloblasts containing needle-like, eosinophilic cytoplasmic inclusions; cytogenetic testing reveals a t(15;17) translocation.
Abdominal imaging reveals a large, calcified suprarenal mass crossing the midline; biopsy demonstrates small round blue cells with N-myc gene amplification.

Matches

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Answer

The findings match as follows: B-cell Acute Lymphoblastic Leukemia pairs with TdT, CD10, and t(12;21). Burkitt Lymphoma pairs with starry sky histology and t(8;14). Acute Promyelocytic Leukemia pairs with Auer rods and t(15;17). Neuroblastoma pairs with a midline-crossing calcified mass and N-myc amplification.
Each specific diagnosis has highly conserved and tested cytogenetic or histologic markers. Mapping the t(12;21) to B-ALL, t(8;14) to Burkitt Lymphoma, t(15;17) to APL, and N-myc amplification to Neuroblastoma accurately links the pathophysiology to the disease state.

Step-by-Step Solution

1
Analyze the first description focusing on TdT/CD10 positivity and the t(12;21) translocation.
Identified as B-cell Acute Lymphoblastic Leukemia.
These are the classic immunophenotypic and cytogenetic markers for the most common pediatric leukemia.
2
Analyze the second description focusing on the facial mass, 'starry sky' macrophage pattern, and t(8;14).
Identified as Burkitt Lymphoma.
The 'starry sky' appearance and c-myc translocation t(8;14) are pathognomonic for this highly aggressive B-cell non-Hodgkin lymphoma.
3
Analyze the third description focusing on myeloblasts, Auer rods, and the t(15;17) translocation.
Identified as Acute Promyelocytic Leukemia.
Auer rods and the PML-RARA gene fusion caused by t(15;17) define APL, which is treated with all-trans retinoic acid (ATRA).
4
Analyze the fourth description focusing on the calcified midline abdominal mass and N-myc amplification.
Identified as Neuroblastoma.
Unlike Wilms tumor, Neuroblastoma frequently crosses the midline, is calcified, and its prognosis correlates strongly with N-myc gene amplification.

Key Concept

Molecular, cytogenetic, and histologic hallmarks of pediatric hematologic and solid malignancies.
Estimated Time:1m 30s
Question 1234Question →

Match each clinical presentation of a gynecologic condition with the most appropriate corresponding management step.

Click a left item, then click its matching right item

Items

A 32-year-old primigravida at 39 weeks gestation presents in early labor with clustered, painful vesicles on an erythematous base on the labia majora.
A 24-year-old woman with a copper intrauterine device presents with bilateral lower quadrant pain, mucopurulent cervical discharge, and cervical motion tenderness. She is hemodynamically stable and afebrile.
A 28-year-old woman complains of a copious, frothy, yellow-green vaginal discharge. Microscopic evaluation of the discharge reveals motile, pear-shaped organisms.
A 21-year-old woman reports intense vaginal itching and a thick, white discharge. Vaginal pH is 4.2, and microscopy reveals pseudohyphae.

Matches

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Answer

HSV in labor matches with cesarean delivery; PID with an IUD matches with empiric antibiotics and maintaining the IUD; trichomoniasis matches with patient and partner treatment; vulvovaginal candidiasis matches with antifungal therapy without partner treatment.
Each gynecologic infection has specific, evidence-based management protocols. Active genital herpes during labor necessitates a cesarean delivery to prevent neonatal CNS infection. PID in the presence of an IUD is managed with broad-spectrum antibiotics while keeping the device in place, avoiding unnecessary contraceptive disruption. Trichomoniasis, as an STI, strictly requires partner treatment to stop transmission and reinfection cycles. In contrast, vulvovaginal candidiasis is an overgrowth of normal flora, so treatment is limited to the symptomatic patient with antifungals, without the need for partner therapy.

Step-by-Step Solution

1
Evaluate the patient with active vesicular lesions during early labor.
Identify active genital herpes simplex virus (HSV) infection.
Active HSV lesions during vaginal delivery pose a high risk of vertical transmission to the neonate, necessitating cesarean delivery.
2
Assess the patient with pelvic inflammatory disease (PID) who has an intrauterine device (IUD).
Determine the need for antibiotic therapy and IUD management.
Current guidelines recommend initiating empiric broad-spectrum antibiotics for PID and retaining the IUD, as removal is only indicated if there is no clinical improvement within 48 to 72 hours.
3
Analyze the microscopic findings of motile, pear-shaped organisms in frothy discharge.
Diagnose Trichomonas vaginalis infection.
Trichomoniasis is a sexually transmitted infection, meaning systemic therapy is required for the patient and all recent sexual partners must be treated simultaneously to prevent reinfection.
4
Review the presentation of intense itching, thick white discharge, and pseudohyphae.
Diagnose vulvovaginal candidiasis.
This is a fungal infection, not an STI, so it is treated with a short course of antifungal medication, and partner evaluation is unnecessary.

Key Concept

Management of common gynecologic infections requires tailoring treatment to the specific pathogen, including consideration of mode of delivery in active HSV, partner treatment in STIs like trichomoniasis, and device management in PID.
Question 1235Question →

Match each clinical presentation of a pregnant patient with the most appropriate routine screening test or intervention indicated at that specific gestational age.

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Items

A primigravida at 16 weeks gestation who missed first-trimester evaluation, seeking screening for fetal aneuploidy and neural tube defects.
A pregnant patient at 26 weeks gestation without preexisting diabetes, presenting for a routine second-trimester follow-up visit.
An Rh(D)-negative pregnant woman at 28 weeks gestation whose current indirect Coombs test is negative.
A multiparous woman at 36 weeks gestation with an uncomplicated pregnancy and no history of delivering an infant with invasive bacterial disease.

Matches

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Answer

The correct matches align gestational milestones with ACOG guidelines: 16 weeks requires the quadruple marker screen; 26 weeks requires the 50-g oral glucose challenge test; 28 weeks in an Rh(D)-negative patient requires anti-D immune globulin; and 36 weeks requires Group B Streptococcus rectovaginal screening.
Each routine prenatal intervention must be precisely timed to maximize clinical utility and accuracy. The quadruple marker screen is most accurate between 15 and 22 weeks. Universal screening for gestational diabetes with a 50-g glucose load is indicated at 24 to 28 weeks when insulin resistance begins to peak. Rh(D)-negative, unsensitized women require prophylactic anti-D immune globulin at 28 weeks to prevent alloimmunization for the remainder of the pregnancy. Group B Streptococcus screening is recommended near term (36-37 weeks) to ensure the result is valid at the time of delivery.

Step-by-Step Solution

1
Identify the gestational age and specific maternal risk factors (such as Rh status) presented in each clinical scenario.
The scenarios present distinct milestones: 16 weeks, 26 weeks, 28 weeks (with Rh-negative status), and 36 weeks.
Routine prenatal interventions are strictly scheduled according to gestational age milestones and specific maternal characteristics.
2
Correlate each gestational age with the standard, evidence-based routine screening or intervention recommended for that timeframe.
Matched 16 weeks to aneuploidy/neural tube defect screening, 26 weeks to gestational diabetes screening, 28 weeks to alloimmunization prophylaxis, and 36 weeks to neonatal sepsis prophylaxis.
Applying the correct test at the appropriate time ensures optimal maternal and fetal preventive care.

Key Concept

Routine prenatal care involves specific screening modalities and prophylactic interventions that are strictly tied to gestational age milestones to optimize clinical outcomes.
Question 1236Question →

Match each patient's clinical presentation and biomarker profile with the most likely ovarian neoplasm diagnosis.

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Items

A 1717-year-old female presents with a rapidly growing pelvic mass. Laboratory evaluation reveals a markedly elevated serum alpha-fetoprotein (AFP) and normal β\beta-hCG.
A 2222-year-old female presents with pelvic pain and a solid adnexal mass. Labs show an elevated serum lactate dehydrogenase (LDH) and normal AFP.
A 6565-year-old female presents with postmenopausal bleeding. Endometrial biopsy shows simple hyperplasia. Pelvic ultrasound reveals a solid unilateral ovarian mass.
A 6262-year-old female presents with progressive abdominal distension and early satiety. Imaging shows a complex adnexal mass with ascites. Serum CA-125 is significantly elevated.

Matches

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Answer

The correct matches align the age demographic, clinical signs of hormone production, and specific tumor markers (AFP, LDH, CA-125) with their respective ovarian neoplasms.
Each clinical presentation strongly correlates with a specific gynecologic neoplasm's classic demographic, tumor marker profile, and associated clinical findings. Germ cell tumors present in younger patients with specific markers (AFP, LDH), sex cord-stromal tumors present with hormonal manifestations, and epithelial tumors present with advanced-stage abdominal symptoms in older patients.

Step-by-Step Solution

1
Analyze the presentation of the 1717-year-old with elevated AFP.
The elevation of AFP strongly indicates an endodermal sinus (yolk sac) tumor.
Yolk sac tumors are malignant germ cell tumors that characteristically secrete alpha-fetoprotein.
2
Evaluate the 2222-year-old with a solid mass and elevated LDH.
Elevated lactate dehydrogenase points to a dysgerminoma.
Dysgerminomas are the most common malignant germ cell tumors and typically produce LDH rather than AFP.
3
Assess the 6565-year-old with postmenopausal bleeding and endometrial hyperplasia.
The concurrent endometrial hyperplasia suggests an estrogen-secreting granulosa cell tumor.
Granulosa cell tumors are sex cord-stromal tumors that produce excessive estrogen, leading to endometrial proliferation.
4
Examine the presentation of the 6262-year-old with ascites and elevated CA-125.
These findings are classic for serous cystadenocarcinoma.
Malignant epithelial ovarian tumors, particularly serous carcinomas, typically occur in older women and present with elevated CA-125 and ascites.

Key Concept

Clinical and biochemical profiling of ovarian neoplasms
Question 1237Question →

Match each pediatric patient's clinical presentation with the most likely corresponding imaging finding.

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Items

A 2-week-old previously healthy full-term infant who presents with sudden-onset bilious emesis and hemodynamic instability.
A 6-month-old infant presenting with episodic, inconsolable crying, drawing up of the legs, and lethargy between episodes.
A 4-week-old premature infant (born at 28 weeks gestation) who develops temperature instability, feeding intolerance, and bloody stools.
A newborn with Down syndrome who develops bilious vomiting within the first 24 hours of life.
A newborn with a known diagnosis of cystic fibrosis who fails to pass meconium within the first 48 hours and develops progressive abdominal distension.

Matches

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Answer

Match sudden bilious emesis in a full-term infant to malrotation (corkscrew sign); episodic crying and lethargy in an infant to intussusception (target sign); bloody stools in a premature infant to necrotizing enterocolitis (pneumatosis intestinalis); early bilious emesis in Down syndrome to duodenal atresia (double bubble sign); and failure to pass meconium in cystic fibrosis to meconium ileus (soap bubble sign).
Each clinical vignette provides classic epidemiological and symptomatic clues for a specific pediatric gastrointestinal disorder. A 2-week-old full-term infant with sudden bilious emesis and instability suggests malrotation with midgut volvulus, diagnosed by a corkscrew sign on an upper GI series. A 6-month-old with episodic crying, leg drawing, and lethargy indicates intussusception, classically showing a target sign on ultrasound. A premature infant with feeding intolerance and bloody stools points to necrotizing enterocolitis, diagnosed by pneumatosis intestinalis on plain radiography. A newborn with Down syndrome and bilious vomiting suggests duodenal atresia, marked by a 'double bubble' sign. Finally, a newborn with cystic fibrosis failing to pass meconium indicates meconium ileus, which presents with a 'soap bubble' appearance on radiography.

Step-by-Step Solution

1
Analyze each clinical vignette to establish the most likely underlying diagnosis based on patient age, risk factors, and presenting symptoms.
Diagnoses identified: malrotation with midgut volvulus, intussusception, necrotizing enterocolitis, duodenal atresia, and meconium ileus.
Accurate diagnosis is required to correctly identify the pathognomonic imaging finding for each condition.
2
Recall the classic imaging modality of choice and pathognomonic radiological signs for each identified diagnosis.
Malrotation correlates with an upper GI series showing a corkscrew sign; intussusception correlates with an ultrasound showing a target sign; necrotizing enterocolitis correlates with an X-ray showing pneumatosis intestinalis; duodenal atresia correlates with an X-ray showing a double bubble; meconium ileus correlates with an X-ray showing a soap bubble appearance.
Matching the diagnosis to the imaging finding evaluates knowledge of standard diagnostic workups for pediatric gastrointestinal emergencies.
3
Map each vignette to the corresponding imaging description in the right-hand column.
All items are successfully matched based on their diagnostic correlations.
To complete the matching task accurately and comprehensively.

Key Concept

Classic clinical presentations and pathognomonic imaging findings of pediatric gastrointestinal emergencies.
Question 1238Question →

Match the following classic radiologic findings with the most appropriate pediatric gastrointestinal pathology.

Click a left item, then click its matching right item

Items

Intussusception
Hypertrophic pyloric stenosis
Midgut volvulus
Duodenal atresia
Necrotizing enterocolitis

Matches

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Answer

The correct matches pair each pediatric gastrointestinal pathology with its classic radiologic finding: Intussusception with the ultrasound 'target sign', Hypertrophic pyloric stenosis with specific ultrasound muscle measurements (>4 mm thick, >14 mm long), Midgut volvulus with the 'corkscrew' sign on an upper GI series, Duodenal atresia with the 'double-bubble' sign, and Necrotizing enterocolitis with pneumatosis intestinalis.
Each radiologic finding represents the distinct anatomical and pathological changes characteristic of its respective disease process. Intussusception creates a concentric, multi-layered 'target' appearance as bowel telescopes into itself. Pyloric stenosis is diagnosed by direct measurement of the pathologically hypertrophied pyloric muscle. Midgut volvulus involves the twisting of the mesentery and bowel, radiographically visualized as a 'corkscrew' pattern of contrast flowing through the twisted jejunum. Duodenal atresia is a complete congenital obstruction, causing dilation of the stomach and proximal duodenum ('double-bubble') with no gas passing distally. Necrotizing enterocolitis involves bacterial invasion of the ischemic bowel wall, producing intramural gas seen as pneumatosis intestinalis.

Step-by-Step Solution

1
Analyze the imaging findings for the right lower/upper quadrant ultrasound.
The 'target sign' represents telescoping bowel.
This confirms the diagnosis of intussusception.
2
Identify the significance of muscle thickness > 4 mm and length > 14 mm on ultrasonography.
These measurements indicate hypertrophy of the pyloric muscle.
This is diagnostic of hypertrophic pyloric stenosis.
3
Evaluate the 'corkscrew' sign on the upper gastrointestinal contrast study.
This indicates twisting of the small bowel around the superior mesenteric artery.
This is the classic finding for midgut volvulus.
4
Interpret the 'double-bubble' sign with absent distal gas.
This demonstrates complete proximal obstruction at the level of the duodenum.
This confirms the diagnosis of duodenal atresia.
5
Assess the finding of intramural bowel gas on plain radiography.
This represents pneumatosis intestinalis, caused by gas-producing bacteria invading a compromised bowel wall.
This is the pathognomonic sign for necrotizing enterocolitis.

Key Concept

Recognizing classic radiologic imaging patterns is essential for the timely diagnosis and management of pediatric gastrointestinal emergencies.
Estimated Time:1m 30s
Question 1239Question →

Match each clinical vignette describing an obstetric emergency to the most likely underlying diagnosis. Evaluate the specific risk factors and clinical findings to determine the correct etiology.

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Items

A 32-year-old at 35 weeks gestation with a history of a transmural myomectomy presents with sudden-onset, sharp abdominal pain. Vaginal exam reveals the presenting fetal part is no longer palpable, and profound fetal bradycardia is noted.
A 28-year-old at 37 weeks gestation with severe polyhydramnios experiences a massive gush of clear fluid following spontaneous rupture of membranes. This is immediately followed by unremitting abdominal pain, a rigid uterus, and nonreassuring fetal status.
A 30-year-old at 36 weeks gestation with a known succenturiate placental lobe undergoes artificial rupture of membranes. Minutes later, she develops modest vaginal bleeding and the fetal heart tracing reveals a persistent sinusoidal pattern.
A 34-year-old at 32 weeks gestation with a history of multiple prior cesarean deliveries presents with new-onset, painless, bright red vaginal bleeding following sexual intercourse. Fetal heart tracing is reactive and reassuring.

Matches

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Answer

The correct matches are: 1) The transmural myomectomy vignette matches Uterine rupture; 2) The polyhydramnios rapid decompression vignette matches Placental abruption; 3) The succenturiate lobe and amniotomy vignette matches Vasa previa; 4) The painless bleeding post-intercourse vignette matches Placenta previa.
Differentiating obstetric emergencies requires synthesizing maternal history, inciting events, and fetal monitoring. Uterine rupture occurs in scarred uteri and is marked by loss of fetal station. Placental abruption involves a painful, rigid uterus and can be triggered by sudden uterine decompression. Vasa previa presents with fetal bleeding, identifiable by a sinusoidal heart rate following membrane rupture in high-risk placental anatomies. Placenta previa classically presents as painless, bright red maternal bleeding without immediate fetal distress.

Step-by-Step Solution

1
Analyze the vignette involving the patient with a transmural myomectomy.
The patient presents with sudden severe pain, loss of fetal station, and fetal bradycardia.
These findings are pathognomonic for uterine rupture, a major risk in patients with prior transmural uterine surgery.
2
Evaluate the vignette detailing polyhydramnios and a sudden massive fluid gush.
The rapid loss of amniotic fluid is immediately followed by a rigid, painful uterus and fetal distress.
Sudden decompression of the overdistended uterus causes shearing forces between the placenta and uterine wall, resulting in placental abruption.
3
Assess the vignette describing a succenturiate lobe, amniotomy, and bleeding.
The fetus develops a sinusoidal heart rate pattern following amniotomy.
A sinusoidal pattern indicates severe fetal anemia, confirming that the bleeding originates from torn fetal vessels (vasa previa) associated with the succenturiate lobe.
4
Review the vignette with a patient experiencing painless bleeding after intercourse.
The patient has bright red bleeding without pain and a reassuring fetal heart tracing.
This is the classic presentation of placenta previa, where the placenta covers the cervical os and bleeds easily upon minor contact, typically without causing immediate fetal distress.

Key Concept

Clinical differentiation of third-trimester obstetric emergencies
Question 1240Question →

Based on the World Health Organization Medical Eligibility Criteria (WHO MEC), which contraceptive method is most appropriate for each patient's clinical presentation?

Click a left item, then click its matching right item

Items

A 30-year-old woman on apixaban for an unprovoked pulmonary embolism who experiences heavy, prolonged menses.
A 25-year-old woman diagnosed with active, purulent cervicitis today who requests immediate initiation of a highly effective, long-acting method.
A 37-year-old woman who smokes one pack of cigarettes daily and prefers a daily, patient-controlled oral contraceptive.
A 41-year-old woman currently undergoing chemotherapy for estrogen-receptor-positive breast cancer who desires a long-acting reversible method.

Matches

Show answer & explanation

Answer

Match the VTE patient with heavy menses to the Levonorgestrel IUD; the active cervicitis patient to the Etonogestrel implant; the 37-year-old smoker to the Progestin-only pill; and the breast cancer patient to the Copper IUD.
Each match correctly identifies the WHO MEC Category 1 or 2 (safe) contraceptive option that aligns with the patient's specific request (e.g., long-acting, daily oral, management of heavy bleeding) while strictly avoiding Category 3 and 4 contraindications.

Step-by-Step Solution

1
Evaluate the 30-year-old on apixaban for VTE.
Estrogen is Category 4. Copper IUD worsens her heavy bleeding. LNG-IUD is Category 2 and treats the heavy bleeding effectively.
Must avoid estrogen due to VTE risk, but also manage the heavy menstrual bleeding.
2
Evaluate the 25-year-old with active cervicitis.
IUD insertion is Category 4 due to PID risk. Etonogestrel implant is long-acting, highly effective, and safe.
Uterine instrumentation during active cervical infection can introduce bacteria to the upper reproductive tract.
3
Evaluate the 37-year-old who smokes one pack per day.
Age >=35 and smoking >=15 cigarettes/day makes estrogen Category 4. Progestin-only pill is a safe daily oral method.
Estrogen in this demographic drastically increases the risk of myocardial infarction and stroke.
4
Evaluate the 41-year-old with breast cancer.
All hormonal methods are Category 4. Copper IUD is the only safe highly effective, long-acting method.
Breast cancer growth can be stimulated by both estrogen and progestin.

Key Concept

Applying the WHO Medical Eligibility Criteria (MEC) to safely select contraceptive methods based on patient comorbidities.
Estimated Time:1m 30s
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