Gynecologic Disorders

Front 1

A 23-year-old female presents with a lump in her breast. On examination, a single, firm, nontender, mobile mass is palpated. The most likely diagnosis is:

Back 1

Fibroadenomas- second most common benign tumor of the breast. Most common tumor in adolescents and women in their 20s. They are usually single and are firm or rubbery, nontender, and mobile. They do not change in size with the menstrual cycle. Fibrocystic changes are the second most common of the benign breast conditions. Symptoms of fibrocystic changes include breast tenderness that is cyclical and often bilateral. Nodularity is a common physical finding. This condition is most common between the ages of 20 and 50 years. A galactocele is a discrete, milk-filled, cystic or firm mass in the breast of a lactating or recently lactating woman

Front 2

A 22-year-old female presents with a complaint of increased vaginal discharge, no itching, and an unpleasant odor. On examination a grayish white discharge is noted at the introitus and adhering to the vaginal walls. There is no erythema. The most likely finding on a wet mount examination will be:

Back 2

Clue cells

The most likely diagnosis for this patient is bacterial vaginosis. Characteristics of this infection include an increased, malodorous vaginal discharge. There is usually no itching or erythema. The discharge is typically grayish white, is present at the introitus, and adheres to the vaginal walls. Clue cells are epithelial cells stippled with bacteria that obscure the cell border. This is a classic finding with bacterial vaginosis. Other findings include vaginal pH greater than 4.5 and release of an amine (fishy) odor when KOH 10% is applied to the discharge (Centers for Disease Control and Prevention. [2010]. Sexually transmitted diseases treatment guidelines.

Front 3

Persistent vague abdominal pain or discomfort in a 65-year-old woman may be an early sign of:

Back 3

Ovarian Cancer

Early signs of ovarian carcinoma include abdominal discomfort or pain, pressure sensation on the bladder or rectum, pelvic fullness or bloating, and vague gastrointestinal symptoms.

Front 4

A 23-year-old overweight nulliparous female presents with a history of periods every 2 to 3 months for the past 2 years. She has facial acne and is mildly hirsute. The correct term for her menstrual pattern is:

Back 4

Oligomenorrhea is infrequent menses at intervals of more than 35 days

Front 5

Systemic symptoms are uncommon during recurrences of herpes genitalis is true or false?

Back 5

TRUE!

A recurrent genital herpes infection usually takes on a milder course and does not present with systemic symptoms such as fever, malaise, and headache.

Front 6

A nonpregnant 27-year-old female presents in your office with complaints of burning with urination and mild suprapubic discomfort for the past 2 days. What would help you to determine whether she has cystitis or pyelonephritis?

Back 6

Costovertebral angle tenderness

-usually present with pyelonephritis. It would not be present with cystitis

Front 7

An 18-year-old female, who is not sexually active, has never had a period. She has normal breast development and both pubic and axillary hair. Possible causes for her primary amenorrhea include:

Back 7

Uterine agenesis

Primary amenorrhea in association with normal breast development and normal pubic and axillary hair growth is often associated with uterine agenesis. This is the second most frequent cause of primary amenorrhea. The individual with androgen insensitivity syndrome will also have primary amenorrhea. Breast development occurs, but there is little or no pubic or axillary hair. The female with Turner's syndrome has no secondary sexual characteristics development. Asherman's syndrome is characterized by scarring or adhesions in the intrauterine cavity. This is usually the result of uterine surgical procedures or pelvic infection. This would be an unlikely cause for an 18-year-old who has never had a period and who is not sexually active

Front 8

For which of the following women would a breast ultrasound be most appropriate?

A: A 55-year-old with mammogram showing microcalcifications

B: A 25-year-old with a nontender, palpable mass

C:A 40-year-old with breast pain and no palpable mass

D:A 30-year-old with nipple discharge from one breast

Back 8

A 25-year-old with a nontender, palpable mass

The main function of breast ultrasound is to differentiate between a solid and cystic mass. It may also be useful in the differential diagnosis of masses in the dense breast tissue of younger women

Front 9

Hysterosalpingography (HSG)

Back 9

It may be therapeutic as well as diagnostic

This procedure, in addition to being used for evaluation of tubal patency, is in some cases also therapeutic. Postprocedure pregnancy rates are highest when an oil-based medium is used. HSG is performed ideally in the early to midfollicular phase. This timing reduces the risk of irradiating an existing pregnancy. In the procedure, radiopaque dye is injected via a cannula through the cervix. Two radiographic views are usually taken to evaluate the uterus and fallopian tubes

Front 10

A 23-year-old overweight nulliparous female presents with a history of periods every 2 to 3 months for the past 2 years. She has facial acne and is mildly hirsute. The most likely diagnosis for this client is:

Back 10

Polycystic ovarian syndrome

Polycystic ovarian syndrome (PCOS) is characterized by hyperandrogenism evidenced by hirsutism and/or hyperandrogenemia, ovarian dysfunction with oligoanovulation and/or polycystic ovaries, and exclusion of related disorders. About 60% of women with PCOS are obese

Front 11

Characteristics of normal vaginal secretions in a reproductive-age woman include:

Back 11

Characteristics of normal vaginal secretions include a pH of 3.8 to 4.2, presence of epithelial cells, lactobacilli, and a variety of aerobic and anaerobic bacteria. Normal vaginal secretions pool in the posterior fornix and do not adhere to the vaginal walls

Front 12

A 65-year-old female presents with a complaint of intense itching in her vulvar area for the past month. She has not noticed any abnormal vaginal discharge. On examination, thick white plaques are noted in the vulvar area. There is no discrete mass noted. Which of the following is one of the most common causes of vulvar pruritus with a white, wrinkled-appearing lesion involving the entire vulva in a postmenopausal woman?

Back 12

Lichen sclerosus

Lichen sclerosus presents with pruritus and a white, wrinkled-appearing lesion that worsens over time, that may involve the entire vulva, and that may cause adhesions and atrophy of the labia minora. Vulvodynia is a condition presenting with chronic vulvar pain and discomfort. Erythema and "paper cut" erosions may be present. Vulvar vestibulitis syndrome is pain localized to the vulvar vestibule. Localized tenderness and erythema are common. Vulvar cancer may present with intense pruritus and a unifocal plaque, ulcer, or mass on the labia majora

Front 13

A 32-year-old female presents with no menses for the past 3 months. She has a negative urine pregnancy test, normal TSH, and normal prolactin level. A progesterone challenge test is administered, and she has no withdrawal bleeding. She does have withdrawal bleeding when both estrogen and progesterone are administered. Potential causes for this client's amenorrhea include:

Back 13

Hypothalamic dysfunction

results in differing levels of hypoestrogenism depending on the severity of the dysfunction. Hypothalamic dysfunction may be caused by chronic disease, anorexia nervosa, stress, excessive exercise, malnutrition, or, rarely, an anatomic lesion. The individual with androgen insensitivity syndrome would have primary amenorrhea. Although she may have some withdrawal bleeding with Asherman's syndrome, the fact that she has had no menses or even spotting for 3 months makes this less likely. The individual with polycystic ovarian syndrome will have a withdrawal bleed with a progesterone challenge unless there is significant hyperandrogenemia causing endometrial decidualization

Front 14

A 52-year-old female presents with a complaint of leaking urine. During questioning she admits that she does notice that it occurs when she laughs or coughs. She has had to give up her aerobics classes because she frequently leaks urine during the exercises. Treatment options that would be appropriate for the type of incontinence that this patient is experiencing include:

Back 14

Pelvic floor muscle exercises

Nonsurgical treatment for stress incontinence usually involves efforts to enhance the ability of the pelvic floor muscles to compensate for increased intra-abdominal pressure. These include muscle-strengthening exercises, improving estrogen status, electrical stimulation of the muscles, and use of alpha-adrenergic agonists. Bladder retraining and anticholinergic-antimuscarinics are used in treatment of urge incontinence. Intermittent catheterization may be used with bladder retention

Front 15

A 20-year-old female presents with a complaint of swelling on one side of her labia. On examination, a 3-cm nontender cystic mass is noted lateral to the posterior vestibule. This is most likely a:

Back 15

Bartholin's duct cyst

The Bartholin's gland ducts are located bilaterally at approximately 5 o'clock and 7 o'clock at the vaginal introitus. These ducts may become obstructed, causing cyst formation. These cysts are usually not tender unless there is infection present

Front 16

A lesion of secondary syphilis is:

Back 16

Condyloma lata

Patients with secondary syphilis present with localized or diffused mucocutaneous lesions in the palms, soles, mucous patches, and condyloma lata, and with generalized lymphadenopathy along with flu-like symptoms (low-grade fever, headache, sore throat, malaise, arthralgias).

Front 17

A 50-year-old female presents with irregular bleeding at intervals of 20 to 24 days lasting 5 to 6 days and at times heavy over the past 6 months. Her pelvic examination is within normal limits. The endometrium is adequately visualized and is measured with transvaginal ultrasound to be 7 mm. Appropriate management would include:

Back 17

Refer for further evaluation

The perimenopausal woman having abnormal uterine bleeding needs endometrial evaluation. The initial evaluation may be transvaginal ultrasound to measure endometrial thickness and to detect any structural abnormalities. Endometrial thickness of 5 mm or greater or suboptimal visualization of the uterus requires further evaluation. This may include endometrial biopsy possibly combined with saline infusion sonohysterogram or hysteroscopy

Front 18

In which of the following situations is cotesting with cervical cytology plus HPV-DNA testing appropriate?

Back 18

Screening test for 34-year-old female with no previous abnormal Pap test

Cotesting with a combination of cervical cytology plus HPV-DNA testing is appropriate for women 30 years of age and older. Cotesting is not recommended for women younger than 30 years of age because of the high prevalence of human papillomavirus (HPV) infections in sexually active women in this age group. Women 30 years and older with both a negative cytology and negative HPV-DNA test should be rescreened no sooner than 3 years

Front 19

The most lethal gynecologic malignancy is:

Back 19

Ovarian carcinoma

Mortality rate from ovarian carcinoma exceeds all other genital tract malignancies because of the fact that it presents in advanced stage.

Front 20

A 32-year-old female presents with no menses for the past 3 months. She has a negative urine pregnancy test, normal TSH, and normal prolactin level. A progesterone challenge test is administered, and she has no withdrawal bleeding. She does have withdrawal bleeding when both estrogen and progesterone are administered. Which of the following laboratory or diagnostic tests is most appropriate as the next step in this patient's evaluation?

Back 20

FSH and LH levels

The absence of a withdrawal bleed after a progesterone challenge but occurrence of bleeding after estrogen and progesterone are administered suggests that the woman has inadequate endogenous estrogen production but an intact endometrium and outflow tract. Hypoestrogenism may result from problems anywhere in the hypothalamic-pituitary-ovarian axis. Elevated follicle-stimulating hormone (FSH) and luteinizing hormone (LH) indicate that the problem is ovarian. Normal or low FSH and LH indicate that the problem is either in the hypothalamus or pituitary gland. An estradiol level is not necessary because hypoestrogenism has already been established, and a hysterosalpingography is not needed because an intact endometrium and outflow tract have been established

Front 21

Your examination of a female patient indicates that she has external genital warts. You will want to explain to her that:

Back 21

There is no therapy that will eliminate the HPV virus

Goal of treatment is to eliminate present visible disease and improve symptoms; however, there is no therapy that will completely eliminate the HPV virus.

Front 22

An 18-year-old female, who is not sexually active, has never had a period. She has normal breast development and both pubic and axillary hair. The genotype for this condition is:

Back 22

46XX

The individual with uterine agenesis has a normal female karyotype of 46XX. The individual with androgen insensitivity syndrome has a male karyotype of 46XY. The karyotype 45X is seen with Turner's syndrome, and 47XXY is seen with Klinefelter's syndrome in males

Front 23

Translucent nodules on the surface of the cervix are most likely:

Back 23

Nabothian cysts

Nabothian cysts are small translucent yellow or white nodules on the surface of the cervix. These are retention cysts of the endocervical glands and are a normal variation

Front 24

A 38-year-old female presents with menorrhagia and dysmenorrhea for the past 2 years. Physical examination reveals a smooth, diffusely enlarged uterus that is slightly tender. The most likely diagnosis is:

Back 24

Adenomyosis

Adenomyosis is the growth of endometrial tissue in the myometrium. Dysmenorrhea may begin up to 1 week before menses and persist until after the period is over. Heavy bleeding is also associated with adenomyosis. Pelvic examination often reveals a diffusely enlarged, smooth uterus that is tender especially at the time of menses

Front 25

Varicoceles may cause infertility by:

Back 25

Decreasing the sperm count

A varicocele is a dilatation of the internal spermatic vein. It is believed to cause infertility by raising the testicular temperature, which causes decreased sperm production

Front 26

A 52-year-old female with a large uterine fibroid has been placed on leuprolide acetate, a GnRH agonist, to decrease the size of the tumor prior to surgical removal. Which of the following is a common side effect of this medication?

Back 26

Hot flashes

GnRH agonists such as leuprolide acetate act by causing a hypoestrogenic state in the woman. This drug may be used prior to surgery to provide temporary relief from bleeding and to decrease the size of the uterine fibroid. Because side effects include those seen with estrogen deficiency, including hot flashes and bone mineral depletion, this drug is recommended only for short-term therapy

Front 27

A 26-year-old woman presents with multiple, painless, umbilicated papules on her mons pubis. The most likely diagnosis is:

Back 27

Molluscum contagiosum

Molluscum contagiosum has characteristic light-colored papules with an umbilicated center that can be found on the trunk, lower extremities, abdomen, inner thigh, or genital area.

Front 28

A 22-year-old sexually active female presents with complaint of lower abdominal pain since her period ended 2 days ago. She has had an intrauterine contraceptive (IUC) for the past 2 years and has had a new sexual partner in the past 2 months. On examination you find that she has cervical motion tenderness. She does not have significant uterine or adnexal tenderness. Appropriate management would include:

Back 28

Treat with ceftriaxone 250 mg IM plus doxycycline 100 mg po bid for 14 days

According to the Centers for Disease Control and Prevention (CDC), empiric treatment of pelvic inflammatory disease (PID) should be initiated in sexually active young women and others at risk for sexually transmitted infections (STIs) if they have pelvic or lower abdominal pain, no other cause for the illness can be identified, and one or more of the following is present on pelvic examination: uterine tenderness, adnexal tenderness, or cervical motion tenderness. Evidence is insufficient to recommend removal of intrauterine contraception (IUC) in women diagnosed with acute PID

Front 29

A 28-year-old female presents with the complaint of intense vaginal itching. She complains of a "bad smell" especially after intercourse. Pelvic examination reveals erythema of the vaginal walls and cervix and frothy, yellow-green vaginal discharge. You suspect:

Back 29

Trichomoniasis

Trichomoniasis usually presents with a foul-smelling vaginal discharge and itching. Dysuria and dyspareunia may also be present. Examination findings include presence of a frothy, yellow-green vaginal discharge and vulvovaginal erythema. Petechial lesions may also be seen on the cervix and are sometimes called strawberry marks. Male partners are usually asymptomatic but may have symptoms of urethritis or prostatitis

Front 30

Another name for a dermoid cyst is:

Back 30

Benign cystic teratoma

A dermoid cyst is also known as a benign cystic teratoma. It is the most common ovarian germ cell tumor.

Front 31

A 10-year-old female has recently developed breast buds. Which of the following statements would be true concerning this young girl?

Back 31

She has most likely started her growth spurt

Generally, accelerated growth is the first sign of puberty, followed by breast budding, and then appearance of pubic hair, peak growth velocity, and menarche. This sequence of pubertal development generally takes 3 to 4 years

Front 32

A positive "whiff" or amine test is suggestive of:

Back 32

Bacterial vaginosis

A positive "whiff" test is the fishy odor that may be found when 10% KOH is added to a vaginal discharge sample of a patient with bacterial vaginosis. The whiff test is part of Amsel's criteria for diagnosing bacterial vaginosis along with vaginal pH = 4.5, clue cells on saline wet mount, and homogeneous white discharge coating the vaginal wall.

Front 33

The most common cause for chronic pelvic pain in reproductive-age women is:

Back 33

Endometriosis

Seven percent to 10% of premenopausal women are affected by endometriosis; it is the most common cause of chronic pelvic pain.

Front 34

Turner's syndrome can be suspected when the patient has primary amenorrhea and:

Back 34

Short stature and webbed neck

People with Turner's syndrome phenotypically present with short stature, webbed neck, shield chest with widely spaced nipples, increased carrying angle of elbow, arched palate, low neck hairline, short fourth metacarpal bones, disproportionately short legs, swollen hands and feet, lack of breast development, and scant pubic hair.

Front 35

Anticholinergic agents may be used in the treatment of:

Back 35

Urge incontinence

Management/treatment of urge incontinence includes bladder retraining with scheduled voiding, biofeedback, Kegel exercises, avoidance of bladder irritants, surgical removal of obstruction, and use of anticholinergic agents (oxybutynin chloride, tolterodine tartrate).

Front 36

Neoplasm with the highest mortality rate of all cancers that are gynecologically related is:

Back 36

Ovarian carcinoma

Ovarian carcinoma is a malignant neoplasm of the ovary with the highest mortality rate of all cancers that are gynecologically related.

Front 37

A client presents today for an examination with complaints of dysuria, vaginal discharge, and itching. You obtain a wet mount that demonstrates a pH of 4.0, few WBCs, and pseudohyphae. You would prescribe:

Back 37

Terconazole vaginal cream

Vaginal candidiasis presents with vaginal itching and discharge, dyspareunia, vulvar dysuria, and vaginal burning, irritation, and soreness. Diagnostic findings include a normal pH of less than 4.5, negative amine, and a wet mount showing no clue cells, few white blood cells (WBCs), and the presence of hyphae, pseudohyphae, buds, or filaments. Treatment will be with an antifungal agent such as terconazole. In bacterial vaginosis, the pH is greater than 4.5, amine is positive, and a wet mount will demonstrate clue cells and decreased lactobacilli. Trichomoniasis will demonstrate a pH of greater than 4.5, amine may be positive, and a wet mount will demonstrate many WBCs and motile trichomonads

Front 38

The definitive diagnosis of endometriosis is made with:

Back 38

Laparoscopy

Direct visualization with laparoscopy or laparotomy may reveal classic implants; classified as Stage I—minimal, Stage II—mild, Stage III—moderate, and Stage IV—severe.

Front 39

The Bethesda System equivalent for moderate dysplasia or CIN III on a Pap test is:

Back 39

High-grade squamous epithelial lesion

As per the Bethesda System, the equivalent of CIN III on a Pap test is high-grade squamous intraepithelial lesion (HSIL).

Front 40

Vaginal cancer is most commonly found in which part of the vagina?

Back 40

The upper one-third of the vagina

Front 41

Which of the following treatments for genital warts may be used during pregnancy?

Back 41

Trichloracetic acid

For the treatment of genital warts in pregnancy, the Centers for Disease Control and Prevention recommends trichloracetic or bichloracetic acid (80–90% solution): apply a small amount carefully to wart and allow it to dry. It will turn white. Then, apply sodium bicarbonate or talc to neutralize or remove unreacted acid. May reapply weekly

Front 42

A 22-year-old female comes to the office because she has noticed "bumps around her vagina." Your examination indicates that these are external genital warts. You would want to explain to her that:

Back 42

There is no therapy that will eliminate the HPV virus

The currently available treatments for genital warts do not eradicate the virus. The Centers for Disease Control and Prevention (CDC) currently recommends that treatment of partners is not necessary for the management of genital warts. An increase in the frequency of Pap tests is not recommended. If genital warts are located on the cervix, a biopsy is recommended to exclude high-grade squamous intraepithelial lesions prior to treatment (Centers for Disease Control and Prevention.

Front 43

Androgen insensitivity syndrome was previously known as:

Back 43

Testicular feminization

Androgen insensitivity/resistance syndrome is a genetically transmitted androgen receptor defect. The individual is genotypic male (46XY) but phenotypic female or has both female and male characteristics. Previously, this was called testicular feminization.

Front 44

Which of the following is true concerning dysfunctional uterine bleeding?

Back 44

Usually associated with anovulatory cycles

Dysfunctional uterine bleeding (DUB) is a variety of bleeding manifestations secondary to chronic anovulation.

Front 45

Contraceptive method that has also been FDA approved for treatment of endometriosis?

Back 45

Sub Q 104 DMPA

Sub Q 104 DMPA is FDA approved for treatment of endometriosis. Other medical management includes analgesics (nonsteroidal anti-inflammatory drugs are first choice), gonadotropin-releasing hormone (GnRH) agonists, and danazol to induce regression of endometrial implants; IM DMPA also has been found to be effective.

Front 46

A 30-year-old female presents at the emergency room stating that she was raped earlier that same evening. She appears anxious and smiles nervously while answering questions about the incident. Her breath smells of alcohol and her speech is slightly slurred. She states that her last consensual intercourse was about 1 week ago. She has not used birth control for the past year as she would like to get pregnant. Which of the following tests would not be routinely ordered as part of an assessment of this sexual assault victim?

Back 46

Urine toxicology screen

Urine or blood toxicology screening for drugs/alcohol is generally not advised as part of the sexual assault assessment unless necessary in providing care for the woman. This information may be used against the victim if she goes to trial. Baseline testing for sexually transmitted diseases (STDs; including HIV) and for pregnancy if no contraception is being used is usually performed as part of sexual assault assessment. Of course, none of these tests should be performed without the woman's informed consen

Front 47

A 54-year-old woman has been scheduled for a modified radical mastectomy for breast cancer and has been advised that she will probably be started on tamoxifen after the surgery. When educating this patient concerning the use of tamoxifen, it is important to tell her that:

Back 47

Use of this medication increases the risk for endometrial cancer

The use of tamoxifen does increase a woman's risk for endometrial cancer and deep vein thrombosis. Tamoxifen is an estrogen agonist/antagonist used as adjuvant therapy after surgery for postmenopausal women with breast cancers that have estrogen-positive receptors. Women should continue the medication for at least 5 years. Side effects include hot flashes, nausea and vomiting, fluid retention, weight gain, and thrombocytopenia

Front 48

Leiomyomata arising from tissue within the uterine wall are:

Back 48

Interstitial

Leiomyomata can be found in different areas within and around the uterine cavity and surrounding ligaments. Submucosal myomas protrude into the uterine cavity. Subserosal myomas bulge through the outer uterine wall. Intraligamentous myomas are found within the broad ligament. Interstitial (intramural) myomas stay within the uterine wall as it grows; they are the most common form of myoma. Pedunculated myomas are on a thin pedicle or stalk attached to the uterus.

Front 49

Which of the following is a major advantage of loop electrosurgical excision procedure (LEEP) over either cryosurgery or laser vaporization for the treatment of preinvasive cervical lesions?

Back 49

Excised tissue provides a specimen for further evaluation

A major advantage of LEEP is that it is not a destructive technique, so the excised tissue is suitable for further histologic examination. Both cryosurgery and laser vaporization destroy the transformation zone so a specimen is not available for further diagnostic evaluation

Front 50

A 24-year-old woman presents with complaint of nontender mass in her left breast that does not change with menstrual cycle. On examination you note a freely movable, 0.5 cm × 1 cm, firm, rubbery nontender mass. The most likely diagnosis is:

Back 50

Fibroadenoma

Fibroadenoma are firm, well delineated, freely movable, smooth, rubbery, round, typically marble-sized, nontender masses and they are usually unilateral

Front 51

The most common method of assisted reproductive technology is:

Back 51

In vitro fertilization (IVF)

In vitro fertilization is the most common assisted reproductive technology with a success rate of 15–20%. IVF is a series of complex procedures wherein the oocytes are extracted, fertilized in the laboratory, and then transferred through the cervix into the uterus.

Front 52

A patient with latent syphilis may present with:

Back 52

No signs of infection

detection is through serologic testing.

Front 53

A treatment for atrophic vaginitis with the goal of prevention of recurrence is:

Back 53

Topical estrogen cream

Application of topical estrogen to the affected area is recommended for women with atrophy of genitalia.

Front 54

Risk factors for breast carcinoma include:

Back 54

History of endometrial cancer

Risk factors for breast carcinoma include the following: • The BRCA1 and BRCA2 genes • Advancing age • Mother and/or sister with breast cancer • Previous breast cancer • Perimenopausal status • Previous endometrial or colon cancer • Previous breast biopsy with atypical hyperplasia, lobular neoplasm • Menarche before age 12; menopause after age 55 • Nulliparity, first pregnancy after 30 • Hormone replacement therapy, oral contraceptive pills (questionable) • Obesity, environmental factors; exposure to radiation or pesticides • Heavy alcohol use; fat in diet

Front 55

Signs and symptoms of atrophic vaginitis include:

Back 55

Vaginal pH 5.5–7.0

Typical findings with atrophic vaginitis include dry vagina with little rugation, vagina that may be pink and pale or may have inflamed mucosa and small petechiae, no malodorous discharge, no pathogen on wet mount, and an alkaline vaginal pH of 5.5–7.0

Front 56

A 52-year-old female presents with a complaint of leaking urine. During questioning she admits that she does notice that it occurs when she laughs or coughs. She has had to give up her aerobics classes because she frequently leaks urine during the exercises. What she is describing best fits the definition for:

Back 56

Stress incontinence

Stress incontinence is the involuntary loss of urine during activities that increase intra-abdominal pressure such as laughing, coughing, and jumping. Urge incontinence is involuntary loss of urine associated with a sudden, strong urge to void. Overflow incontinence is a result of urinary retention with bladder distention and overflow of urine. Functional incontinence results from medically reversible causes such as delirium, infection, medications, and restricted mobility

Front 57

An indicator of loss of lactobacilli in the vagina is:

Back 57

Elevated pH

Loss of lactobacilli (hydrogen–peroxide-producing strains) results in elevated pH and subsequent overgrowth of bacteria—bacteria concentrations are 100- to 1000-fold.

Front 58

All of the following statements concerning infertility are correct except:

Back 58

Heavy caffeine use in men may decrease fertility

Studies have failed to confirm that moderate caffeine consumption (250 mg/day) by men or women has any negative impact on fertility. There is some evidence that higher levels of caffeine intake by women may delay conception or increase the risk of pregnancy loss. Cocaine use can impair spermatogenesis. Marijuana use can inhibit the secretion of GnRH and may suppress reproductive function in both women and men. Heavy alcohol use by both men and women may have a negative impact on fertility

Front 59

A 36-year-old is seen in your office on day 18 of her cycle for her routine annual examination. She has no complaints. Pelvic exam reveals a 9-cm firm pelvic mass anterior to the uterus. The most likely diagnosis is:

Back 59

Benign cystic teratoma

Benign cystic teratomas usually measure between 5 and 10 cm in diameter and they are composed of well-differentiated tissue from all three germ layers. Patients are usually asymptomatic but may experience acute pain if the teratoma twists or ruptures.

Front 60

Which of the following statements is true concerning primary dysmenorrhea?

Back 60

It is often associated with increased prostaglandin activity

Primary dysmenorrhea is menstrual pain without related pathology. The cause of primary dysmenorrhea is increased prostaglandin production in the endometrium. Onset is usually within 1 to 2 years of menarche when ovulatory cycles are established. Pain usually begins with onset of menstrual flow and may last up to 48 hours, when most prostaglandin is released

Front 61

A 26-year-old woman and her husband present at the clinic stating that they are having sexual problems. They have been married for 3 months and have not had sexual intercourse. They were reading a book about sexual problems and think that the problem is vaginismus. An examination finding that would confirm that she has vaginismus would include:

Back 61

Involuntary vaginal spasm when a finger is inserted

Vaginismus is a condition in which there is recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina when a woman either anticipates or experiences attempted entry of the vagina by a penis or other object such as a finger or speculum

Front 62

A known risk factor for cancer of the vulva is:

Back 62

Cigarette smoking

Risk factors for developing vulvar carcinoma are history of abnormal Pap test, multiple sexual partners, cigarette smoking, chronic irritation, and vulvar dermatoses.

Front 63

The first step in the evaluation of a HSIL Pap test result is:

Back 63

Immediate loop electrosurgical excision or colposcopy with endocervical assessment

As per the ASCCP (2013 ) guidelines, the next step to managing a HSIL Pap test result is immediate loop electrosurgical excision or colposcopy with endocervical assessment.

Front 64

A woman who will be taking a nonsteroidal anti-inflammatory drug (NSAID) for primary dysmenorrhea should be told to:

Back 64

Avoid these medications if she has an aspirin sensitivity

Studies have shown that beginning NSAIDs at the start of menses is as effective as starting before menses starts. Most women need medication only for the first 2–3 days of bleeding when prostaglandin release would be the highest. Changes in dosage or type of NSAID may be considered if the first one is not effective. Women with hypersensitivity to aspirin should not take NSAIDs (Katz, V., Lentz, G., Lobo, R., & Gershenson, D. [2007]. Comprehensive gynecology