Gyneco(351-378)

A 24-year-old female comes to the emergency room with a 2-day history of lower abdominal pain, fever, chills, and malaise. The patient also complains of nausea and multiple episodes of vomiting in the past 24 hours. On physical examination, there is bilateral adnexal tenderness, muco-purulent cervical discharge, and cervical motion tenderness. The patient has a temperature of 40°C. Her last menstrual period was 4 weeks ago, and her pregnancy test is negative. She admits to being sexually active but denies a history of any sexually transmitted diseases (STDs). She is currently not using birth control.If hospitalization was chosen for this patient, which of the following is an acceptable first-line parenteral regimen for her condition?

A 24-year-old female comes to the emergency room with a 2-day history of lower abdominal pain, fever, chills, and malaise. The patient also complains of nausea and multiple episodes of vomiting in the past 24 hours. On physical examination, there is bilateral adnexal tenderness, muco-purulent cervical discharge, and cervical motion tenderness. The patient has a temperature of 40°C. Her last menstrual period was 4 weeks ago, and her pregnancy test is negative. She admits to being sexually active but denies a history of any sexually transmitted diseases (STDs). She is currently not using birth control.Which of the following statements regarding the relationship between combined oral contraceptive pills (OCPs) and this patient’s condition is true?

A 24-year-old female comes to the emergency room with a 2-day history of lower abdominal pain, fever, chills, and malaise. The patient also complains of nausea and multiple episodes of vomiting in the past 24 hours. On physical examination, there is bilateral adnexal tenderness, muco-purulent cervical discharge, and cervical motion tenderness. The patient has a temperature of 40°C. Her last menstrual period was 4 weeks ago, and her pregnancy test is negative. She admits to being sexually active but denies a history of any sexually transmitted diseases (STDs). She is currently not using birth control.200. Which of the following organisms is not associated with the condition described in this case?

A 24-year-old female comes to the emergency room with a 2-day history of lower abdominal pain, fever, chills, and malaise. The patient also complains of nausea and multiple episodes of vomiting in the past 24 hours. On physical examination, there is bilateral adnexal tenderness, muco-purulent cervical discharge, and cervical motion tenderness. The patient has a temperature of 40°C. Her last menstrual period was 4 weeks ago, and her pregnancy test is negative. She admits to being sexually active but denies a history of any sexually transmitted diseases (STDs). She is currently not using birth control.All of the following are direct risk factors for PID except

A 24-year-old female comes to the emergency room with a 2-day history of lower abdominal pain, fever, chills, and malaise. The patient also complains of nausea and multiple episodes of vomiting in the past 24 hours. On physical examination, there is bilateral adnexal tenderness, muco-purulent cervical discharge, and cervical motion tenderness. The patient has a temperature of 40°C. Her last menstrual period was 4 weeks ago, and her pregnancy test is negative. She admits to being sexually active but denies a history of any sexually transmitted diseases (STDs). She is currently not using birth control.Which of the following is (are) a complication(s) of disseminated gonococcal infection (DGI)?

A 24-year-old heterosexually active male comes to your office with complaints of a 2-day history of dysuria. He denies fever, urgency, frequency, or hematuria. Physical examination reveals no suprapubic or costovertebral tenderness. Urologic examination reveals mucupurulent urethral discharge, nontender testes, normal prostate, and no penile lesions. Urine analysis is positive for leukocyte esterase, but it is negative for nitrite and blood. You send a swab of his urethral discharge for gram stain.The patient’s urethral gram stain reveals 20 WBCs per high power field. There are no intracellular gram-negative diplococci seen. What is the most likely diagnosis in this patient?

A 24-year-old heterosexually active male comes to your office with complaints of a 2-day history of dysuria. He denies fever, urgency, frequency, or hematuria. Physical examination reveals no suprapubic or costovertebral tenderness. Urologic examination reveals mucupurulent urethral discharge, nontender testes, normal prostate, and no penile lesions. Urine analysis is positive for leukocyte esterase, but it is negative for nitrite and blood. You send a swab of his urethral discharge for gram stain.What is the most likely organism causing this condition?

A 24-year-old heterosexually active male comes to your office with complaints of a 2-day history of dysuria. He denies fever, urgency, frequency, or hematuria. Physical examination reveals no suprapubic or costovertebral tenderness. Urologic examination reveals mucupurulent urethral discharge, nontender testes, normal prostate, and no penile lesions. Urine analysis is positive for leukocyte esterase, but it is negative for nitrite and blood. You send a swab of his urethral discharge for gram stain.You prescribe an appropriate antibiotic regimen for this patient and his current sexual partner. He returns to your office stating that he and his partner have completed the recommended treatment. They have been in a monogamous relationship since then. His symptoms have resolved completely. He wants to know if further testing can be done to make sure the “infection is gone.” You advise him that

A 23-year-old female graduate student presents to your office for her annual gynecologic examination. She has been sexually active for 4 years with the same partner. She is up-to-date with cervical cancer screening, and her Papanicolaou (Pap) smears have all been normal. The patient appears worried and says she wants to be checked for “that HPV virus.” Several of her friends have had abnormal Pap smears and were told that the human papillomavirus (HPV) was responsible for these findings. She asks how to prevent getting HPV and whether there are treatments to “get rid of it.” On examination, her external genitalia and cervix appear normal without evidence of lesions. Bimanual examination reveals a small, anterverted uterus with no masses.You inform the patient that

A 23-year-old female graduate student presents to your office for her annual gynecologic examination. She has been sexually active for 4 years with the same partner. She is up-to-date with cervical cancer screening, and her Papanicolaou (Pap) smears have all been normal. The patient appears worried and says she wants to be checked for “that HPV virus.” Several of her friends have had abnormal Pap smears and were told that the human papillomavirus (HPV) was responsible for these findings. She asks how to prevent getting HPV and whether there are treatments to “get rid of it.” On examination, her external genitalia and cervix appear normal without evidence of lesions. Bimanual examination reveals a small, anterverted uterus with no masses.Which of the following statements is true about HPV?

A 25-year-old sexually active female comes to your office with a 2-week history of “growths” in the vulvar region. On examination, you find multiple “cauliflower” verrucous lesions on the labia majora and minora.Which of the following statements about syphilis is true?

A 25-year-old sexually active female comes to your office with a 2-week history of “growths” in the vulvar region. On examination, you find multiple “cauliflower” verrucous lesions on the labia majora and minora.What is the treatment of choice in patients who are not allergic to penicillin for primary, secondary, or early latent syphilis (syphilis acquired within the preceding year without evidence of disease)?

A 25-year-old sexually active female comes to your office with a 2-week history of “growths” in the vulvar region. On examination, you find multiple “cauliflower” verrucous lesions on the labia majora and minora.What is the most likely diagnosis in this patient?

A 25-year-old sexually active female comes to your office with a 2-week history of “growths” in the vulvar region. On examination, you find multiple “cauliflower” verrucous lesions on the labia majora and minora.All of the following are acceptable treatments for this condition except

A 25-year-old sexually active female comes to your office with a 2-week history of “growths” in the vulvar region. On examination, you find multiple “cauliflower” verrucous lesions on the labia majora and minora.The patient should be counseled that

A 24-year-old female comes to your office with a 2-day history of dysuria accompanied by painful genital lesions that have coalesced to form ulcers. The patient also has fever, malaise, myalgias, and headache. There is no previous history of this condition. She has had three sexual partners in the past and inconsistently uses barrier contraceptive methods.You tell the patient the most likely diagnosis is

A 24-year-old female comes to your office with a 2-day history of dysuria accompanied by painful genital lesions that have coalesced to form ulcers. The patient also has fever, malaise, myalgias, and headache. There is no previous history of this condition. She has had three sexual partners in the past and inconsistently uses barrier contraceptive methods.Which of the following statements concerning the patient’s condition is false?

A 24-year-old female comes to your office with a 2-day history of dysuria accompanied by painful genital lesions that have coalesced to form ulcers. The patient also has fever, malaise, myalgias, and headache. There is no previous history of this condition. She has had three sexual partners in the past and inconsistently uses barrier contraceptive methods.Strategies for the screening and diagnosis of HIV should include

A 24-year-old female comes to your office with a 2-day history of dysuria accompanied by painful genital lesions that have coalesced to form ulcers. The patient also has fever, malaise, myalgias, and headache. There is no previous history of this condition. She has had three sexual partners in the past and inconsistently uses barrier contraceptive methods.Which of the following accurately describes the natural history of HIV?

A 27-year-old nulligravida female comes to your office with her husband. They are concerned about not having conceived after a year of regular, unprotected intercourse. The patient denies any major medical illnesses, and she takes no medications. The husband reports he is healthy and has never fathered a child. Both the patient and her husband are visibly upset and somewhat tearful while discussing their frustrations about not being pregnant yet. They express that they are anxious to begin “all the tests necessary” as soon as possible so they can have a child without further delay.What is the most appropriate diagnosis for this couple’s condition?

A 27-year-old nulligravida female comes to your office with her husband. They are concerned about not having conceived after a year of regular, unprotected intercourse. The patient denies any major medical illnesses, and she takes no medications. The husband reports he is healthy and has never fathered a child. Both the patient and her husband are visibly upset and somewhat tearful while discussing their frustrations about not being pregnant yet. They express that they are anxious to begin “all the tests necessary” as soon as possible so they can have a child without further delay.Infertility is defined as failure to conceive with unprotected regular sexual intercourse after

A 27-year-old nulligravida female comes to your office with her husband. They are concerned about not having conceived after a year of regular, unprotected intercourse. The patient denies any major medical illnesses, and she takes no medications. The husband reports he is healthy and has never fathered a child. Both the patient and her husband are visibly upset and somewhat tearful while discussing their frustrations about not being pregnant yet. They express that they are anxious to begin “all the tests necessary” as soon as possible so they can have a child without further delay.What is the most appropriate initial step in this couple’s evaluation?

A 27-year-old nulligravida female comes to your office with her husband. They are concerned about not having conceived after a year of regular, unprotected intercourse. The patient denies any major medical illnesses, and she takes no medications. The husband reports he is healthy and has never fathered a child. Both the patient and her husband are visibly upset and somewhat tearful while discussing their frustrations about not being pregnant yet. They express that they are anxious to begin “all the tests necessary” as soon as possible so they can have a child without further delay.The patient’s initial evaluation does not reveal any abnormalities. You discuss with the patient that the next step is to confirm the presence of ovulation. All of the following are acceptable methods for assessing ovulation except

A 27-year-old nulligravida female comes to your office with her husband. They are concerned about not having conceived after a year of regular, unprotected intercourse. The patient denies any major medical illnesses, and she takes no medications. The husband reports he is healthy and has never fathered a child. Both the patient and her husband are visibly upset and somewhat tearful while discussing their frustrations about not being pregnant yet. They express that they are anxious to begin “all the tests necessary” as soon as possible so they can have a child without further delay.All of the following may be direct causes of female infertility except

A 27-year-old nulligravida female comes to your office with her husband. They are concerned about not having conceived after a year of regular, unprotected intercourse. The patient denies any major medical illnesses, and she takes no medications. The husband reports he is healthy and has never fathered a child. Both the patient and her husband are visibly upset and somewhat tearful while discussing their frustrations about not being pregnant yet. They express that they are anxious to begin “all the tests necessary” as soon as possible so they can have a child without further delay.Evaluation for tubal patency or “pelvic factor” is best accomplished by

A 27-year-old nulligravida female comes to your office with her husband. They are concerned about not having conceived after a year of regular, unprotected intercourse. The patient denies any major medical illnesses, and she takes no medications. The husband reports he is healthy and has never fathered a child. Both the patient and her husband are visibly upset and somewhat tearful while discussing their frustrations about not being pregnant yet. They express that they are anxious to begin “all the tests necessary” as soon as possible so they can have a child without further delay.The postcoital test is performed to assess which of the following?

A 27-year-old nulligravida female comes to your office with her husband. They are concerned about not having conceived after a year of regular, unprotected intercourse. The patient denies any major medical illnesses, and she takes no medications. The husband reports he is healthy and has never fathered a child. Both the patient and her husband are visibly upset and somewhat tearful while discussing their frustrations about not being pregnant yet. They express that they are anxious to begin “all the tests necessary” as soon as possible so they can have a child without further delay.Appropriate initial screening for male infertility includes which of the following?

A 27-year-old nulligravida female comes to your office with her husband. They are concerned about not having conceived after a year of regular, unprotected intercourse. The patient denies any major medical illnesses, and she takes no medications. The husband reports he is healthy and has never fathered a child. Both the patient and her husband are visibly upset and somewhat tearful while discussing their frustrations about not being pregnant yet. They express that they are anxious to begin “all the tests necessary” as soon as possible so they can have a child without further delay.It is appropriate to initiate an infertility evaluation after 6 months of trying to conceive in which of the following conditions?