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Gyneco(251-300)

A detailed illustration of various gynecological health issues, depicting a diverse group of women discussing symptoms, examining charts, and learning about women's health.

Gynecological Health Quiz

Test your knowledge on various gynecological conditions and their management with our comprehensive 50-question quiz. Designed for healthcare professionals and students alike, this quiz covers essential topics related to women's health.

Key Areas Covered:

  • Breast Health
  • Vulvovaginal Disorders
  • Cervical Cancer Screening
  • Diagnosis and Treatment Strategies
50 Questions12 MinutesCreated by ConsultingNurse72
A 23-year-old female consults her physician because of a breast mass; the mass is mobile, firm, and approximately 1 cm in diameter. It is located in the upper outer quadrant of the right breast. No axillary lymph nodes are present.What is the treatment of choice for the condition described here?
A. Modified radical mastectomy
B. lumpectomy
C. biopsy
D. Radical mastectomy
E. Watchful waiting
A 33-year-old female comes to your office with a 2-month history of a bloody unilateral left nipple discharge. She also has noted a small and soft lump just beneath the areola on the left side. On examination, there is a 4-mm soft mass located just inferior to the left areola. No other abnormalities are present in either breast. What is the most likely diagnosis in this patient?
A. Carcinoma of the breast
B. fibroadenoma
C. Intraductal papilloma
D. Fibrocystic breast disease
E. None of the above
A 21-year-old woman comes to your office complaining of severe vulvo-vaginal itching and discharge. She just finished a course of antibiotics for an uncomplicated urinary tract infection, and she states that her urinary symptoms have resolved. She has been sexually active with the same male partner for more than a year. They use latex condoms, and she has been taking oral contraceptive pills for the past 3 months. She has no medical problems or history of sexually transmitted infections (STIs). Her annual Papanicolaou (Pap) tests have all been normal. On inspection of the external genitalia, you note vulvar erythema, fissures, and swelling. On speculum examination, you note a thick, white, curdy discharge adherent to the vaginal walls with no odor. She has no vulvovaginal or cervical lesions. You perform a gross and microscopic examination of the vaginal discharge. The vaginal pH is 4, the whiff test is negative, the wet mount (saline-prepped slide) reveals no evidence of clue cells or trichomonads, and the KOH prepped slide reveals several pseudohyphae.What is the most likely diagnosis in this patient?
A. Physiologic discharge
B. Bacterial vaginosis (BV)
C. Vulvovaginal candidiasis (VVC)
D. trichomoniasis
E. An allergic vaginitis secondary to latex condoms
A 21-year-old woman comes to your office complaining of severe vulvo-vaginal itching and discharge. She just finished a course of antibiotics for an uncomplicated urinary tract infection, and she states that her urinary symptoms have resolved. She has been sexually active with the same male partner for more than a year. They use latex condoms, and she has been taking oral contraceptive pills for the past 3 months. She has no medical problems or history of sexually transmitted infections (STIs). Her annual Papanicolaou (Pap) tests have all been normal. On inspection of the external genitalia, you note vulvar erythema, fissures, and swelling. On speculum examination, you note a thick, white, curdy discharge adherent to the vaginal walls with no odor. She has no vulvovaginal or cervical lesions. You perform a gross and microscopic examination of the vaginal discharge. The vaginal pH is 4, the whiff test is negative, the wet mount (saline-prepped slide) reveals no evidence of clue cells or trichomonads, and the KOH prepped slide reveals several pseudohyphae.You treat the patient accordingly and her symptoms resolve. She returns 6 months later for her routine Pap smear. The Pap smear results return as “satisfactory for evaluation, negative for intraepithelial lesion or malignancy, fungal organisms morphologically consistent with Candida species.” The patient is asymptomatic, and speculum and pelvic examination are normal. What is the next most appropriate step?
A. Treat the patient for VVC only if her wet prep is positive for pseudohyphae
B. Treat the patient for VVC only if a vaginal culture is positive for Candida albicans
C. Treat the patient for VVC only if both a wet prep and vaginal culture are positive for yeast
D. No intervention is required at this time
E. Repeat the Pap smear
A 21-year-old woman comes to your office complaining of severe vulvo-vaginal itching and discharge. She just finished a course of antibiotics for an uncomplicated urinary tract infection, and she states that her urinary symptoms have resolved. She has been sexually active with the same male partner for more than a year. They use latex condoms, and she has been taking oral contraceptive pills for the past 3 months. She has no medical problems or history of sexually transmitted infections (STIs). Her annual Papanicolaou (Pap) tests have all been normal. On inspection of the external genitalia, you note vulvar erythema, fissures, and swelling. On speculum examination, you note a thick, white, curdy discharge adherent to the vaginal walls with no odor. She has no vulvovaginal or cervical lesions. You perform a gross and microscopic examination of the vaginal discharge. The vaginal pH is 4, the whiff test is negative, the wet mount (saline-prepped slide) reveals no evidence of clue cells or trichomonads, and the KOH prepped slide reveals several pseudohyphae.Which of the following has not been shown to increase the risk for recurrence of this condition?
A. high-carbohydrate diets
B. Diabetes mellitus
C. Oral contraceptives
D. frequent/prolonged antibiotic use
E. immunodeficiency
A 21-year-old woman comes to your office complaining of severe vulvo-vaginal itching and discharge. She just finished a course of antibiotics for an uncomplicated urinary tract infection, and she states that her urinary symptoms have resolved. She has been sexually active with the same male partner for more than a year. They use latex condoms, and she has been taking oral contraceptive pills for the past 3 months. She has no medical problems or history of sexually transmitted infections (STIs). Her annual Papanicolaou (Pap) tests have all been normal. On inspection of the external genitalia, you note vulvar erythema, fissures, and swelling. On speculum examination, you note a thick, white, curdy discharge adherent to the vaginal walls with no odor. She has no vulvovaginal or cervical lesions. You perform a gross and microscopic examination of the vaginal discharge. The vaginal pH is 4, the whiff test is negative, the wet mount (saline-prepped slide) reveals no evidence of clue cells or trichomonads, and the KOH prepped slide reveals several pseudohyphae.Which of the following is an appropriate treatment for this patient?
A. metronidazole (500 mg orally twice a day for 7 days)
B. tinidazole 2 g orally in a single dose
C. Yogurt with live acidophilus cultures (8 ounces orally or 1 tablespoon intravaginally, four times daily for 7 days)
D. Boric acid tablets (600 mg intravaginally daily for 2 weeks)
E. fluconazole (one dose of 150 mg orally)
A 21-year-old woman comes to your office complaining of severe vulvo-vaginal itching and discharge. She just finished a course of antibiotics for an uncomplicated urinary tract infection, and she states that her urinary symptoms have resolved. She has been sexually active with the same male partner for more than a year. They use latex condoms, and she has been taking oral contraceptive pills for the past 3 months. She has no medical problems or history of sexually transmitted infections (STIs). Her annual Papanicolaou (Pap) tests have all been normal. On inspection of the external genitalia, you note vulvar erythema, fissures, and swelling. On speculum examination, you note a thick, white, curdy discharge adherent to the vaginal walls with no odor. She has no vulvovaginal or cervical lesions. You perform a gross and microscopic examination of the vaginal discharge. The vaginal pH is 4, the whiff test is negative, the wet mount (saline-prepped slide) reveals no evidence of clue cells or trichomonads, and the KOH prepped slide reveals several pseudohyphae.This patient returns 2 weeks later stating that she has not responded to the treatment you prescribed. What should you do next?
A. Repeat the same treatment, but double the dose
B. Repeat the same treatment, but double the duration of use
C. Reconsider the diagnosis, and reevaluate the patient
D. Apply topical metronidazole gel to her vulvar and vaginal areas
E. Reassure the patient that it often takes several weeks for symptoms to resolve
A 21-year-old woman comes to your office complaining of severe vulvo-vaginal itching and discharge. She just finished a course of antibiotics for an uncomplicated urinary tract infection, and she states that her urinary symptoms have resolved. She has been sexually active with the same male partner for more than a year. They use latex condoms, and she has been taking oral contraceptive pills for the past 3 months. She has no medical problems or history of sexually transmitted infections (STIs). Her annual Papanicolaou (Pap) tests have all been normal. On inspection of the external genitalia, you note vulvar erythema, fissures, and swelling. On speculum examination, you note a thick, white, curdy discharge adherent to the vaginal walls with no odor. She has no vulvovaginal or cervical lesions. You perform a gross and microscopic examination of the vaginal discharge. The vaginal pH is 4, the whiff test is negative, the wet mount (saline-prepped slide) reveals no evidence of clue cells or trichomonads, and the KOH prepped slide reveals several pseudohyphae.Which of the following is not included in the classification for uncomplicated vulvovaginal candidiasis as defined by the Centers for Disease Control and Prevention (CDC)?
A. Sporadic and infrequent episodes
B. Mild to moderate signs and symptoms
C. Occurring in pregnant women
D. C. albicans
E. Occurring in nonimmunocompromised individuals
A 21-year-old woman comes to your office complaining of severe vulvo-vaginal itching and discharge. She just finished a course of antibiotics for an uncomplicated urinary tract infection, and she states that her urinary symptoms have resolved. She has been sexually active with the same male partner for more than a year. They use latex condoms, and she has been taking oral contraceptive pills for the past 3 months. She has no medical problems or history of sexually transmitted infections (STIs). Her annual Papanicolaou (Pap) tests have all been normal. On inspection of the external genitalia, you note vulvar erythema, fissures, and swelling. On speculum examination, you note a thick, white, curdy discharge adherent to the vaginal walls with no odor. She has no vulvovaginal or cervical lesions. You perform a gross and microscopic examination of the vaginal discharge. The vaginal pH is 4, the whiff test is negative, the wet mount (saline-prepped slide) reveals no evidence of clue cells or trichomonads, and the KOH prepped slide reveals several pseudohyphae.Which of the following statements regarding prophylactic antifungal therapy for recurrent VVC is true?
A. There is no evidence to support that prophylactic antifungal therapy for recurrent VVC reduces the risk of recurrence
B. Prophylactic therapy for recurrent VCC is not necessary for nonimmunocompromised patients since their symptoms are not severe
C. Prophylactic therapy for recurrent VCC is effective indefinitely, even after therapy has been discontinued
D. Oral flucanozole therapy (150 mg orally once every 3 days for 2 weeks, followed by 150 mg orally each week for 6 months) has been shown to decrease the number of VVC episodes in women suffering from recurrent VVC
E. Prophylactic therapy for recurrent VCC should be initiated in all HIV- infected women, even in the absence of symptoms
A 29-year-old woman comes to your office with a 2-week history of a persistent, malodorous vaginal discharge. The unpleasant “fishy” odor appears to worsen after sex. She denies any vaginal itching, urinary symptoms, or any other complaints. She is in a long-standing monogamous relationship with her husband, who is asymptomatic. She has no history of sexually transmitted diseases (STDs) or abnormal Pap test results. She has been douching weekly for the past several months. On examination, there is a thin, milky, off-white discharge present at the introitus without any evidence of vulvar irritation. On speculum examination, the discharge is homogeneous and pooling on the floor of the vagina with no signs of vaginal or cervical inflammation. You perform a gross and microscopic examination of the vaginal discharge: The pH is 6, the whiff test is strongly positive, the wet mount slide reveals the presence of several clue cells but no trichomonads or polymorphonuclear/white blood cells (WBCs), and the KOH slide reveals no evidence of pseudohyphae or budding yeast cells. What is the most likely diagnosis in this patient?
A. Physiologic discharge
B. trichomoniasis
C. candidiasis
D. Atrophic vaginitis
E. Bacterial vaginosis
A 29-year-old woman comes to your office with a 2-week history of a persistent, malodorous vaginal discharge. The unpleasant “fishy” odor appears to worsen after sex. She denies any vaginal itching, urinary symptoms, or any other complaints. She is in a long-standing monogamous relationship with her husband, who is asymptomatic. She has no history of sexually transmitted diseases (STDs) or abnormal Pap test results. She has been douching weekly for the past several months. On examination, there is a thin, milky, off-white discharge present at the introitus without any evidence of vulvar irritation. On speculum examination, the discharge is homogeneous and pooling on the floor of the vagina with no signs of vaginal or cervical inflammation. You perform a gross and microscopic examination of the vaginal discharge: The pH is 6, the whiff test is strongly positive, the wet mount slide reveals the presence of several clue cells but no trichomonads or polymorphonuclear/white blood cells (WBCs), and the KOH slide reveals no evidence of pseudohyphae or budding yeast cells.Which of the following statements regarding this patient’s condition is (are) true?
A. It is considered a sexually transmitted infection
B. Treating the partner will prevent recurrence
C. It has no association with preterm labor
D. It has no association with postpartum endometritis
E. It is the result of an overgrowth of lactobacilli in the vagina
A 29-year-old woman comes to your office with a 2-week history of a persistent, malodorous vaginal discharge. The unpleasant “fishy” odor appears to worsen after sex. She denies any vaginal itching, urinary symptoms, or any other complaints. She is in a long-standing monogamous relationship with her husband, who is asymptomatic. She has no history of sexually transmitted diseases (STDs) or abnormal Pap test results. She has been douching weekly for the past several months. On examination, there is a thin, milky, off-white discharge present at the introitus without any evidence of vulvar irritation. On speculum examination, the discharge is homogeneous and pooling on the floor of the vagina with no signs of vaginal or cervical inflammation. You perform a gross and microscopic examination of the vaginal discharge: The pH is 6, the whiff test is strongly positive, the wet mount slide reveals the presence of several clue cells but no trichomonads or polymorphonuclear/white blood cells (WBCs), and the KOH slide reveals no evidence of pseudohyphae or budding yeast cells.Which of the following is no longer an acceptable treatment for this patient’s condition, according to the CDC?
A. metronidazole (500 mg orally twice a day for 7 days)
B. metronidazole (2 g orally for a single dose)
C. Metronidazole gel 0.75% (5 g intravaginally at bedtime for 5 days)
D. clindamycin (300 mg orally twice a day for 7 days)
E. Clindamycin cream 2% (5 g intravaginally at bedtime for 7 days)
A 29-year-old woman comes to your office with a 2-week history of a persistent, malodorous vaginal discharge. The unpleasant “fishy” odor appears to worsen after sex. She denies any vaginal itching, urinary symptoms, or any other complaints. She is in a long-standing monogamous relationship with her husband, who is asymptomatic. She has no history of sexually transmitted diseases (STDs) or abnormal Pap test results. She has been douching weekly for the past several months. On examination, there is a thin, milky, off-white discharge present at the introitus without any evidence of vulvar irritation. On speculum examination, the discharge is homogeneous and pooling on the floor of the vagina with no signs of vaginal or cervical inflammation. You perform a gross and microscopic examination of the vaginal discharge: The pH is 6, the whiff test is strongly positive, the wet mount slide reveals the presence of several clue cells but no trichomonads or polymorphonuclear/white blood cells (WBCs), and the KOH slide reveals no evidence of pseudohyphae or budding yeast cells.What is the most common class of organisms associated with this patient’s condition?
A. Aerobic bacteria
B. Anaerobic bacteria
C. virus
D. fungi/yeast
E. protozoa
A 29-year-old woman comes to your office with a 2-week history of a persistent, malodorous vaginal discharge. The unpleasant “fishy” odor appears to worsen after sex. She denies any vaginal itching, urinary symptoms, or any other complaints. She is in a long-standing monogamous relationship with her husband, who is asymptomatic. She has no history of sexually transmitted diseases (STDs) or abnormal Pap test results. She has been douching weekly for the past several months. On examination, there is a thin, milky, off-white discharge present at the introitus without any evidence of vulvar irritation. On speculum examination, the discharge is homogeneous and pooling on the floor of the vagina with no signs of vaginal or cervical inflammation. You perform a gross and microscopic examination of the vaginal discharge: The pH is 6, the whiff test is strongly positive, the wet mount slide reveals the presence of several clue cells but no trichomonads or polymorphonuclear/white blood cells (WBCs), and the KOH slide reveals no evidence of pseudohyphae or budding yeast cells.Treatment for BV is indicated for all of the following patients except
A. All nonpregnant women who have signs and symptoms of BV
B. Women who have evidence of BV based on Pap smear
C. All pregnant women who have signs and symptoms of BV
D. Women who have a reported history of allergy to metronidazole
E. Women with a reported history of alcoholism, due to the potential interaction between alcohol and metronidazole
A 17-year-old woman comes to your office with her partner complaining of severe vaginal itching and malodorous discharge. She denies any vaginal bleeding or urinary symptoms. She has been sexually active with a new partner for the past 3 months. On external genital examination, you note vulvar edema and erythema. Speculum examination reveals copious, frothy, yellow-green, malodorous discharge with petechial-like lesions on the cervix. A bimanual examination reveals no cervical motion tenderness and no uterine or adnexal masses or tenderness. You perform a gross and microscopic examination of the vaginal discharge: The pH is 6, the whiff test is slightly positive, the wet mount reveals several motile flagellated organisms and many WBCs (>10/HPF) but no clue cells, and there are no pseudohyphae or budding yeast cells noted on the KOH slide.What is the most likely diagnosis in this patient?
A. candidiasis
B. trichomoniasis
C. Bacterial vaginosis
D. Physiologic discharge
E. Atrophic vaginitis
A 17-year-old woman comes to your office with her partner complaining of severe vaginal itching and malodorous discharge. She denies any vaginal bleeding or urinary symptoms. She has been sexually active with a new partner for the past 3 months. On external genital examination, you note vulvar edema and erythema. Speculum examination reveals copious, frothy, yellow-green, malodorous discharge with petechial-like lesions on the cervix. A bimanual examination reveals no cervical motion tenderness and no uterine or adnexal masses or tenderness. You perform a gross and microscopic examination of the vaginal discharge: The pH is 6, the whiff test is slightly positive, the wet mount reveals several motile flagellated organisms and many WBCs (>10/HPF) but no clue cells, and there are no pseudohyphae or budding yeast cells noted on the KOH slide.All of the following statements are true regarding the patient’s condition except
A. It is a sexually transmitted infection
B. It is a potential cause of preterm labor
C. Males with this condition are usually symptomatic
D. Pap tests are not reliable diagnostic tests for this condition
E. The organism that causes this condition is a protozoa
A 17-year-old woman comes to your office with her partner complaining of severe vaginal itching and malodorous discharge. She denies any vaginal bleeding or urinary symptoms. She has been sexually active with a new partner for the past 3 months. On external genital examination, you note vulvar edema and erythema. Speculum examination reveals copious, frothy, yellow-green, malodorous discharge with petechial-like lesions on the cervix. A bimanual examination reveals no cervical motion tenderness and no uterine or adnexal masses or tenderness. You perform a gross and microscopic examination of the vaginal discharge: The pH is 6, the whiff test is slightly positive, the wet mount reveals several motile flagellated organisms and many WBCs (>10/HPF) but no clue cells, and there are no pseudohyphae or budding yeast cells noted on the KOH slide.All of the following are acceptable treatments for her condition except
A. Clindamycin phosphate cream (5 g intravaginally at bedtime for 5 to 7 days)
B. tinidazole (2 g orally in a single dose)
C. metronidazole (500 mg orally twice a day for 7 days)
D. metronidazole (2 g orally in a single dose)
E. Metronidazole gel (5 g intravaginally twice a day for 7 days)
A 17-year-old woman comes to your office with her partner complaining of severe vaginal itching and malodorous discharge. She denies any vaginal bleeding or urinary symptoms. She has been sexually active with a new partner for the past 3 months. On external genital examination, you note vulvar edema and erythema. Speculum examination reveals copious, frothy, yellow-green, malodorous discharge with petechial-like lesions on the cervix. A bimanual examination reveals no cervical motion tenderness and no uterine or adnexal masses or tenderness. You perform a gross and microscopic examination of the vaginal discharge: The pH is 6, the whiff test is slightly positive, the wet mount reveals several motile flagellated organisms and many WBCs (>10/HPF) but no clue cells, and there are no pseudohyphae or budding yeast cells noted on the KOH slide.Which of the following recommendations should you give her at this time?
A. Her partner should be treated for trichomonas only if he has symptoms
B. Screening for other STIs is unnecessary since trichomoniasis is not an STI
C. She can continue with normal sexual activity during the course of her treatment
D. Her partner should be treated for trichomonas even if he is asymptomatic
E. She can choose between metronidazole intravaginal gel or tablets because the efficacy for either route of administration is equivalent
A 17-year-old woman comes to your office with her partner complaining of severe vaginal itching and malodorous discharge. She denies any vaginal bleeding or urinary symptoms. She has been sexually active with a new partner for the past 3 months. On external genital examination, you note vulvar edema and erythema. Speculum examination reveals copious, frothy, yellow-green, malodorous discharge with petechial-like lesions on the cervix. A bimanual examination reveals no cervical motion tenderness and no uterine or adnexal masses or tenderness. You perform a gross and microscopic examination of the vaginal discharge: The pH is 6, the whiff test is slightly positive, the wet mount reveals several motile flagellated organisms and many WBCs (>10/HPF) but no clue cells, and there are no pseudohyphae or budding yeast cells noted on the KOH slide.Which of the following are potential noninfectious causes of vulvovaginitis?
A. Estrogen deficiency
B. Latex allergy
C. nonoxynol-9
D. Local anesthetics
E. All of the above
A Female with an “ASC-US” Pap Test Result. A 26-year-old woman comes to your office for her health maintenance examination. She is married with two children, and she has no major medical illnesses. She reports a 10 pack-year history of cigarette smoking. She has had 10 heterosexual partners in her lifetime and denies a history of sexually transmitted disease (STD). All of her Papanicolaou (Pap) tests have been normal. Her physical examination, including pelvic, is unremarkable. A week later, you receive her Pap result, which reads “satisfactory for evaluation, ASC-US.”Which of the following would be appropriate as initial management for this patient?
A. Repeat the Pap test in 1 year
B. Perform an endocervical curettage only
C. Perform human papilloma virus (HPV) DNA testing
D. Perform cryotherapy
E. Perform a loop electrosurgical excision procedure (LEEP)
A Female with an “ASC-US” Pap Test Result. A 26-year-old woman comes to your office for her health maintenance examination. She is married with two children, and she has no major medical illnesses. She reports a 10 pack-year history of cigarette smoking. She has had 10 heterosexual partners in her lifetime and denies a history of sexually transmitted disease (STD). All of her Papanicolaou (Pap) tests have been normal. Her physical examination, including pelvic, is unremarkable. A week later, you receive her Pap result, which reads “satisfactory for evaluation, ASC-US.”All of the following are known risk factors for carcinoma of the cervix except
A. Multiple sexual partners
B. Early age of first intercourse
C. Infection with “high-risk” HPV subtypes
D. smoking
E. Alcohol use
A Female with an “ASC-US” Pap Test Result. A 26-year-old woman comes to your office for her health maintenance examination. She is married with two children, and she has no major medical illnesses. She reports a 10 pack-year history of cigarette smoking. She has had 10 heterosexual partners in her lifetime and denies a history of sexually transmitted disease (STD). All of her Papanicolaou (Pap) tests have been normal. Her physical examination, including pelvic, is unremarkable. A week later, you receive her Pap result, which reads “satisfactory for evaluation, ASC-US.”What is the most appropriate approach to a patient who undergoes cervical cancer screening with liquid-based cytology and the Pap returns as “satisfactory for evaluation, ASC-US, positive for high-risk HPV type”?
A. repeat Pap test in 4 to 6 months
B. repeat HPV DNA testing in 4 to 6 months
C. colposcopy
D. Continue annual Pap tests
E. Cryosurgery or LEEP
A Female with an “ASC-US” Pap Test Result. A 26-year-old woman comes to your office for her health maintenance examination. She is married with two children, and she has no major medical illnesses. She reports a 10 pack-year history of cigarette smoking. She has had 10 heterosexual partners in her lifetime and denies a history of sexually transmitted disease (STD). All of her Papanicolaou (Pap) tests have been normal. Her physical examination, including pelvic, is unremarkable. A week later, you receive her Pap result, which reads “satisfactory for evaluation, ASC-US.”Carcinoma of the cervix is associated with which HPV types?
A. 6, 11
B. 16, 18, 31, 45
C. 40, 42
D. 53, 54
E. All of the above
A Female with an “ASC-US” Pap Test Result. A 26-year-old woman comes to your office for her health maintenance examination. She is married with two children, and she has no major medical illnesses. She reports a 10 pack-year history of cigarette smoking. She has had 10 heterosexual partners in her lifetime and denies a history of sexually transmitted disease (STD). All of her Papanicolaou (Pap) tests have been normal. Her physical examination, including pelvic, is unremarkable. A week later, you receive her Pap result, which reads “satisfactory for evaluation, ASC-US.”Which of the following statements is true?
A. The risk of invasive carcinoma with ASC-US is less than 1.0%
B. AGC is associated with endometrial neoplasia, not cervical neoplasia
C. approximately 75% of women with LSIL have histologically confirmed high-grade cervical lesions (CIN 2/3)
D. approximately 25% of women with HSIL have histologically confirmed high-grade cervical lesions (CIN 2/3)
E. ASC-US is more frequently associated with histologically confirmed high-grade cervical lesions (CIN 2/3) than ASC-H
A Female with an “ASC-US” Pap Test Result. A 26-year-old woman comes to your office for her health maintenance examination. She is married with two children, and she has no major medical illnesses. She reports a 10 pack-year history of cigarette smoking. She has had 10 heterosexual partners in her lifetime and denies a history of sexually transmitted disease (STD). All of her Papanicolaou (Pap) tests have been normal. Her physical examination, including pelvic, is unremarkable. A week later, you receive her Pap result, which reads “satisfactory for evaluation, ASC-US.”Your colleague asks your opinion about liquidbased cytology for cervical cancer screening. You explain that advantages of liquid-based cytology include
A. It is less expensive than conventional Pap tests
B. It permits reflex HPV testing
C. Collection of a cervical specimen is easier than with conventional Pap
D. The patient is more comfortable during cervical sampling than with conventional Pap
E. All of the above
A 33-year-old female (gravida 2, para 2) comes to your office for a routine annual examination. She has never smoked and has no history of STDs. She is in a stable, monogamous relationship with her husband. Her previous Pap smears have been normal. Her physical examination is normal, including pelvic examination. You perform a Pap smear at this time. Two weeks later, the Pap smear comes back as “satisfactory for evaluation, consistent with LSIL.”Which of the following would be most appropriate as initial management for this patient?
A. Continue routine screening because she has no other risk factors for cervical dysplasia
B. Repeat a Pap test in 4 to 6 months
C. perform HPV DNA typing
D. Perform colposcopy
E. perform LEEP or cryotherapy
A 33-year-old female (gravida 2, para 2) comes to your office for a routine annual examination. She has never smoked and has no history of STDs. She is in a stable, monogamous relationship with her husband. Her previous Pap smears have been normal. Her physical examination is normal, including pelvic examination. You perform a Pap smear at this time. Two weeks later, the Pap smear comes back as “satisfactory for evaluation, consistent with LSIL.”The patient returns after having a colposcopy that was satisfactory (the entire squamocolumnar junction was visualized). Her cervical biopsy was consistent with “CIN 1,” and her endocervical curettage (ECC) was “negative for neoplasia.” All of the following are acceptable management plans for biopsy-confirmed CIN 1 except
A. repeat Pap smear and colposcopy at 12 months
B. perform LEEP or cryotherapy
C. perform HPV DNA testing at 12 months
D. repeat Pap smears at 6 and 12 months
E. Perform total hysterectomy
A 33-year-old female (gravida 2, para 2) comes to your office for a routine annual examination. She has never smoked and has no history of STDs. She is in a stable, monogamous relationship with her husband. Her previous Pap smears have been normal. Her physical examination is normal, including pelvic examination. You perform a Pap smear at this time. Two weeks later, the Pap smear comes back as “satisfactory for evaluation, consistent with LSIL.”Which part of the cervix is most vulnerable to dysplastic changes?
A. The squamous epithelium
B. The columnar epithelium
C. The squamocolumnar junction
D. The superior lip of the cervix
E. The inferior lip of the cervix
You are seeing a 14-year-old girl today for a routine exam. She has never been sexually active. Her mother accompanies her to the visit and wants to know what your opinion is regarding the new “HPV (human papillomavirus) shot.” You tell her that the quadrivalent HPV vaccine
A. Is not necessary because the patient is a virgin and HPV is only transmitted sexually
B. Is not appropriate for the patient because she is too young
C. Is not appropriate for the patient because she is too old
D. provides 99% to 100% protection from HPV types 6, 11, 16, and 18
E. provides 99% to 100% protection from all HPV subtypes
A 23-year-old woman comes to your office with a 6-month history of fatigue, anxiety, emotional lability, difficulty concentrating, and insomnia. She also complains of breast tenderness, abdominal bloating, and food cravings. She denies any menstrual irregularities or prodromal life stressors. These symptoms recur on a regular basis during the week leading up to her menstrual period but completely resolve within the first 3 days of menses. She denies any suicidal ideations. However, she tearfully admits that she feels totally incapacitated when she is symptomatic and that these symptoms are adversely affecting her personal and professional life. What is the most likely diagnosis in this patient?
A. Generalized anxiety disorder
B. dysmenorrhea
C. Major depression
D. Panic disorder
E. Premenstrual dysphoric disorder syndrome (PMDD)
A 23-year-old woman comes to your office with a 6-month history of fatigue, anxiety, emotional lability, difficulty concentrating, and insomnia. She also complains of breast tenderness, abdominal bloating, and food cravings. She denies any menstrual irregularities or prodromal life stressors. These symptoms recur on a regular basis during the week leading up to her menstrual period but completely resolve within the first 3 days of menses. She denies any suicidal ideations. However, she tearfully admits that she feels totally incapacitated when she is symptomatic and that these symptoms are adversely affecting her personal and professional life.What is the main characteristic that differentiates this condition from major depression?
A. The type of symptoms
B. The severity of symptoms
C. The duration of this condition
D. The timing of the symptoms relative to the menstrual cycle
E. Occurs in reproductive-age women
A 23-year-old woman comes to your office with a 6-month history of fatigue, anxiety, emotional lability, difficulty concentrating, and insomnia. She also complains of breast tenderness, abdominal bloating, and food cravings. She denies any menstrual irregularities or prodromal life stressors. These symptoms recur on a regular basis during the week leading up to her menstrual period but completely resolve within the first 3 days of menses. She denies any suicidal ideations. However, she tearfully admits that she feels totally incapacitated when she is symptomatic and that these symptoms are adversely affecting her personal and professional life.What is the main characteristic that differentiates this condition from premenstrual syndrome (PMS)?
A. The type of symptoms
B. The severity of symptoms
C. The duration of this condition
D. The timing of the symptoms relative to the menstrual cycle
E. Occurs in reproductive-age women
A 51-year-old woman has been experiencing progressive symptoms of profuse night sweats and frequent hot flushes occurring both day and night. She finds her emotional state increasingly labile. She is also experiencing sleep disturbances and anxiety. She denies any other complaints. Her last period was approximately 12 months ago. She has no history of medical problems or affective disorders. Her pulse is 78 beats/ minute, and her blood pressure is 122/74 mmHg. Her pelvic examination reveals atrophic external genitalia, a small anteverted uterus, and no adnexal masses. The rest of her examination is completely normal.What is the most likely diagnosis in this patient?
A. pheochromocytoma
B. hyperthyroidism
C. menopause
D. Generalized anxiety disorder
E. Depression or panic attacks
A 51-year-old woman has been experiencing progressive symptoms of profuse night sweats and frequent hot flushes occurring both day and night. She finds her emotional state increasingly labile. She is also experiencing sleep disturbances and anxiety. She denies any other complaints. Her last period was approximately 12 months ago. She has no history of medical problems or affective disorders. Her pulse is 78 beats/ minute, and her blood pressure is 122/74 mmHg. Her pelvic examination reveals atrophic external genitalia, a small anteverted uterus, and no adnexal masses. The rest of her examination is completely normal.What is the most effective treatment option for this patient?
A. Thyroid replacement
B. Estrogen with progestin (hormone therapy [HT])
C. antidepressants
D. Estrogen alone (estrogen therapy [ET])
E. progestin/progesterone alone
A 51-year-old woman has been experiencing progressive symptoms of profuse night sweats and frequent hot flushes occurring both day and night. She finds her emotional state increasingly labile. She is also experiencing sleep disturbances and anxiety. She denies any other complaints. Her last period was approximately 12 months ago. She has no history of medical problems or affective disorders. Her pulse is 78 beats/ minute, and her blood pressure is 122/74 mmHg. Her pelvic examination reveals atrophic external genitalia, a small anteverted uterus, and no adnexal masses. The rest of her examination is completely normal.Alternative therapies, with demonstrated efficacy, for this patient’s condition might include
A. Black cohosh
B. Soy isoflavones
C. Red clover
D. Selective serotonin reuptake inhibitors (SSRIs)/ selective serotonin and norepinephrine reuptake inhibitor (SSNRIs)
E. All of the above
A 51-year-old woman has been experiencing progressive symptoms of profuse night sweats and frequent hot flushes occurring both day and night. She finds her emotional state increasingly labile. She is also experiencing sleep disturbances and anxiety. She denies any other complaints. Her last period was approximately 12 months ago. She has no history of medical problems or affective disorders. Her pulse is 78 beats/ minute, and her blood pressure is 122/74 mmHg. Her pelvic examination reveals atrophic external genitalia, a small anteverted uterus, and no adnexal masses. The rest of her examination is completely normal.If this patient was also complaining of vaginal dryness, reasonable treatment options would include
A. Intravaginal estrogen creams/tablets
B. An intravaginal estrogen ring
C. Vaginal moisturizers
D. Increased foreplay and intercourse
E. All of the above
A 51-year-old woman has been experiencing progressive symptoms of profuse night sweats and frequent hot flushes occurring both day and night. She finds her emotional state increasingly labile. She is also experiencing sleep disturbances and anxiety. She denies any other complaints. Her last period was approximately 12 months ago. She has no history of medical problems or affective disorders. Her pulse is 78 beats/ minute, and her blood pressure is 122/74 mmHg. Her pelvic examination reveals atrophic external genitalia, a small anteverted uterus, and no adnexal masses. The rest of her examination is completely normal.The HT (combined estrogen/progestin) arm of the Women’s Health Initiative (WHI) randomized, controlled trial (RCT) was stopped prematurely primarily because patients in the treatment group demonstrated an increased relative risk for what condition?
A. Breast cancer
B. Endometrial cancer
C. Colon cancer
D. Osteoporotic fractures
E. All of the above
A 51-year-old woman has been experiencing progressive symptoms of profuse night sweats and frequent hot flushes occurring both day and night. She finds her emotional state increasingly labile. She is also experiencing sleep disturbances and anxiety. She denies any other complaints. Her last period was approximately 12 months ago. She has no history of medical problems or affective disorders. Her pulse is 78 beats/ minute, and her blood pressure is 122/74 mmHg. Her pelvic examination reveals atrophic external genitalia, a small anteverted uterus, and no adnexal masses. The rest of her examination is completely normal.Which of the following statements regarding postmenopausal osteoporosis is true?
A. The most rapid loss of bone density occurs within the first 5 years of menopause
B. Surgical menopause is a lower risk factor for osteoporosis than natural menopause
C. The protective effects of estrogen on bone density are maintained after discontinuation
D. All women should undergo bone density testing at menopause
E. the U.S. Preventive Services Task Force (USPSTF) recommends against bone density testing for women older than age 65 years
A 51-year-old woman has been experiencing progressive symptoms of profuse night sweats and frequent hot flushes occurring both day and night. She finds her emotional state increasingly labile. She is also experiencing sleep disturbances and anxiety. She denies any other complaints. Her last period was approximately 12 months ago. She has no history of medical problems or affective disorders. Her pulse is 78 beats/ minute, and her blood pressure is 122/74 mmHg. Her pelvic examination reveals atrophic external genitalia, a small anteverted uterus, and no adnexal masses. The rest of her examination is completely normal.Your patient also complains of chronic urinary urgency and frequency. She admits that she needs to wear a pad and also notes leakage of urine whenever she coughs, laughs, or sneezes. She has no history of urinary tract infections (UTIs), diabetes, or kidney problems. The most likely diagnosis for this patient is
A. Urge incontinence
B. Stress incontinence
C. Mixed incontinence
D. Overflow incontinence
E. Neurogenic bladder
A 51-year-old woman has been experiencing progressive symptoms of profuse night sweats and frequent hot flushes occurring both day and night. She finds her emotional state increasingly labile. She is also experiencing sleep disturbances and anxiety. She denies any other complaints. Her last period was approximately 12 months ago. She has no history of medical problems or affective disorders. Her pulse is 78 beats/ minute, and her blood pressure is 122/74 mmHg. Her pelvic examination reveals atrophic external genitalia, a small anteverted uterus, and no adnexal masses. The rest of her examination is completely normal.Initial workup for this patient would include all of the following except
A. urinalysis
B. Postvoid residual
C. Voiding diary
D. Urine culture
E. Bladder ultrasound
A 14-year-old female comes to your office with a 6-month history of lower midabdominal pain. The pain is colicky in nature, radiates to the back and upper thighs, begins with onset of menses, and lasts for 2 to 4 days. She has missed several days of school during the past 2 months because the pain was so severe. Menarche began 18 months ago, and her menses became regular 6 months ago. The patient is not sexually active. Physical examination, including abdomen and pelvis, is normal. The patient has normal secondary sexual development.What is the most likely etiology of this patient’s pain?
A. Primary dysmenorrhea
B. Pelvic inflammatory disease (PID)
C. Secondary dysmenorrhea
D. endometriosis
E. Premenstrual syndrome
A 14-year-old female comes to your office with a 6-month history of lower midabdominal pain. The pain is colicky in nature, radiates to the back and upper thighs, begins with onset of menses, and lasts for 2 to 4 days. She has missed several days of school during the past 2 months because the pain was so severe. Menarche began 18 months ago, and her menses became regular 6 months ago. The patient is not sexually active. Physical examination, including abdomen and pelvis, is normal. The patient has normal secondary sexual development.The etiology of this patient’s conditions is related to
A. Increased levels of prostaglandin
B. Decreased levels of prostaglandin
C. Increased levels of cyclic adenosine monophosphate (cAMP)
D. Decreased levels of cAMP
E. None of the above
A 14-year-old female comes to your office with a 6-month history of lower midabdominal pain. The pain is colicky in nature, radiates to the back and upper thighs, begins with onset of menses, and lasts for 2 to 4 days. She has missed several days of school during the past 2 months because the pain was so severe. Menarche began 18 months ago, and her menses became regular 6 months ago. The patient is not sexually active. Physical examination, including abdomen and pelvis, is normal. The patient has normal secondary sexual development.What would you recommend as initial treatment of choice?
A. Nonsteroidal anti-inflammatory drugs (NSAIDs)
B. Oral contraceptive pills (OCPs)
C. gonadotropin-releasing hormone (GnRH) agonist
D. acetaminophen
E. Intrauterine device (IUD) placement
A 14-year-old female comes to your office with a 6-month history of lower midabdominal pain. The pain is colicky in nature, radiates to the back and upper thighs, begins with onset of menses, and lasts for 2 to 4 days. She has missed several days of school during the past 2 months because the pain was so severe. Menarche began 18 months ago, and her menses became regular 6 months ago. The patient is not sexually active. Physical examination, including abdomen and pelvis, is normal. The patient has normal secondary sexual development.The pathophysiology of this patient’s pain is associated with
A. Vasodilation of the uterine arteries
B. Vasoconstriction of the uterine arteries
C. Vasodilation of the pelvic veins
D. Vasodilation of the uterine veins
E. None of the above
A 14-year-old female comes to your office with a 6-month history of lower midabdominal pain. The pain is colicky in nature, radiates to the back and upper thighs, begins with onset of menses, and lasts for 2 to 4 days. She has missed several days of school during the past 2 months because the pain was so severe. Menarche began 18 months ago, and her menses became regular 6 months ago. The patient is not sexually active. Physical examination, including abdomen and pelvis, is normal. The patient has normal secondary sexual development.When does the disorder described usually begin?
A. 13 to 16 years of age
B. within 3 years of onset of the larche (breast development)
C. within 5 years of onset of the larche
D. within 3 years of onset of menarche (first menses)
E. within 5 years of onset of menarche
A 14-year-old female comes to your office with a 6-month history of lower midabdominal pain. The pain is colicky in nature, radiates to the back and upper thighs, begins with onset of menses, and lasts for 2 to 4 days. She has missed several days of school during the past 2 months because the pain was so severe. Menarche began 18 months ago, and her menses became regular 6 months ago. The patient is not sexually active. Physical examination, including abdomen and pelvis, is normal. The patient has normal secondary sexual development.Which of the following is not usually associated with primary dysmenorrhea?
A. Pain beginning with onset of menses
B. Pain peaking during heaviest flow
C. Pain responsive to NSAIDs
D. endometriosis
E. Pain responsive to OCPs
A 14-year-old female comes to your office with a 6-month history of lower midabdominal pain. The pain is colicky in nature, radiates to the back and upper thighs, begins with onset of menses, and lasts for 2 to 4 days. She has missed several days of school during the past 2 months because the pain was so severe. Menarche began 18 months ago, and her menses became regular 6 months ago. The patient is not sexually active. Physical examination, including abdomen and pelvis, is normal. The patient has normal secondary sexual development.Which of the following is more consistent with premenstrual syndrome (PMS) than with primary dysmenorrhea?
A. Symptoms that interfere with patient’s daily function
B. Symptoms that are cyclic in nature
C. Abdominal symptoms associated with menses
D. Symptoms with onset during late luteal phase
E. Diagnosis based generally on history alone
A 14-year-old female comes to your office with a 6-month history of lower midabdominal pain. The pain is colicky in nature, radiates to the back and upper thighs, begins with onset of menses, and lasts for 2 to 4 days. She has missed several days of school during the past 2 months because the pain was so severe. Menarche began 18 months ago, and her menses became regular 6 months ago. The patient is not sexually active. Physical examination, including abdomen and pelvis, is normal. The patient has normal secondary sexual development.The patient returns 6 months later. She has tried several different NSAIDs, using the correct doses and regimens you prescribed. She had partial relief of her pain but still experiences such bothersome symptoms that she still misses school occasionally. At this time, you recommend that she
A. Continue the NSAIDs only
B. Discontinue the NSAIDs and begin oxycodone
C. add OCPs
D. Switch to danazol
E. Undergo laparoscopic presacral neuroectomy
A 24-year-old nulligravida woman comes to your office with an 18-month history of cyclic, debilitating pelvic pain related to menses. Her menses is regular and heavy, requiring 10 to 15 thick pads on the days of heaviest flow. She denies ever being diagnosed with a sexually transmitted infection (STI). She and her husband have been engaging in regular intercourse without contraception for 1 year in an attempt to conceive. On pelvic examination, you find a normalsized, immobile, retroverted uterus with nodularity and tenderness on palpation of the uterosacral ligaments.You inform the patient that the most likely diagnosis is
A. Uterine fibroid
B. endometriosis
C. adenomyosis
D. PID
E. Endometrial carcinoma
A 24-year-old nulligravida woman comes to your office with an 18-month history of cyclic, debilitating pelvic pain related to menses. Her menses is regular and heavy, requiring 10 to 15 thick pads on the days of heaviest flow. She denies ever being diagnosed with a sexually transmitted infection (STI). She and her husband have been engaging in regular intercourse without contraception for 1 year in an attempt to conceive. On pelvic examination, you find a normalsized, immobile, retroverted uterus with nodularity and tenderness on palpation of the uterosacral ligaments.You further explain that her pain is described most accurately as
A. Primary dysmenorrhea
B. Secondary dysmenorrhea
C. Premenstrual syndrome
D. Psychogenic pain
E. None of the above
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