Gyneco(251-300)

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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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?

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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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