NR602 Final
16yo girl has h/o secondary amenorrhea. Menarche at 10yo, normal cycles x2yrs, has now not
menstruated x4yrs. What is maximum common etiology of this hassle?
A. Eating sickness
b. Pregnancy
c. Anovulatory cycles
d. Stress - ANS-a
18yo female c/o secondary amenorrhea. On examination, there is ordinary secondary
intercourse traits and everyday genitalia. Pregnancy is dominated out. What could necessitate
further eval?
A. Elevated blood cholesterol levels
b. Androgen deficiency
c. Galactorrhea
d. Hirsutism - ANS-c
22yo woman c/o pelvic pain. Exam exhibits cervical motion and uterine tenderness. Which
supports PID dx?
A. Temp <100F
b. Absence of WBCs in vag fluid
c. Mucopurulent vag discharge
d. Lab documentation of cervical infection w/E. Coli - ANS-c
24yo female is dx'd w/primary dysmenorrhea. Which med would be used as first-line to help
control symptoms?
A. Antianxiety meds
b. Progesterone-only contraception
c. Oral steroids
d. NSAIDs - ANS-d
25yo female c/o tender area near her introitus and to the L of her perineum. Very painful sex
was first sign. Initially bump was very small, but now is ping-pong ball size. On exam, abscess is
present on L medial side of labia minora and there's edema extending into perineum. What is
dx?
A. Lipoma
b. Dermoid cyst
,c. Bartholin's cyst
d. Skene's duct cyst - ANS-c
25yo female c/o vaginal irritation and discharge. On exam, cervix is easily friable and
erythematous. No adnexal tenderness. Wet prep reveals mobile protozoa on NS slide. This
most likely represents:
a. Trichomonas
b. Mucopurulent cervicitis
c. Bacterial vaginosis
d. Gonorrhea - ANS-a
25yo postmenopausal female c/o pain in upper outer quadrant of L breast x1mo. Best course of
action would be:
a. Reassure pt that pain is often not presenting symptom of breast cancer.
B. Teach pt breast self-exam.
C. Order labs as most likely this is secondary to hormonal fluctuation
d. Perform breast exam and order mammo - ANS-d
28yo female c/o breast tenderness, fatigue, abd bloating, fluid retention, irritability 1wk before
her menses onset. What is most important info to obtain from this pt to determine if the pt has
PMS?
A. Severity of symptoms
b. Occurrence of symptoms in menstrual cycle
c. Frequency and number of symptoms over past 4mo - ANS-b
32yo woman c/o postcoital bleeding. Which would not be included in the initial assessment?
A. Pap smear
b. Uterine biopsy
c. Pelvic ultrasound
d. CBC w/diff - ANS-b
35yo woman c/o 6mo h/o hypermenorrhea, backache, pelvic pressure. On exam, you discover
12wk size uterus w/irregular contour. What does this represent?
A. Uterine cancer
b. Dysfunctional uterine bleeding
c. Uterine fibroid
d. Fecal impaction - ANS-c
,39yo female has completed course of amox for strep throat. LMP was 2wks ago, says it was
normal. On exam, there's erythema of extern. Genitalia w/small amount of white discharge.
Micro wet prep reveals few clue cells, but many budding hyphae. No WBCs. Which one would
be the most appropriate treatment?
A. Metronidazole 500mg BID x7 days
b. OTC hydrocortisone 1% cream TID
c. Fluconazole tabs 150mg x1 dose
d. Erythromycin 500mg TID x10 days - ANS-c
4 phenotypes of PCOD/S: - ANS--Hyperandrogenism/chronic anovulation
-Hyperandrogenism/polycystic ovaries on US but w/ovulatory cycles
-Chronic anovulation/polycystic ovaries w/out hyperandrogenism
-Hyperandrogenism, chronic anovulation, polycystic ovaries
49yo female c/o dark, watery brown vaginal discharge. Which best describes what might be
seen on physical exam in pt's with cervical cancer?
A. Ulcerated firm cervix
b. Vague lower abd pain
c. Enlarged tender femoral lymph nodes
d. Soft, still shaped cervix - ANS-a
Absolute contraind. For estrog. Replacement therapy - ANS--h/o breast ca
-Undx vag bleeding
-Carcinoma
-Active liver dz
Adolescent diagnostic criteria for PCOD/S - ANS-All 3 criteria according to Rotterdam should be
present:
-Oligomenorrhea/amenorrhea present 2y after menarche
-Polycystic ovaries on US should incl. Evidence of incr. Ovarian size
-Hyperandrogenemia dx'd via lab analysis
Adult diagnostic criteria for PCOD/S - ANS-Rotterdam Consensus Criteria:
-Evidence of 2 out of 3: hyperandrogenism, oligo-ovulation/anovulation, polycystic ovaries on
US
Affective symptoms of PMS - ANS-Depression
Angry outburst
Anxiety
Confusion
Social withdrawal
, Amenorrhea description (primary) - ANS-Failure to reach menarche by 15yo (w/norm.
Secondary sexual charact.) or 13yo (no secondary sexual charact.)
Amenorrhea description (secondary) - ANS-Cessation of reg. Menses x3mo or cessation of
irreg. Menses x6mo
Assessment findings for vulvodynia - ANS-Mons pubis, labia majora/minora, vestibule,
perineum, clit:
-Burning
-Stinging
-Itching
-Aching
-Soreness
-Throbbing
-Irritation
-Rawness
Dyspareunia
Usually no visible abnorm., but maybe erythema/lichen sclerosis at pain/itching site
Assessment findings in PID - ANS--Asymptomatic
-Sympt. Usually begin during/within 1wk of menses
-Unusual/new onset abnorm. Uterine bleeding, dysmenorr. W/or w/out menorrhagia
-Low abd tenderness or pain/rebound tenderness
-Fever
-Malaise
-Vag discharge/lesion
-Urinary discomf.
-N/v
-Cervical motion tenderness/uterine tenderness
-Dyspareunia
-Subclinical PID
-Adnexal tenderness
Assessment findings in vulvar ca - ANS--Preinvasive lesions: flat, hyperkeratotic, may vary in
color (white, pink, brown)
-SCC: maybe Lg lesion that grows outward from epithel. Surface or as small ulcer
Assessment findings of atroph. Vaginitis - ANS--Vag dryness/burning/itching/irritation
-Atrophy/absence/decr. Vag rugae
-Pruritis
-Blood-tinged vag discharge
-Bleeding after intercourse
-Erythematous/petechial patches on vag mucosa
-Dyspareunia
16yo girl has h/o secondary amenorrhea. Menarche at 10yo, normal cycles x2yrs, has now not
menstruated x4yrs. What is maximum common etiology of this hassle?
A. Eating sickness
b. Pregnancy
c. Anovulatory cycles
d. Stress - ANS-a
18yo female c/o secondary amenorrhea. On examination, there is ordinary secondary
intercourse traits and everyday genitalia. Pregnancy is dominated out. What could necessitate
further eval?
A. Elevated blood cholesterol levels
b. Androgen deficiency
c. Galactorrhea
d. Hirsutism - ANS-c
22yo woman c/o pelvic pain. Exam exhibits cervical motion and uterine tenderness. Which
supports PID dx?
A. Temp <100F
b. Absence of WBCs in vag fluid
c. Mucopurulent vag discharge
d. Lab documentation of cervical infection w/E. Coli - ANS-c
24yo female is dx'd w/primary dysmenorrhea. Which med would be used as first-line to help
control symptoms?
A. Antianxiety meds
b. Progesterone-only contraception
c. Oral steroids
d. NSAIDs - ANS-d
25yo female c/o tender area near her introitus and to the L of her perineum. Very painful sex
was first sign. Initially bump was very small, but now is ping-pong ball size. On exam, abscess is
present on L medial side of labia minora and there's edema extending into perineum. What is
dx?
A. Lipoma
b. Dermoid cyst
,c. Bartholin's cyst
d. Skene's duct cyst - ANS-c
25yo female c/o vaginal irritation and discharge. On exam, cervix is easily friable and
erythematous. No adnexal tenderness. Wet prep reveals mobile protozoa on NS slide. This
most likely represents:
a. Trichomonas
b. Mucopurulent cervicitis
c. Bacterial vaginosis
d. Gonorrhea - ANS-a
25yo postmenopausal female c/o pain in upper outer quadrant of L breast x1mo. Best course of
action would be:
a. Reassure pt that pain is often not presenting symptom of breast cancer.
B. Teach pt breast self-exam.
C. Order labs as most likely this is secondary to hormonal fluctuation
d. Perform breast exam and order mammo - ANS-d
28yo female c/o breast tenderness, fatigue, abd bloating, fluid retention, irritability 1wk before
her menses onset. What is most important info to obtain from this pt to determine if the pt has
PMS?
A. Severity of symptoms
b. Occurrence of symptoms in menstrual cycle
c. Frequency and number of symptoms over past 4mo - ANS-b
32yo woman c/o postcoital bleeding. Which would not be included in the initial assessment?
A. Pap smear
b. Uterine biopsy
c. Pelvic ultrasound
d. CBC w/diff - ANS-b
35yo woman c/o 6mo h/o hypermenorrhea, backache, pelvic pressure. On exam, you discover
12wk size uterus w/irregular contour. What does this represent?
A. Uterine cancer
b. Dysfunctional uterine bleeding
c. Uterine fibroid
d. Fecal impaction - ANS-c
,39yo female has completed course of amox for strep throat. LMP was 2wks ago, says it was
normal. On exam, there's erythema of extern. Genitalia w/small amount of white discharge.
Micro wet prep reveals few clue cells, but many budding hyphae. No WBCs. Which one would
be the most appropriate treatment?
A. Metronidazole 500mg BID x7 days
b. OTC hydrocortisone 1% cream TID
c. Fluconazole tabs 150mg x1 dose
d. Erythromycin 500mg TID x10 days - ANS-c
4 phenotypes of PCOD/S: - ANS--Hyperandrogenism/chronic anovulation
-Hyperandrogenism/polycystic ovaries on US but w/ovulatory cycles
-Chronic anovulation/polycystic ovaries w/out hyperandrogenism
-Hyperandrogenism, chronic anovulation, polycystic ovaries
49yo female c/o dark, watery brown vaginal discharge. Which best describes what might be
seen on physical exam in pt's with cervical cancer?
A. Ulcerated firm cervix
b. Vague lower abd pain
c. Enlarged tender femoral lymph nodes
d. Soft, still shaped cervix - ANS-a
Absolute contraind. For estrog. Replacement therapy - ANS--h/o breast ca
-Undx vag bleeding
-Carcinoma
-Active liver dz
Adolescent diagnostic criteria for PCOD/S - ANS-All 3 criteria according to Rotterdam should be
present:
-Oligomenorrhea/amenorrhea present 2y after menarche
-Polycystic ovaries on US should incl. Evidence of incr. Ovarian size
-Hyperandrogenemia dx'd via lab analysis
Adult diagnostic criteria for PCOD/S - ANS-Rotterdam Consensus Criteria:
-Evidence of 2 out of 3: hyperandrogenism, oligo-ovulation/anovulation, polycystic ovaries on
US
Affective symptoms of PMS - ANS-Depression
Angry outburst
Anxiety
Confusion
Social withdrawal
, Amenorrhea description (primary) - ANS-Failure to reach menarche by 15yo (w/norm.
Secondary sexual charact.) or 13yo (no secondary sexual charact.)
Amenorrhea description (secondary) - ANS-Cessation of reg. Menses x3mo or cessation of
irreg. Menses x6mo
Assessment findings for vulvodynia - ANS-Mons pubis, labia majora/minora, vestibule,
perineum, clit:
-Burning
-Stinging
-Itching
-Aching
-Soreness
-Throbbing
-Irritation
-Rawness
Dyspareunia
Usually no visible abnorm., but maybe erythema/lichen sclerosis at pain/itching site
Assessment findings in PID - ANS--Asymptomatic
-Sympt. Usually begin during/within 1wk of menses
-Unusual/new onset abnorm. Uterine bleeding, dysmenorr. W/or w/out menorrhagia
-Low abd tenderness or pain/rebound tenderness
-Fever
-Malaise
-Vag discharge/lesion
-Urinary discomf.
-N/v
-Cervical motion tenderness/uterine tenderness
-Dyspareunia
-Subclinical PID
-Adnexal tenderness
Assessment findings in vulvar ca - ANS--Preinvasive lesions: flat, hyperkeratotic, may vary in
color (white, pink, brown)
-SCC: maybe Lg lesion that grows outward from epithel. Surface or as small ulcer
Assessment findings of atroph. Vaginitis - ANS--Vag dryness/burning/itching/irritation
-Atrophy/absence/decr. Vag rugae
-Pruritis
-Blood-tinged vag discharge
-Bleeding after intercourse
-Erythematous/petechial patches on vag mucosa
-Dyspareunia
