WGU D120 Questions with Correct Answers | Latest Update
a. Safety is paramount
b. Adhere to ethical practices
1. Discuss the 4 Principles of Practice
c. Value base system health care delivery
d. Prevention and early migration of disease
a. Woman 19-49 MMR, hep b, and varicella for those non immune.
b. Girls 11-26 HPV vaccine
c. Tdap 19-64 replace Td
d. Women 50> influenza annually
i. 19-49 annually for health care workers
ii. Chronic diseases, HD, DM
1. Identify the appropriate age and interval of recommended health screening for women.
iii. Pregnant women
e. Pneumococcal 65 >or chronic disease, alcohol, immunocompromised
f. Contraindicated in pregnant women
i. MMR
ii. Varicella
iii. HPV
a. History
1. b. Physical Exam
Outline the elements of the Well Woman Physical (refer to your women's health SOAP note
i. (1) inspection of the external genitalia, vagina, and cervix; (2) collection of cytologic speci-
from D117)
mens from the exocervix (or ectocervix) and superficial endocervical canal; and (3) palpation
of the cervix, uterus, and adnexa.
a. History
1. Outline the elements of the Well Woman Physical (refer to your women's health SOAP note b. Physical Exam
from D117) i. (1) inspection of the external genitalia, vagina, and cervix; (2) collection of cytologic speci-
e cervix, uterus, and adnexa. mens from the exocervix (or ectocervix) and superficial endocervical canal; and (3) palpation
of th
i. Chadwick sign dark discoloration of vulva vaginal walls
ii. Abdominal stria
iii. Linea nigra midline of lower abdomen
iv. Chloasma pigmentation under eyes (hormonal contraceptives)
b. Probable physical changes
1. Ditterentiate the signs of pregnancy
i. Uterine enlargement Piskacek Sign
a. Presumptive Skin and mucus membrane changes
ii. Hagar Sign softer cervix
iii. Pregnancy test
c. Positive
i. Fetal heartbeat endo ultrasound (6 weeks)
ii. Fetal movements (7-8 weeks)
a. White lesions
i. Vitiligo
1. Loss of pigment / observation
ii. Lichen sclerosis
1. Intense itching and dyspareunia/topical steroids, carcinoma
1. Identify the benign conditions of the vulva.
iii. Lichen planus
1. Auto immune Wickham striae, classic fernlike or lacy patterns./ topical steroids
iv. Lichen simples chronicus
1. Mimics psoriasa biosy needed/ immediate potency topical steroids
,WGU D120 Questions with Correct Answers | Latest Update
v. Vulvovaginal atrophy
1. Postmenamaual decreased fat / estrogen creams/ moisturizers/ lubricants
i. Eczema
1. Allergic contact mc, itching swelling and crusting /discontinue use of allergen
ii. Seborrheic dermatitis
a. Red Lesions 1. Red glazed shiney appreace on skin folds, greasy scalp areas/topical steroids
iii. Psoriasis
1. Auto immune, red plaques with clear borders, biopsy, itscing is common, pustular form
confused with candidia/ topical steroids
i. Genital melanosis
1. Dark pigment on muscus menbranes/ expectant management
a. Pigmented lesions
ii. Acanthosis nigricans
1. Pigmented areas on vulva, axilla and neck r/t insulin resistance/ weight loss and glucose
control.
i. Aphthous ulcers
1. Painful like canker sores 2cm wide to 1cm deep / symptomatic
ii. Bechet disease
1. Genital and oral ulcers with uveitis in combo with antivirals or IBS/depends
a. Ulcerations a fissures
iii. Chrons disease
1. Granulomatous intestinal tract inflammatory process/ treat bowels disease
iv. Traumatic ulcerations
1. Scratching itching neglect /counseling suspect psych disorder
i. Epidermal cysts
1. MC, obstructed hair follicle/ body hair care/ deflation
ii. Vulvar vestibular papillomatosis
1. Soft elongated papules/ reassurance
iii. Genital warts
1. Human papilloma virus
iv. Fox-fordyce disease
1. Chronic inflammation of apocrine glands/systemic antipruritic
a. Solid cysts or masses
v. Hidradenitis suppurativa
1. Red papules painful recurrent seen in obesity/ corticosteroids, abt for celluutis, oral
contraceptive reduces reoccurrence
vi. Vascular lesion
1. tortuous varicosities; cherry angiomas and hematomas/Evaluation, compression; possible
evacuation of expanding hematoma
vii. Urethral caruncle
1. Solitary red papule at the urethral meatus; usually <1 cm diameter; appears as a collar
, WGU D120 Questions with Correct Answers | Latest Update
around urethral opening/ Observation and biopsy as needed; estrogen creams; surgery rarely
indicated
a. The most significant of the vulvar anomalies are those that pose challenges to the assignment of gender at birth.
a. Ambiguous genitalia can present with clitoromegaly, bifid clitoris, or midline fusion of the labioscrotal folds.
of the genital tubercle to develop. Incomplete development of the genitalia can result in a
Clitoral agenesis may result from the failure
cloaca with no separation of the bladder and the vagina.
in utero masculinization due to androgens from maternal or fetal congenital adrenal hyper-
plasia, androgen-producing tumors of the mother's ovary or adrenal glands, or the mother's
. Female pseudo hermaphroditism is caused by use of exogenous androgens. Often the infant will present with ambiguous genitalia.
The enlarged clitoris is the most conspicuous abnormality.
a. Male pseudohermaphroditism, which most commonly results from mosaicism, may occur with varying degrees of virilization and müllerian development.
a. Androgen insensitivity syndrome (a form of male pseudohermaphroditism and formerly genetic deficiency of androgen receptors that results in a 46,XY infant developing female
called testicular feminization) is a external genitalia and, later in life, secondary sexual characteristics.
some degree of both female and male development externally and internally; dual gonadal
a. True hermaphroditism is rare. The attected child has
development occurs with either a combined ovotestes or separate gonads.
a. WHo
i. Type I—Partial or total removal of the clitoris and/or prepuce (clitoridectomy)
ii. Type II—Partial or total removal of the clitoris and labia minora, with or without the excision
of the labia majora (excision)
1. Discuss iatrogenic anatomical changes of the vulva.
iii. Type III—Narrowing of the vaginal orifice with creation of a covering seal by cutting and
appositioning the labia minora and/or the labia majora, with or without excision of the clitoris
(infibulation)
iv. Type IV—All other harmful procedures to the female genitalia for nonmedical purposes;
for example, pricking, piercing, incising, scraping, and cauterizing
i. Papillomatosis
1. Appear like papilloma virus/ reassurance
a. Epithelial Changes
ii. Contact dermatitis
1. irritation/ discontinue irritant
i. Ulcers
1. most ulceration of the vagina is associated with acute infection due to herpes simplex or
cytomegalovirus;/ steroids
a. Ulcerations and fistulas
ii. Fistulas
1. bladder or rectum into the vagina may occur due to surgical complication, infection, or
malignancy/ surgical
i. Bartholin cyst
1. Cystic mass below hymenal ring at 4 or 8 o'clock; must rule out underlying malignancy in
older women/ no treatment; if symptomatic, consider drainage with Word catheter placement
a. Cystic Masses or marsupialization
ii. Gartner duct cyst
1. soft cystic structures formed from remnants of the Wolflan duct;/ asymptomatic
, WGU D120 Questions with Correct Answers | Latest Update
i. represents the most extreme instance of a vaginal anomaly, with total absence of the vagina
a. Vaginal agenesis
except for the most distal portion that is derived from the urogenital sinus,
i. bulging, membrane-like structure may be noticed in the vestibule, usually blocking egress
a. Imperforate hymen
of mucus. If not detected until after menarche, an imperforate hymen
a. müllerian agenesis or Rokitansky-Küster-Hauser syndrome i. the uterus is absent but the fallopian tubes are spared,
i. is most commonly found at the junction of the upper and middle thirds of the vagina
a. transverse vaginal septum,
a. midline longitudinal septum
i. double cervix
a. Adenosis of the vaginal i. wall consists of islands of columnar epithelium in the normal squamous epithelium.
i. are small (0.3 to 3 cm), sac-like projections that can be found along the posterior urethra in
a. Urethral diverticula
the midline of the anterior vaginal wall
i. The more common type occurs in older women and is frequently related to long-standing
lichen sclerosis.
ii. The less common type occurs in younger women and is related to infection with the human
papillomavirus and smoking.
a. Epidemiology
iii. Most tumors are squamous cell carcinomas, and they occur mainly in postmenopausal
women
iv. vulvar cancer may also occur in association with the venereal diseases syphilis, lym-
phogranuloma venereum, and granuloma inguinale
i. Itching is the most common symptom, although some patients present with palpable or
visible abnormalities of the vulva.
1. vulvar and vaginal cancer.a. Clinical features ii. Asymptomatic
iii. Approximately 20% of the lesions have a "warty" appearance, and the lesions are multi-
centric in about two-thirds of cases.
i. Diagnosis requires biopsy of suspicious lesions, which can be done in the oflce with the
vulvar and vaginal cancer a. Diagnosis
patient under local anesthesia.
i. Most cases of VIN can be treated adequately by local superficial surgical excision with
primary closure. margins of about 5 mm are usually adequate. For extensive lesions involving
most of the vulva, a "skinning" vulvectomy
vulvar and vaginal cancer a. Management
ii. Since the 1980s, a vulva-conserving approach has been used for most primary lesions, and
the groin dissection has usually been performed through a separate groin incision
i. The overall survival rate for vulvar carcinoma is about 70%.
vulvar and vaginal cancer Prognosis ii. Patients with positive nodes have a 5-year survival rate of about 50%, whereas those with
negative nodes have a 5-year survival rate of about 90%.
a. Bacterial vaginosis s/s
a. Safety is paramount
b. Adhere to ethical practices
1. Discuss the 4 Principles of Practice
c. Value base system health care delivery
d. Prevention and early migration of disease
a. Woman 19-49 MMR, hep b, and varicella for those non immune.
b. Girls 11-26 HPV vaccine
c. Tdap 19-64 replace Td
d. Women 50> influenza annually
i. 19-49 annually for health care workers
ii. Chronic diseases, HD, DM
1. Identify the appropriate age and interval of recommended health screening for women.
iii. Pregnant women
e. Pneumococcal 65 >or chronic disease, alcohol, immunocompromised
f. Contraindicated in pregnant women
i. MMR
ii. Varicella
iii. HPV
a. History
1. b. Physical Exam
Outline the elements of the Well Woman Physical (refer to your women's health SOAP note
i. (1) inspection of the external genitalia, vagina, and cervix; (2) collection of cytologic speci-
from D117)
mens from the exocervix (or ectocervix) and superficial endocervical canal; and (3) palpation
of the cervix, uterus, and adnexa.
a. History
1. Outline the elements of the Well Woman Physical (refer to your women's health SOAP note b. Physical Exam
from D117) i. (1) inspection of the external genitalia, vagina, and cervix; (2) collection of cytologic speci-
e cervix, uterus, and adnexa. mens from the exocervix (or ectocervix) and superficial endocervical canal; and (3) palpation
of th
i. Chadwick sign dark discoloration of vulva vaginal walls
ii. Abdominal stria
iii. Linea nigra midline of lower abdomen
iv. Chloasma pigmentation under eyes (hormonal contraceptives)
b. Probable physical changes
1. Ditterentiate the signs of pregnancy
i. Uterine enlargement Piskacek Sign
a. Presumptive Skin and mucus membrane changes
ii. Hagar Sign softer cervix
iii. Pregnancy test
c. Positive
i. Fetal heartbeat endo ultrasound (6 weeks)
ii. Fetal movements (7-8 weeks)
a. White lesions
i. Vitiligo
1. Loss of pigment / observation
ii. Lichen sclerosis
1. Intense itching and dyspareunia/topical steroids, carcinoma
1. Identify the benign conditions of the vulva.
iii. Lichen planus
1. Auto immune Wickham striae, classic fernlike or lacy patterns./ topical steroids
iv. Lichen simples chronicus
1. Mimics psoriasa biosy needed/ immediate potency topical steroids
,WGU D120 Questions with Correct Answers | Latest Update
v. Vulvovaginal atrophy
1. Postmenamaual decreased fat / estrogen creams/ moisturizers/ lubricants
i. Eczema
1. Allergic contact mc, itching swelling and crusting /discontinue use of allergen
ii. Seborrheic dermatitis
a. Red Lesions 1. Red glazed shiney appreace on skin folds, greasy scalp areas/topical steroids
iii. Psoriasis
1. Auto immune, red plaques with clear borders, biopsy, itscing is common, pustular form
confused with candidia/ topical steroids
i. Genital melanosis
1. Dark pigment on muscus menbranes/ expectant management
a. Pigmented lesions
ii. Acanthosis nigricans
1. Pigmented areas on vulva, axilla and neck r/t insulin resistance/ weight loss and glucose
control.
i. Aphthous ulcers
1. Painful like canker sores 2cm wide to 1cm deep / symptomatic
ii. Bechet disease
1. Genital and oral ulcers with uveitis in combo with antivirals or IBS/depends
a. Ulcerations a fissures
iii. Chrons disease
1. Granulomatous intestinal tract inflammatory process/ treat bowels disease
iv. Traumatic ulcerations
1. Scratching itching neglect /counseling suspect psych disorder
i. Epidermal cysts
1. MC, obstructed hair follicle/ body hair care/ deflation
ii. Vulvar vestibular papillomatosis
1. Soft elongated papules/ reassurance
iii. Genital warts
1. Human papilloma virus
iv. Fox-fordyce disease
1. Chronic inflammation of apocrine glands/systemic antipruritic
a. Solid cysts or masses
v. Hidradenitis suppurativa
1. Red papules painful recurrent seen in obesity/ corticosteroids, abt for celluutis, oral
contraceptive reduces reoccurrence
vi. Vascular lesion
1. tortuous varicosities; cherry angiomas and hematomas/Evaluation, compression; possible
evacuation of expanding hematoma
vii. Urethral caruncle
1. Solitary red papule at the urethral meatus; usually <1 cm diameter; appears as a collar
, WGU D120 Questions with Correct Answers | Latest Update
around urethral opening/ Observation and biopsy as needed; estrogen creams; surgery rarely
indicated
a. The most significant of the vulvar anomalies are those that pose challenges to the assignment of gender at birth.
a. Ambiguous genitalia can present with clitoromegaly, bifid clitoris, or midline fusion of the labioscrotal folds.
of the genital tubercle to develop. Incomplete development of the genitalia can result in a
Clitoral agenesis may result from the failure
cloaca with no separation of the bladder and the vagina.
in utero masculinization due to androgens from maternal or fetal congenital adrenal hyper-
plasia, androgen-producing tumors of the mother's ovary or adrenal glands, or the mother's
. Female pseudo hermaphroditism is caused by use of exogenous androgens. Often the infant will present with ambiguous genitalia.
The enlarged clitoris is the most conspicuous abnormality.
a. Male pseudohermaphroditism, which most commonly results from mosaicism, may occur with varying degrees of virilization and müllerian development.
a. Androgen insensitivity syndrome (a form of male pseudohermaphroditism and formerly genetic deficiency of androgen receptors that results in a 46,XY infant developing female
called testicular feminization) is a external genitalia and, later in life, secondary sexual characteristics.
some degree of both female and male development externally and internally; dual gonadal
a. True hermaphroditism is rare. The attected child has
development occurs with either a combined ovotestes or separate gonads.
a. WHo
i. Type I—Partial or total removal of the clitoris and/or prepuce (clitoridectomy)
ii. Type II—Partial or total removal of the clitoris and labia minora, with or without the excision
of the labia majora (excision)
1. Discuss iatrogenic anatomical changes of the vulva.
iii. Type III—Narrowing of the vaginal orifice with creation of a covering seal by cutting and
appositioning the labia minora and/or the labia majora, with or without excision of the clitoris
(infibulation)
iv. Type IV—All other harmful procedures to the female genitalia for nonmedical purposes;
for example, pricking, piercing, incising, scraping, and cauterizing
i. Papillomatosis
1. Appear like papilloma virus/ reassurance
a. Epithelial Changes
ii. Contact dermatitis
1. irritation/ discontinue irritant
i. Ulcers
1. most ulceration of the vagina is associated with acute infection due to herpes simplex or
cytomegalovirus;/ steroids
a. Ulcerations and fistulas
ii. Fistulas
1. bladder or rectum into the vagina may occur due to surgical complication, infection, or
malignancy/ surgical
i. Bartholin cyst
1. Cystic mass below hymenal ring at 4 or 8 o'clock; must rule out underlying malignancy in
older women/ no treatment; if symptomatic, consider drainage with Word catheter placement
a. Cystic Masses or marsupialization
ii. Gartner duct cyst
1. soft cystic structures formed from remnants of the Wolflan duct;/ asymptomatic
, WGU D120 Questions with Correct Answers | Latest Update
i. represents the most extreme instance of a vaginal anomaly, with total absence of the vagina
a. Vaginal agenesis
except for the most distal portion that is derived from the urogenital sinus,
i. bulging, membrane-like structure may be noticed in the vestibule, usually blocking egress
a. Imperforate hymen
of mucus. If not detected until after menarche, an imperforate hymen
a. müllerian agenesis or Rokitansky-Küster-Hauser syndrome i. the uterus is absent but the fallopian tubes are spared,
i. is most commonly found at the junction of the upper and middle thirds of the vagina
a. transverse vaginal septum,
a. midline longitudinal septum
i. double cervix
a. Adenosis of the vaginal i. wall consists of islands of columnar epithelium in the normal squamous epithelium.
i. are small (0.3 to 3 cm), sac-like projections that can be found along the posterior urethra in
a. Urethral diverticula
the midline of the anterior vaginal wall
i. The more common type occurs in older women and is frequently related to long-standing
lichen sclerosis.
ii. The less common type occurs in younger women and is related to infection with the human
papillomavirus and smoking.
a. Epidemiology
iii. Most tumors are squamous cell carcinomas, and they occur mainly in postmenopausal
women
iv. vulvar cancer may also occur in association with the venereal diseases syphilis, lym-
phogranuloma venereum, and granuloma inguinale
i. Itching is the most common symptom, although some patients present with palpable or
visible abnormalities of the vulva.
1. vulvar and vaginal cancer.a. Clinical features ii. Asymptomatic
iii. Approximately 20% of the lesions have a "warty" appearance, and the lesions are multi-
centric in about two-thirds of cases.
i. Diagnosis requires biopsy of suspicious lesions, which can be done in the oflce with the
vulvar and vaginal cancer a. Diagnosis
patient under local anesthesia.
i. Most cases of VIN can be treated adequately by local superficial surgical excision with
primary closure. margins of about 5 mm are usually adequate. For extensive lesions involving
most of the vulva, a "skinning" vulvectomy
vulvar and vaginal cancer a. Management
ii. Since the 1980s, a vulva-conserving approach has been used for most primary lesions, and
the groin dissection has usually been performed through a separate groin incision
i. The overall survival rate for vulvar carcinoma is about 70%.
vulvar and vaginal cancer Prognosis ii. Patients with positive nodes have a 5-year survival rate of about 50%, whereas those with
negative nodes have a 5-year survival rate of about 90%.
a. Bacterial vaginosis s/s
