MSN 622 FINAL COMPREHENSIVE
EXAMINATION TEST SOLVED QUESTIONS
AND CORRECT ANSWERS FULL SOLUTION
REVIEW GUIDE
⩥ An 18-year-old female patient presents to the clinic with complaints of
lower abdominal pain and fever for two days. She also reports cervical
discharge for one week. She has a history of multiple sexual partners and
unprotected sexual intercourse. She denies any nausea or vomiting. On
examination, her temperature is 101 F (38.3 C). Abdominal examination
reveals tenderness on the left lower quadrant. Bimanual examination
shows cervical motion tenderness. What is the best next step in the
management of this patient?
Answer: Beta hcg
⩥ A 25-year-old woman presents to the clinic with nausea, pelvic pain,
and vaginal discharge. The client is sexually active and has multiple
sexual partners. Her blood pressure is 110/70 mmHg, her pulse rate is
110/min, and her temperature is 102 F (38.8 C). On examination,
adnexal tenderness is noted. Which of the following complications is
most likely to occur if this client's condition is left untreated?
Answer: Infertility
⩥ A 16-year-old female presents to the hospital with a complaint of
severe lower abdominal pain that started two hours ago. She also
,complains of fever and abnormal vaginal discharge. On further
questioning, she gives a history of intermenstrual bleeding. A detailed
medical history reveals that she was treated for a similar condition last
year. Her vital signs show blood pressure 110/80 mmHg, respiratory rate
16/min, heart rate 96/min, and temperature 100.4 F (38C). A pelvic
examination performed shows cervical motion tenderness. A blood test
was ordered which shows a white cell count of 15,000 per microliter of
blood. What is the most likely causative organism of the subclinical
form of her condition?
Answer: Chlamydia
⩥ A 26-year-old woman presents with sudden onset severe right lower
quadrant abdominal pain. Examination reveals extreme tenderness on
palpation. She has no history of smoking, alcohol consumption, or illicit
drug use. She has a medical history of 2 previous elective abortions
followed by a D & C. Her menstrual cycle started this morning and
reports it was ten days before it was due. She states that this is unusual
for her. A urine pregnancy test is positive. Blood pressure is 86/60
mmHg, pulse rate is 100/min, and the respiratory rate is 16/min. Two
large-bore needles are placed on each arm, and IV fluids are begun.
Which of the following is the most appropriate next step in the
management of this patient?
Answer: Transvaginal us
⩥ A 21-year-old gravida 2 and para 0+1 with one elective abortion
presents to the clinic with secondary amenorrhea for 3 months. Her
previous cycles were regular and of 28 days duration. There is no history
of vaginal discharge, fever, or abdominal pain. The physical examination
,shows a ten-week sized uterus with no other abnormality. Urinary B-
hCG is positive. On ultrasound, the uterus is empty, and a mass is
present in the right adnexal region. Which of the following is the most
common site of occurrence for this pathology?
Answer: Ampullary
⩥ A 72-year-old woman presents to the clinic with complaints of an
ulcer on the superior aspect of her right labia majora. She has no other
complaints at this time, except for some swelling in her right groin
region. She reports no medical history but notes that she was diagnosed
in her mid-40s with "inflammation" near her vagina but never had it
followed up. On physical exam, a 1 cm patch with ulceration and
increased surrounding vascularity is noted in the area of concern, and
there is widespread erythematous vulvar skin that is paper-thin. A biopsy
of the lesion is taken and squamous cell carcinoma is diagnosed. What is
the most likely molecular origin of this patient's disease?
Answer: Loss fxn in a tumor suppressor protein
⩥ A 72-year-old woman presents to the clinic complaining of a discrete
flesh-colored raised lesion that has been causing labial irritation for a
one-year duration. The patient denies any other complaints at present
and denies any significant medical history. On physical examination,
there is a 5 mm papule near the superior portion of the left labia majora.
Office dermoscopy shows blue ovoid nests and arborizing vessels. A
biopsy of the lesion is taken and the presumed diagnosis is made. The
patient undergoes complete excision with negative margins. Which of
the following best estimates the patient's 3-year survival?
, Answer: 90-100
⩥ A 69-year-old woman presents to the clinic for follow up. She was
recently diagnosed with invasive vulvar squamous cell carcinoma after a
biopsy. The depth of invasion was noted to be 0.8 mm and no lymph
node metastasis was noted. Which of the following is the most
appropriate surgical plan for this patient?
Answer: Wide local with 1-2 margins
⩥ A 57-year-old postmenopausal woman presents with a sensation of
fullness in her pelvis but denies any associated symptoms. Examination
demonstrates a large mass on the left wall of the vagina that extends to
the pelvic sidewall. Biopsy shows squamous cell carcinoma. Which
medication is considered part of the standard therapy for this patient's
condition?
Answer: Cisplatin
⩥ A patient past her reproductive years has carcinoma in situ of the
cervix with cone biopsy showing squamous cell carcinoma with invasion
1 mm beyond the basement membrane. There is no lymphovascular
space invasion. What is the next best step?
Answer: Sumple hysterectomy
⩥ A 32-year-old woman presents to the office for a health maintenance
exam. The patient states she feels healthy and has no complaints.
However, her sister was recently diagnosed with cervical cancer, and she
EXAMINATION TEST SOLVED QUESTIONS
AND CORRECT ANSWERS FULL SOLUTION
REVIEW GUIDE
⩥ An 18-year-old female patient presents to the clinic with complaints of
lower abdominal pain and fever for two days. She also reports cervical
discharge for one week. She has a history of multiple sexual partners and
unprotected sexual intercourse. She denies any nausea or vomiting. On
examination, her temperature is 101 F (38.3 C). Abdominal examination
reveals tenderness on the left lower quadrant. Bimanual examination
shows cervical motion tenderness. What is the best next step in the
management of this patient?
Answer: Beta hcg
⩥ A 25-year-old woman presents to the clinic with nausea, pelvic pain,
and vaginal discharge. The client is sexually active and has multiple
sexual partners. Her blood pressure is 110/70 mmHg, her pulse rate is
110/min, and her temperature is 102 F (38.8 C). On examination,
adnexal tenderness is noted. Which of the following complications is
most likely to occur if this client's condition is left untreated?
Answer: Infertility
⩥ A 16-year-old female presents to the hospital with a complaint of
severe lower abdominal pain that started two hours ago. She also
,complains of fever and abnormal vaginal discharge. On further
questioning, she gives a history of intermenstrual bleeding. A detailed
medical history reveals that she was treated for a similar condition last
year. Her vital signs show blood pressure 110/80 mmHg, respiratory rate
16/min, heart rate 96/min, and temperature 100.4 F (38C). A pelvic
examination performed shows cervical motion tenderness. A blood test
was ordered which shows a white cell count of 15,000 per microliter of
blood. What is the most likely causative organism of the subclinical
form of her condition?
Answer: Chlamydia
⩥ A 26-year-old woman presents with sudden onset severe right lower
quadrant abdominal pain. Examination reveals extreme tenderness on
palpation. She has no history of smoking, alcohol consumption, or illicit
drug use. She has a medical history of 2 previous elective abortions
followed by a D & C. Her menstrual cycle started this morning and
reports it was ten days before it was due. She states that this is unusual
for her. A urine pregnancy test is positive. Blood pressure is 86/60
mmHg, pulse rate is 100/min, and the respiratory rate is 16/min. Two
large-bore needles are placed on each arm, and IV fluids are begun.
Which of the following is the most appropriate next step in the
management of this patient?
Answer: Transvaginal us
⩥ A 21-year-old gravida 2 and para 0+1 with one elective abortion
presents to the clinic with secondary amenorrhea for 3 months. Her
previous cycles were regular and of 28 days duration. There is no history
of vaginal discharge, fever, or abdominal pain. The physical examination
,shows a ten-week sized uterus with no other abnormality. Urinary B-
hCG is positive. On ultrasound, the uterus is empty, and a mass is
present in the right adnexal region. Which of the following is the most
common site of occurrence for this pathology?
Answer: Ampullary
⩥ A 72-year-old woman presents to the clinic with complaints of an
ulcer on the superior aspect of her right labia majora. She has no other
complaints at this time, except for some swelling in her right groin
region. She reports no medical history but notes that she was diagnosed
in her mid-40s with "inflammation" near her vagina but never had it
followed up. On physical exam, a 1 cm patch with ulceration and
increased surrounding vascularity is noted in the area of concern, and
there is widespread erythematous vulvar skin that is paper-thin. A biopsy
of the lesion is taken and squamous cell carcinoma is diagnosed. What is
the most likely molecular origin of this patient's disease?
Answer: Loss fxn in a tumor suppressor protein
⩥ A 72-year-old woman presents to the clinic complaining of a discrete
flesh-colored raised lesion that has been causing labial irritation for a
one-year duration. The patient denies any other complaints at present
and denies any significant medical history. On physical examination,
there is a 5 mm papule near the superior portion of the left labia majora.
Office dermoscopy shows blue ovoid nests and arborizing vessels. A
biopsy of the lesion is taken and the presumed diagnosis is made. The
patient undergoes complete excision with negative margins. Which of
the following best estimates the patient's 3-year survival?
, Answer: 90-100
⩥ A 69-year-old woman presents to the clinic for follow up. She was
recently diagnosed with invasive vulvar squamous cell carcinoma after a
biopsy. The depth of invasion was noted to be 0.8 mm and no lymph
node metastasis was noted. Which of the following is the most
appropriate surgical plan for this patient?
Answer: Wide local with 1-2 margins
⩥ A 57-year-old postmenopausal woman presents with a sensation of
fullness in her pelvis but denies any associated symptoms. Examination
demonstrates a large mass on the left wall of the vagina that extends to
the pelvic sidewall. Biopsy shows squamous cell carcinoma. Which
medication is considered part of the standard therapy for this patient's
condition?
Answer: Cisplatin
⩥ A patient past her reproductive years has carcinoma in situ of the
cervix with cone biopsy showing squamous cell carcinoma with invasion
1 mm beyond the basement membrane. There is no lymphovascular
space invasion. What is the next best step?
Answer: Sumple hysterectomy
⩥ A 32-year-old woman presents to the office for a health maintenance
exam. The patient states she feels healthy and has no complaints.
However, her sister was recently diagnosed with cervical cancer, and she
