VARNEY'S MIDWIFERY SEVENTH
EDITION JULIA PHILLIPPI 250
QUESTIONS, CORRECT ANSWERS AND
RATIONALE
Domain 1: Midwifery Frameworks, Primary Care, & Gynecologic Health
(Questions 1–50)
Question 1
A 24-year-old individual presents for an annual wellness exam. During the
history, she reveals a history of intimate partner violence (IPV). According to
trauma-informed care principles and Varney’s framework, what is the most
appropriate immediate response by the midwife?
* A) Document the disclosure, immediately call law enforcement, and provide
emergency shelter contact numbers.
* B) Validate the disclosure, assess immediate safety, and offer a supportive,
nonjudgmental choice of resources.
* C) Initiate an immediate psychological consult and contact a social worker to
escort the patient.
,* D) Advise the patient on relationship strategies to de-escalate potential
conflicts at home.
* Correct Answer: B) Validate the disclosure, assess immediate safety, and offer
a supportive, nonjudgmental choice of resources.
* Rationale: Trauma-informed care emphasizes patient autonomy, safety, and
empowerment. Validating the patient's experience and assessing immediate
danger respects their agency without forcing a path of action. Why other
options are incorrect: A breaches confidentiality unless mandatory reporting
laws for immediate severe injury apply, which can escalate danger. C strips the
patient of control. D shifts blame or responsibility to the victim.
## Question 2
A patient presents with persistent vulvar pruritus that has not responded to
over-the-counter antifungal creams. On physical examination, the midwife
notes thin, white, "parchment-like" plaques in a figure-eight distribution around
the vulva and perianal area, with some loss of the labia minora structure. What
is the definitive first-line management for this condition?
* A) Long-term maintenance therapy with oral fluconazole.
* B) Application of low-potency hydrocortisone 1% cream twice daily.
* C) High-potency topical corticosteroid therapy, such as clobetasol propionate
0.05%.
,* D) Immediate wide local surgical excision to rule out malignancy.
* Correct Answer: C) High-potency topical corticosteroid therapy, such as
clobetasol propionate 0.05%.
* Rationale: The clinical presentation is highly indicative of Lichen Sclerosus. The
standard first-line treatment to manage symptoms and prevent further
structural scarring or progression is an ultra-potent topical corticosteroid. Why
other options are incorrect: A is for vulvovaginal candidiasis, which is ruled out
by clinical signs. B is too weak to treat Lichen Sclerosus. D is reserved for biopsy-
confirmed vulvar intraepithelial neoplasia or malignancy, though Lichen
Sclerosus warrants monitoring due to a small risk of squamous cell carcinoma.
## Question 3
An asymptomatic 23-year-old individual requests routine sexually transmitted
infection (STI) screening. Based on current CDC and USPSTF guidelines
integrated into Varney's Midwifery, which screening is universally
recommended for this patient?
* A) Annual screening for Chlamydia trachomatis and Neisseria gonorrhoeae.
* B) Pap test with co-testing for Human Papillomavirus (HPV).
* C) Routine screening for Herpes Simplex Virus (HSV) type 2 serology.
, * D) Annual endometrial biopsy to monitor for subclinical pelvic inflammatory
disease.
* Correct Answer: A) Annual screening for Chlamydia trachomatis and Neisseria
gonorrhoeae.
* Rationale: Routine annual screening for Chlamydia and Gonorrhea is
universally recommended for all sexually active individuals under the age of 25.
Why other options are incorrect: B is incorrect because for individuals aged 21–
29, cervical cytology alone is recommended every 3 years; HPV co-testing is not
routinely added until age 30. C is not recommended for asymptomatic
individuals. D is an invasive diagnostic procedure, not a routine screening tool.
## Question 4
A 32-year-old patient presents with complaints of a profuse, thin, grayish-white
vaginal discharge accompanied by a strong "fishy" odor, particularly noticed
after unprotected intercourse. On examination, vaginal pH is 5.2, and
microscopic analysis reveals epithelial cells covered with coccobacilli that
obscure the cell borders. Which management approach is indicated?
* A) Oral fluconazole 150 mg in a single dose.
* B) Oral metronidazole 500 mg twice daily for 7 days.
* C) Intramuscular ceftriaxone 500 mg in a single dose plus concurrent partner
treatment.
EDITION JULIA PHILLIPPI 250
QUESTIONS, CORRECT ANSWERS AND
RATIONALE
Domain 1: Midwifery Frameworks, Primary Care, & Gynecologic Health
(Questions 1–50)
Question 1
A 24-year-old individual presents for an annual wellness exam. During the
history, she reveals a history of intimate partner violence (IPV). According to
trauma-informed care principles and Varney’s framework, what is the most
appropriate immediate response by the midwife?
* A) Document the disclosure, immediately call law enforcement, and provide
emergency shelter contact numbers.
* B) Validate the disclosure, assess immediate safety, and offer a supportive,
nonjudgmental choice of resources.
* C) Initiate an immediate psychological consult and contact a social worker to
escort the patient.
,* D) Advise the patient on relationship strategies to de-escalate potential
conflicts at home.
* Correct Answer: B) Validate the disclosure, assess immediate safety, and offer
a supportive, nonjudgmental choice of resources.
* Rationale: Trauma-informed care emphasizes patient autonomy, safety, and
empowerment. Validating the patient's experience and assessing immediate
danger respects their agency without forcing a path of action. Why other
options are incorrect: A breaches confidentiality unless mandatory reporting
laws for immediate severe injury apply, which can escalate danger. C strips the
patient of control. D shifts blame or responsibility to the victim.
## Question 2
A patient presents with persistent vulvar pruritus that has not responded to
over-the-counter antifungal creams. On physical examination, the midwife
notes thin, white, "parchment-like" plaques in a figure-eight distribution around
the vulva and perianal area, with some loss of the labia minora structure. What
is the definitive first-line management for this condition?
* A) Long-term maintenance therapy with oral fluconazole.
* B) Application of low-potency hydrocortisone 1% cream twice daily.
* C) High-potency topical corticosteroid therapy, such as clobetasol propionate
0.05%.
,* D) Immediate wide local surgical excision to rule out malignancy.
* Correct Answer: C) High-potency topical corticosteroid therapy, such as
clobetasol propionate 0.05%.
* Rationale: The clinical presentation is highly indicative of Lichen Sclerosus. The
standard first-line treatment to manage symptoms and prevent further
structural scarring or progression is an ultra-potent topical corticosteroid. Why
other options are incorrect: A is for vulvovaginal candidiasis, which is ruled out
by clinical signs. B is too weak to treat Lichen Sclerosus. D is reserved for biopsy-
confirmed vulvar intraepithelial neoplasia or malignancy, though Lichen
Sclerosus warrants monitoring due to a small risk of squamous cell carcinoma.
## Question 3
An asymptomatic 23-year-old individual requests routine sexually transmitted
infection (STI) screening. Based on current CDC and USPSTF guidelines
integrated into Varney's Midwifery, which screening is universally
recommended for this patient?
* A) Annual screening for Chlamydia trachomatis and Neisseria gonorrhoeae.
* B) Pap test with co-testing for Human Papillomavirus (HPV).
* C) Routine screening for Herpes Simplex Virus (HSV) type 2 serology.
, * D) Annual endometrial biopsy to monitor for subclinical pelvic inflammatory
disease.
* Correct Answer: A) Annual screening for Chlamydia trachomatis and Neisseria
gonorrhoeae.
* Rationale: Routine annual screening for Chlamydia and Gonorrhea is
universally recommended for all sexually active individuals under the age of 25.
Why other options are incorrect: B is incorrect because for individuals aged 21–
29, cervical cytology alone is recommended every 3 years; HPV co-testing is not
routinely added until age 30. C is not recommended for asymptomatic
individuals. D is an invasive diagnostic procedure, not a routine screening tool.
## Question 4
A 32-year-old patient presents with complaints of a profuse, thin, grayish-white
vaginal discharge accompanied by a strong "fishy" odor, particularly noticed
after unprotected intercourse. On examination, vaginal pH is 5.2, and
microscopic analysis reveals epithelial cells covered with coccobacilli that
obscure the cell borders. Which management approach is indicated?
* A) Oral fluconazole 150 mg in a single dose.
* B) Oral metronidazole 500 mg twice daily for 7 days.
* C) Intramuscular ceftriaxone 500 mg in a single dose plus concurrent partner
treatment.
