MSN 621 FINAL STUDY GUIDE QUESTIONS AND ANSWERS| LATEST
UPDATE 100% VERIFIED
A 44-year-old woman presents with a 2-day history of itching in the vagina, increased vaginal
discharge, and pain with urination. A history of present illness reveals that the discharge started
a month ago after unprotected sexual intercourse. A review of systems is negative for fever,
nausea, constipation, anorexia, and sleep disturbances. Her past medical history is significant
for type 2 diabetes mellitus. She irregularly uses intravaginal estriol cream for relief of vaginal
dryness. On physical examination, she has vaginal erythema, foamy thick vaginal discharge, and
a strawberry-appearing cervix. Which of the following is the most appropriate step in
management? Observe the vaginal fluid under a microscope.
Lactational breast abscesses are most often caused by which of the following organisms?
Staphylococcus aureus
A 65-year-old woman presents for a follow-up visit. Her physical examination demonstrated a
palpable mass in the upper outer quadrant of the right breast without palpable axillary nodes.
Her diagnostic mammogram demonstrates a 1.2 cm spiculated mass in the upper outer
quadrant of the right breast. A targeted ultrasound shows a hypoechoic mass measuring 1.3 x
1.1 x 0.8 cm. Breast biopsy reveals a moderately differentiated invasive ductal carcinoma
measuring 1.2 cm that is ER/PR positive and HER2/neu negative. What is the best next step?
Lumpectomy and sentinel node biopsy
A 35-year-old woman presents with the chief complaint of pelvic pain. She has a history of
secondary infertility and has had 1 live birth via Caesarean section. Since childbirth, her
symptoms of pelvic pain have worsened. She functions normally with her tasks of daily living
except for the inability to comfortably place a tampon and have pain-free vaginal intercourse.
The provider performs a pelvic exam and obtains a sample to screen for sexually transmitted
infections. Which of the following is the most appropriate next step in management?
Perform a Q-tip test as well as a neuromuscular exam of the pelvis
,Breast ultrasonography done for a 45-year-old woman shows bilateral microcalcifications.
Biopsy specimen analysis is significant for 2 lesions with lobular carcinoma in situ that are
considered concordant with the imaging findings. What is the most appropriate management
for this patient? Prophylactic tamoxifen and life-long surveillance
A 51-year-old woman presents with irregular, heavy menstrual bleeding for the past 6 months.
She reports previously regular cycles every 30 days, lasting 4 to 6 days, with medium flow. She
says her cycles are now occurring every 30 to 45 days, lasting 5 to 12 days, with heavy flow and
occasional passing of clots. Her BMI is 30.2 kg/m2, and her vital signs are within normal limits.
What is the most appropriate next step in evaluating this patient Endometrial sampling
An otherwise healthy 25-year-old nulliparous woman presents with cyclic, "crampy" abdominal
pain that starts within a few hours of the onset of menses and usually resolves within 72 hours.
Her periods have been regular, with no spotting, and her last one occurred 1 week ago. She is
currently sexually active with her husband and is hoping to become pregnant within the next 3
months. What is the best initial pharmacotherapy for this patient? A nonsteroidal anti-
inflammatory drug (NSAID)
A 24-year-old woman presents to the clinic with breast tenderness, which increases before
menses. Ultrasound reveals a round, well-circumscribed, anechoic structure, with an
imperceptible wall. What is the most likely diagnosis? Simple cyst
A 37-year-old woman undergoes a cystoscopy for microscopic hematuria. During the procedure,
a 3 cm mass is observed adjacent to the right labia major without overlying skin changes.
Further inquiry reveals the mass has developed over the past two weeks, and there is no similar
past medical history. It is not tender, not draining, and not bothersome to her. Which of the
following is an indication for referral to a gynecologic specialist? Severe pain when sitting
down
A 58-year-old woman presents with symptoms of vaginal dryness and painful intercourse. The
examination shows a thin, fragile vaginal mucosa, with pH 7.0, and a vaginal maturation index of
22. The patient is started on intravaginal estrogen. On follow-up, her symptoms are improving,
with pH 4.0, and the vaginal maturation index is 55. What is the mechanism through which her
, symptoms improved? Estrogen increases the vaginal squamous cells, providing more
glycogen availability for lactobacilli that convert glycogen into lactic acid and hydrogen peroxide.
A 22-year-old woman presents to the clinic with a history of lower abdominal pain for the past
six months. There is no history of dysuria and dyspareunia. There is no relevant family history of
cancer. The patient noticed that the pain increases during the first two days of her period. The
periods are regular and slightly heavier than usual. She has to change 6 to 7 pads per day. The
patient's blood pressure is 120/80 mmHg, pulse 63/minute, and the temperature is 36.1 C. She
denies any loss of weight. The pelvic examination shows a globularly enlarged and retroverted
uterus. The pregnancy test is negative. She has a recent pelvic ultrasound, which showed some
evidence of endometriosis. What is the most likely diagnosis for this patient? Secondary
dysmenorrhoea
A 35-year-old woman presents with a large, firm, minimally tender subareolar mass in her right
breast. She states it has been present for the last month and has continued to grow. While the
patient denies a family history of breast cancer, she does have a new 6-month-old child. She
denies fevers or chills, and the skin surrounding the mass is devoid of any inflammatory
changes. Ultrasound reveals a well-circumscribed hypoechoic cyst-like structure. A fine needle
aspiration (FNA) reveals a milky discharge. What is the most appropriate next step in the
management of this patient? The patient does not require any further medical interventions.
A 32-year-old woman presents with complaints of breast tenderness and swelling for the past 8
days. The patient states she has a hard time changing clothes due to severe breast pain. The
patient has a past medical history significant for seasonal allergies. She has a 10 pack-year
smoking history. On examination, erythema and swelling are noted near the right areola. An
ultrasound reveals a hypoechoic multiloculated fluid collection beneath the right areola. The
fluid is aspirated and sent for histopathology. The findings are shown in the figure. Which of the
following best describes the findings shown? Abundant anucleated squamous cells,
histiocytes, and acute inflammation
A 45-year-old woman is diagnosed with hormone receptor (HR) positive lobular carcinoma of
the breast. After a detailed evaluation, the client undergoes a radical mastectomy. She is also
started with adjuvant therapy with tamoxifen after the procedure. What is the purpose of this
therapy? Decreases risk of disease recurrence
UPDATE 100% VERIFIED
A 44-year-old woman presents with a 2-day history of itching in the vagina, increased vaginal
discharge, and pain with urination. A history of present illness reveals that the discharge started
a month ago after unprotected sexual intercourse. A review of systems is negative for fever,
nausea, constipation, anorexia, and sleep disturbances. Her past medical history is significant
for type 2 diabetes mellitus. She irregularly uses intravaginal estriol cream for relief of vaginal
dryness. On physical examination, she has vaginal erythema, foamy thick vaginal discharge, and
a strawberry-appearing cervix. Which of the following is the most appropriate step in
management? Observe the vaginal fluid under a microscope.
Lactational breast abscesses are most often caused by which of the following organisms?
Staphylococcus aureus
A 65-year-old woman presents for a follow-up visit. Her physical examination demonstrated a
palpable mass in the upper outer quadrant of the right breast without palpable axillary nodes.
Her diagnostic mammogram demonstrates a 1.2 cm spiculated mass in the upper outer
quadrant of the right breast. A targeted ultrasound shows a hypoechoic mass measuring 1.3 x
1.1 x 0.8 cm. Breast biopsy reveals a moderately differentiated invasive ductal carcinoma
measuring 1.2 cm that is ER/PR positive and HER2/neu negative. What is the best next step?
Lumpectomy and sentinel node biopsy
A 35-year-old woman presents with the chief complaint of pelvic pain. She has a history of
secondary infertility and has had 1 live birth via Caesarean section. Since childbirth, her
symptoms of pelvic pain have worsened. She functions normally with her tasks of daily living
except for the inability to comfortably place a tampon and have pain-free vaginal intercourse.
The provider performs a pelvic exam and obtains a sample to screen for sexually transmitted
infections. Which of the following is the most appropriate next step in management?
Perform a Q-tip test as well as a neuromuscular exam of the pelvis
,Breast ultrasonography done for a 45-year-old woman shows bilateral microcalcifications.
Biopsy specimen analysis is significant for 2 lesions with lobular carcinoma in situ that are
considered concordant with the imaging findings. What is the most appropriate management
for this patient? Prophylactic tamoxifen and life-long surveillance
A 51-year-old woman presents with irregular, heavy menstrual bleeding for the past 6 months.
She reports previously regular cycles every 30 days, lasting 4 to 6 days, with medium flow. She
says her cycles are now occurring every 30 to 45 days, lasting 5 to 12 days, with heavy flow and
occasional passing of clots. Her BMI is 30.2 kg/m2, and her vital signs are within normal limits.
What is the most appropriate next step in evaluating this patient Endometrial sampling
An otherwise healthy 25-year-old nulliparous woman presents with cyclic, "crampy" abdominal
pain that starts within a few hours of the onset of menses and usually resolves within 72 hours.
Her periods have been regular, with no spotting, and her last one occurred 1 week ago. She is
currently sexually active with her husband and is hoping to become pregnant within the next 3
months. What is the best initial pharmacotherapy for this patient? A nonsteroidal anti-
inflammatory drug (NSAID)
A 24-year-old woman presents to the clinic with breast tenderness, which increases before
menses. Ultrasound reveals a round, well-circumscribed, anechoic structure, with an
imperceptible wall. What is the most likely diagnosis? Simple cyst
A 37-year-old woman undergoes a cystoscopy for microscopic hematuria. During the procedure,
a 3 cm mass is observed adjacent to the right labia major without overlying skin changes.
Further inquiry reveals the mass has developed over the past two weeks, and there is no similar
past medical history. It is not tender, not draining, and not bothersome to her. Which of the
following is an indication for referral to a gynecologic specialist? Severe pain when sitting
down
A 58-year-old woman presents with symptoms of vaginal dryness and painful intercourse. The
examination shows a thin, fragile vaginal mucosa, with pH 7.0, and a vaginal maturation index of
22. The patient is started on intravaginal estrogen. On follow-up, her symptoms are improving,
with pH 4.0, and the vaginal maturation index is 55. What is the mechanism through which her
, symptoms improved? Estrogen increases the vaginal squamous cells, providing more
glycogen availability for lactobacilli that convert glycogen into lactic acid and hydrogen peroxide.
A 22-year-old woman presents to the clinic with a history of lower abdominal pain for the past
six months. There is no history of dysuria and dyspareunia. There is no relevant family history of
cancer. The patient noticed that the pain increases during the first two days of her period. The
periods are regular and slightly heavier than usual. She has to change 6 to 7 pads per day. The
patient's blood pressure is 120/80 mmHg, pulse 63/minute, and the temperature is 36.1 C. She
denies any loss of weight. The pelvic examination shows a globularly enlarged and retroverted
uterus. The pregnancy test is negative. She has a recent pelvic ultrasound, which showed some
evidence of endometriosis. What is the most likely diagnosis for this patient? Secondary
dysmenorrhoea
A 35-year-old woman presents with a large, firm, minimally tender subareolar mass in her right
breast. She states it has been present for the last month and has continued to grow. While the
patient denies a family history of breast cancer, she does have a new 6-month-old child. She
denies fevers or chills, and the skin surrounding the mass is devoid of any inflammatory
changes. Ultrasound reveals a well-circumscribed hypoechoic cyst-like structure. A fine needle
aspiration (FNA) reveals a milky discharge. What is the most appropriate next step in the
management of this patient? The patient does not require any further medical interventions.
A 32-year-old woman presents with complaints of breast tenderness and swelling for the past 8
days. The patient states she has a hard time changing clothes due to severe breast pain. The
patient has a past medical history significant for seasonal allergies. She has a 10 pack-year
smoking history. On examination, erythema and swelling are noted near the right areola. An
ultrasound reveals a hypoechoic multiloculated fluid collection beneath the right areola. The
fluid is aspirated and sent for histopathology. The findings are shown in the figure. Which of the
following best describes the findings shown? Abundant anucleated squamous cells,
histiocytes, and acute inflammation
A 45-year-old woman is diagnosed with hormone receptor (HR) positive lobular carcinoma of
the breast. After a detailed evaluation, the client undergoes a radical mastectomy. She is also
started with adjuvant therapy with tamoxifen after the procedure. What is the purpose of this
therapy? Decreases risk of disease recurrence
