1A 24-year-old retail clerk presents to the clinic for an annual exam.
Her last Pap was 3 years ago and was normal. She is a G0 and is
currently not sexually active although she has had two lifetime
partners. She is on oral contraceptive pills for cycle control and has
no medical problems. Based on guidelines, the clinician proceeds to
perform a Pap smear and places the speculum. There are two layers
of cells, squamous and columnar. Where is the most important area
to obtain cells for a Pap smear?
Time Spent - 00:00:10
Your Response:Transformation zone
Rationale:The transformation zone is where cancerous cells are most likely to develop and is
thus the most important area to sample in a Pap test. Zona reticularis is incorrect. This is actually
a part of the adrenal glands that produces hormones. Squamous zone and columnar zone are
incorrect. Although each of these can be affected by the human papillomavirus, the
transformation zone where these two meet (and columnar cells become squamous cells) is the
area of most pathological activity and thus the area that is most important to sample during a Pap
smear. Linea nigra is incorrect. The linea nigra is actually the pigmented line often seen in the
midline with pregnant women.
Remediation:
Bickley, Lynn S. Bates' Guide to Physical Examination and History Taking, 13th ed.,
Philadelphia: Wolters Kluwer Health, Chapter 21: Female Genitalia.
2 An 18-year-old high school senior presents to the clinic
complaining of a vaginal discharge. She states that it is thick and
yellow and that she has had some recent pelvic pain. She is sexually
active and is not using any type of birth control or sexually
transmitted infection (STI) prevention. She denies any burning with
urination, nausea, vomiting, or diarrhea. She has had some fever and
chills with a temperature up to 101.5ºF. Her last menstrual period
was last week. After a physical exam, she is diagnosed with pelvic
inflammatory disease (PID). Visualization of purulent discharge in
which of the following areas would best support a diagnosis of PID?
Time Spent - 00:00:21
Your Response:Cervical os
Rationale:An infection in the uterus, tubes, and ovaries would drain through the cervix and out
of the os. Posterior fornix is incorrect. Any discharge in the fornix may be from the cervix, or it
may be from a vaginal infection. Anterior fornix is incorrect. Again any discharge in the fornix
may be from the cervix, or it could be from a vaginal infection. Skene gland opening is incorrect.
This gland is within the labia minor and surrounds the urethral opening. Discharge from PID
comes from the uterus so would be coming from the os within the introitus. Bartholin gland
opening is incorrect. This opening is just within the introitus near the 4 and 8 o'clock positions of
the labia minora. Discharge from PID would be from the os within the introitus and not from just
inside the introitus.
Remediation:
Bickley, Lynn S. Bates' Guide to Physical Examination and History Taking, 13th ed.,
Philadelphia: Wolters Kluwer Health, Chapter 21: Female Genitalia.
This study source was downloaded by 100000897929959 from CourseHero.com on 04-08-2025 06:01:31 GMT -05:00
https://www.coursehero.com/file/248388821/womens-gen-copydocx/
, 3A 32-year-old G0 woman comes for evaluation on why she and her
husband have been unable to get pregnant. Her husband has been
married before and has two other children, ages 7 and 4 years. The
patient relates she began her periods at age 12 and has been fairly
regular ever since. She began oral contraceptive pills from when she
got married until last year, when she began to try for a pregnancy.
Before this she had regular cycles for 10 years. She has had a history
of five prior partners. She relates she was once treated for a severe
genital infection when she was in college. Based on this patient's
history, what is the best explanation for her infertility?
Time Spent - 00:00:15
Your Response:Prior pelvic inflammatory disease (PID)
Rationale:PID is a genital infection caused by gonorrhea, chlamydia, and other organisms. If not
treated early enough it can lead to tubal pregnancies or infertility. Prior Bartholin gland infection
is incorrect. Although Bartholin cyst infections can be from sexually transmitted infections, they
are only located on the labia and do not lead to fertility issues. Prior herpes infection is incorrect.
Herpes generally only affects the labial tissues, vagina, and cervix. Although a baby delivered
through an outbreak can suffer complications from maternal herpes, it does not affect fertility.
Metabolic disorder with subsequent hormonal irregularities leading to anovulation is incorrect.
Although metabolic disorder does lead to anovulation and infertility problems, this patient relates
being regular all of her life so most likely has no hormonal abnormalities. Secondary amenorrhea
is incorrect. Secondary amenorrhea occurs when a woman having periods stops having them for
some reason. This woman has not had an absence of her menses.
Remediation:
Bickley, Lynn S. Bates' Guide to Physical Examination and History Taking, 13th ed.,
Philadelphia: Wolters Kluwer Health, Chapter 21: Female Genitalia.
4 A 63-year-old office worker comes to the clinic for her women's
health exam. Her last Pap smear was 5 years ago and was normal.
She is married and has been with the same sexual partner for the
last 35 years. After performing the majority of the exam, the
clinician decides to do a speculum exam to collect cytology for Pap
smear. What is the correct position to have the patient in for her
speculum exam?
Time Spent - 00:00:16
Your Response:Lithotomy
Rationale:Lithotomy or dorsal lithotomy position describes a patient lying on an exam table
supine but with the legs abducted with the feet in the stirrups. This was named lithotomy because
it is how doctors used to access the urethra in both men and women to be able to remove stones
with instruments. This is the easiest position to visualize the cervix and do the bimanual exam.
Sitting is incorrect. Obviously the vagina and perineum cannot be accessed in the sitting position.
Supine is incorrect. A purely supine position lying on the back with the legs adducted closed
would provide no exposure to the female genitalia. Prone is incorrect. In the prone position, the
patient is laying on the stomach, and the genitalia are not accessible. Trendelenburg is incorrect.
In the Trendelenburg position, the patient is supine and the legs are elevated higher than the level
of the head. A reverse Trendelenburg has the patient supine with the head higher than the level of
the feet.
This study source was downloaded by 100000897929959 from CourseHero.com on 04-08-2025 06:01:31 GMT -05:00
https://www.coursehero.com/file/248388821/womens-gen-copydocx/
Her last Pap was 3 years ago and was normal. She is a G0 and is
currently not sexually active although she has had two lifetime
partners. She is on oral contraceptive pills for cycle control and has
no medical problems. Based on guidelines, the clinician proceeds to
perform a Pap smear and places the speculum. There are two layers
of cells, squamous and columnar. Where is the most important area
to obtain cells for a Pap smear?
Time Spent - 00:00:10
Your Response:Transformation zone
Rationale:The transformation zone is where cancerous cells are most likely to develop and is
thus the most important area to sample in a Pap test. Zona reticularis is incorrect. This is actually
a part of the adrenal glands that produces hormones. Squamous zone and columnar zone are
incorrect. Although each of these can be affected by the human papillomavirus, the
transformation zone where these two meet (and columnar cells become squamous cells) is the
area of most pathological activity and thus the area that is most important to sample during a Pap
smear. Linea nigra is incorrect. The linea nigra is actually the pigmented line often seen in the
midline with pregnant women.
Remediation:
Bickley, Lynn S. Bates' Guide to Physical Examination and History Taking, 13th ed.,
Philadelphia: Wolters Kluwer Health, Chapter 21: Female Genitalia.
2 An 18-year-old high school senior presents to the clinic
complaining of a vaginal discharge. She states that it is thick and
yellow and that she has had some recent pelvic pain. She is sexually
active and is not using any type of birth control or sexually
transmitted infection (STI) prevention. She denies any burning with
urination, nausea, vomiting, or diarrhea. She has had some fever and
chills with a temperature up to 101.5ºF. Her last menstrual period
was last week. After a physical exam, she is diagnosed with pelvic
inflammatory disease (PID). Visualization of purulent discharge in
which of the following areas would best support a diagnosis of PID?
Time Spent - 00:00:21
Your Response:Cervical os
Rationale:An infection in the uterus, tubes, and ovaries would drain through the cervix and out
of the os. Posterior fornix is incorrect. Any discharge in the fornix may be from the cervix, or it
may be from a vaginal infection. Anterior fornix is incorrect. Again any discharge in the fornix
may be from the cervix, or it could be from a vaginal infection. Skene gland opening is incorrect.
This gland is within the labia minor and surrounds the urethral opening. Discharge from PID
comes from the uterus so would be coming from the os within the introitus. Bartholin gland
opening is incorrect. This opening is just within the introitus near the 4 and 8 o'clock positions of
the labia minora. Discharge from PID would be from the os within the introitus and not from just
inside the introitus.
Remediation:
Bickley, Lynn S. Bates' Guide to Physical Examination and History Taking, 13th ed.,
Philadelphia: Wolters Kluwer Health, Chapter 21: Female Genitalia.
This study source was downloaded by 100000897929959 from CourseHero.com on 04-08-2025 06:01:31 GMT -05:00
https://www.coursehero.com/file/248388821/womens-gen-copydocx/
, 3A 32-year-old G0 woman comes for evaluation on why she and her
husband have been unable to get pregnant. Her husband has been
married before and has two other children, ages 7 and 4 years. The
patient relates she began her periods at age 12 and has been fairly
regular ever since. She began oral contraceptive pills from when she
got married until last year, when she began to try for a pregnancy.
Before this she had regular cycles for 10 years. She has had a history
of five prior partners. She relates she was once treated for a severe
genital infection when she was in college. Based on this patient's
history, what is the best explanation for her infertility?
Time Spent - 00:00:15
Your Response:Prior pelvic inflammatory disease (PID)
Rationale:PID is a genital infection caused by gonorrhea, chlamydia, and other organisms. If not
treated early enough it can lead to tubal pregnancies or infertility. Prior Bartholin gland infection
is incorrect. Although Bartholin cyst infections can be from sexually transmitted infections, they
are only located on the labia and do not lead to fertility issues. Prior herpes infection is incorrect.
Herpes generally only affects the labial tissues, vagina, and cervix. Although a baby delivered
through an outbreak can suffer complications from maternal herpes, it does not affect fertility.
Metabolic disorder with subsequent hormonal irregularities leading to anovulation is incorrect.
Although metabolic disorder does lead to anovulation and infertility problems, this patient relates
being regular all of her life so most likely has no hormonal abnormalities. Secondary amenorrhea
is incorrect. Secondary amenorrhea occurs when a woman having periods stops having them for
some reason. This woman has not had an absence of her menses.
Remediation:
Bickley, Lynn S. Bates' Guide to Physical Examination and History Taking, 13th ed.,
Philadelphia: Wolters Kluwer Health, Chapter 21: Female Genitalia.
4 A 63-year-old office worker comes to the clinic for her women's
health exam. Her last Pap smear was 5 years ago and was normal.
She is married and has been with the same sexual partner for the
last 35 years. After performing the majority of the exam, the
clinician decides to do a speculum exam to collect cytology for Pap
smear. What is the correct position to have the patient in for her
speculum exam?
Time Spent - 00:00:16
Your Response:Lithotomy
Rationale:Lithotomy or dorsal lithotomy position describes a patient lying on an exam table
supine but with the legs abducted with the feet in the stirrups. This was named lithotomy because
it is how doctors used to access the urethra in both men and women to be able to remove stones
with instruments. This is the easiest position to visualize the cervix and do the bimanual exam.
Sitting is incorrect. Obviously the vagina and perineum cannot be accessed in the sitting position.
Supine is incorrect. A purely supine position lying on the back with the legs adducted closed
would provide no exposure to the female genitalia. Prone is incorrect. In the prone position, the
patient is laying on the stomach, and the genitalia are not accessible. Trendelenburg is incorrect.
In the Trendelenburg position, the patient is supine and the legs are elevated higher than the level
of the head. A reverse Trendelenburg has the patient supine with the head higher than the level of
the feet.
This study source was downloaded by 100000897929959 from CourseHero.com on 04-08-2025 06:01:31 GMT -05:00
https://www.coursehero.com/file/248388821/womens-gen-copydocx/
