Women's Health Exam Questions and Answers

Women's Health Exam Questions and Answers "A woman in her first trimester makes an appointment for her first prenatal visit. She is instructed to go to the lab for tests.. What is indicated? - Correct Answer HIV" "Based on the anatomy of the uterus, where would you expect to find the placenta accreta? - Correct Answer Attached to the myometrium, the middle layer of the uterine wall." "A woman complains of 3 months of dysmenorrhea, dyspareunia, & low back pain that worsens before her cycle. Pelvic exam reveals tender nodules in the cul-de-sac & rectovaginal septum. Confirmatory study? - Correct Answer Laparoscopy" "What is the most common cause of secondary amenorrhea? - Correct Answer Pregnancy" "A woman presents with a painless ulcer on the left labia majora 4 weeks ago, which has resolved. Exam reveals painful inguinal lymph nodes that have coalesced to form buboes, rectal pain & bloody purulent discharge. Diagnosis? - Correct Answer Lymphogranuloma venereum initial lesion is painless vesicle & resolves spontaneously. infection spreads to the lymph nodes" "The secretion of what during menses is thought to be a causative factor in the development of primary dysmenorrhea? - Correct Answer Prostaglandins" "A woman presents for annual cervical screening. She has been sexually active since she was 18. Her Pap smear comes back with a finding of atypical squamous cells of undetermined significance. Next step? - Correct Answer HPV testing" "A man presents with multiple lesions on his penis that are skin-colored, cauliflower-shaped, & nonpainful. He has had five new sexual partners recently. How do you diagnose condyloma acuminata aka genital warts? - Correct Answer Clinically" "A woman presents with yellow & frothy vaginal discharge with punctate hemorrhages on the cervix. Wet mount microscopy reveals motile organisms. Diagnosis? - Correct Answer Trichomoniasis" "What diagnostic study is used to diagnose gestational diabetes? - Correct Answer Oral glucose tolerance test, O G T T: done between 24 and 28 weeks of pregnancy" "What is the most useful initial laboratory test in a patient presenting with secondary amenorrhea? - Correct Answer Serum beta-human chorionic gonadotropin" "What most accurately describes the anatomical findings seen in endometriosis? - Correct Answer Aberrant growth of endometrium outside of the uterus" What is the treatment for uncomplicated genital chlamydia infection in pregnancy? - Correct Answer Azithromycin" "A postmenopausal woman complains of vaginal dryness, irritation, & pain with intercourse. She has been using vaginal moisturizers daily & vaginal lubrication during intercourse without improvement. Treatment? - Correct Answer Vaginal estrogen" "A woman is seen for anxiety, irritability, fatigue, & headaches that occur in association with her menstrual cycle & impact her ability to work. Clinical test in the evaluation? - Correct Answer TSH" "A 23-year-old presents & has never undergone screening for cervical cancer and says that she has never been sexually active. Appropriate test according to the USPSTF? - Correct Answer Pap test alone" "What organism is a gram negative diplococci? - Correct Answer Gonorrhoeae" "What is the best way to definitively diagnose ovarian torsion? - Correct Answer Laparoscopy" "In a patient receiving magnesium sulfate for eclampsia, what physical exam finding is characteristically the first manifestation of symptomatic hypermagnesemia? - Correct Answer Loss of deep tendon reflexes: Hypermagnesemia will decrease neuronal impulses causing decreased neuromuscular activity. This action will result in decreased deep tendon reflexes." "A woman has noticed her hair feels thick and heavy, and she has developed hemorrhoids, stretch marks over her trunk, and varicose veins on her legs. Which will resolve postpartum? - Correct Answer Thickened hair" "A woman presents at eight weeks gestation. Her BP is 160/110. It was 162/112 at her previous visit. Treatment? - Correct Answer Labetalol" "A woman has pelvic pain & vaginal bleeding. An adnexal mass is palpated on exam.. Her serum human chorionic gonadotropin level is 4000. Transvaginal ultrasound does not show an intrauterine gestational sac & shows a suspicious adnexal mass. Diagnosis? - Correct Answer Ectopic pregnancy" "What is the first-line diagnostic imaging study in women with dysfunctional uterine bleeding? - Correct Answer Transvaginal ultrasound" "At one minute of life a neonate is noted to have some cyanosis in the extremities, his pulse is 115 bpm, he actively flexes his arms and legs equally, he grimaces weakly, & he has a strong cry. APGAR score? - Correct Answer Eight" "What is the most important risk factor for placental abruption? - Correct Answer Prior placental abruption" "A woman presents with irregular menses, hirsutism, & acne. She does not wish to become pregnant. First-line pharmacologic treatment for this condition? - Correct Answer Oral contraceptive pills, O C P's" "What is associated with an increased risk of breast cancer? - Correct Answer Night shift work" "After a successful vaginal delivery, a woman has persistent vaginal bleeding leading to postpartum hemorrhage. Cause? - Correct Answer Uterine atony" "A woman presents for evaluation of infertility. Her diagnosis is anovulation due to polycystic ovarian syndrome. Treatment? - Correct Answer Clomiphene" "A woman is diagnosed with an ectopic pregnancy. Her human chorionic gonadotropin level is 4000 and there is no fetal cardiac activity on transvaginal ultrasound. Treatment? - Correct Answer Methotrexate" "A woman has never been pregnant before, but she has always had protected intercourse. She has regular menses. What test screens for ovarian reserve? - Correct Answer Anti-müllerian hormone level: Patency of the fallopian tubes and assessment of the ovarian cavity may be confirmed by hysterosalpingogra" "A woman presents with a history of anovulation & signs of hyper androgenism. Labs reveal elevated free testosterone & slightly elevated D H E A-S levels. FSH is slightly low & LH is within normal limits for Tanner stage, sex, & age. Diagnosis? - Correct Answer Polycystic ovarian syndrome" "A woman presents to her gynecologist with concerns for postcoital spotting. Her last Pap was 3 years ago. History reveals risk factors for cervical cancer. A Pap smear for cervical cancer screening is notable for atypical squamous cells. Risk factor? - Correct Answer Human papillomavirus infection, HPV" "A woman has heavy menstrual bleeding & chronic pelvic pain. She does not desire future fertility. Pelvic ultrasound shows multiple intramural & subserosal fibroids. Her hemoglobin is 7.5. What is long-term treatment for fibroids? - Correct Answer Hysterectomy" "Routine Pap smear is positive for atypical squamous cells of undetermined significance. Next step in management? - Correct Answer Human papillomavirus testing, HPV testing" "A woman presents at 41 weeks gestation for follow-up and to decide about whether labor needs to be induced. Her Bishop score is 4; she is admitted for labor & delivery to induce labor. What medication is given to induce labor? - Correct Answer dinoprostone: For women with a Bishop score of 6 or less, a ripening process is recommended & can be accomplished by administering a prostaglandin like dinoprostone or misoprostol" "A woman presents with thin, gray discharge. A wet prep sample is collected. What finding confirms the diagnosis on microscopic examination of the wet prep? - Correct Answer Clue cells, this is B V" "A woman complains of sudden-onset, severe, left lower quadrant abdominal pain that began 30 minutes ago while she was running. She has nausea and has vomited twice due to the pain. She is diagnosed with ovarian torsion on transvaginal ultrasound with Doppler. Treatment? - Correct Answer Consult gynecology surgery" "A woman presents for a routine Pap smear. The cytology report notes findings of atypical squamous cells of undetermined significance ASC-US. Follow-up testing? - Correct Answer Human papillomavirus testing: HPV" "A woman has skin changes on her left breast that are itchy & painful but no discharge or fever. On exam, a 2 cm scaly lesion is noted on the left nipple with extension to the areola. Her left breast exam is also concerning for a 2 cm palpable mass in the upper outer quadrant. Diagnosis? - Correct Answer Paget disease of the breast" "A woman is diagnosed with a ruptured ovarian cyst. She is hemodynamically stable, and a pelvic ultrasound shows a small amount of peritoneal fluid. Treatment? - Correct Answer Outpatient management with oral analgesia" "What diagnostic study confirms the diagnosis of genital herpes simplex virus in a patient with active lesions? - Correct Answer Polymerase chain reaction, PCR" "A woman has purulent vaginal discharge & bleeding after intercourse. Exam reveals purulent discharge on the ectocervix & cervical friability. She is afebrile and has no cervical motion tenderness on exam. Diagnosis? - Correct Answer Cervicitis" "What is first-line therapy for primary dysmenorrhea aka painful periods? - Correct Answer Ibuprofen" "A woman has bilateral breast pain that consistently occurs the week prior to the onset of her period. Diagnosis? - Correct Answer Cyclic breast pain" "A woman complains of intermittent lower abdominal pain, painful periods, & occasional pain with defecation. She is not currently sexually active. Physical exam is unremarkable. Diagnosis? - Correct Answer Endometriosis" "What is the appropriate gestational age to screen pregnant women for Group B strep infection? - Correct Answer 36 weeks" "A woman complains of pelvic pain & vaginal discharge. She has had 3 male sexual partners recently & does not use condoms. Cervical motion tenderness is found on physical exam; an empiric diagnosis of pelvic inflammatory disease is made. Treatment? - Correct Answer Ceftriaxone AND doxycycline" "A woman is diagnosed with leiomyomas. She was 13 years old when she had her first menstrual period & uses a low-dose combined oral contraceptive. She is African American. Which of the following factors increases the risk of leiomyomas in this patient? - Correct Answer The patient is African American" "What is true regarding the treatment plan of placental abruption? - Correct Answer Depends on fetal status, maternal hemodynamic stability, and gestational age of the fetus" "What exam finding is most concerning for breast cancer? - Correct Answer Nontender, firm, immobile mass" "What pathogen most commonly causes lactational mastitis? - Correct Answer Staph" "A woman who is 22 weeks gestation has a history of hypertension that is normally controlled with diet and exercise. She has a blood pressure of 154/89 with mild proteinuria on dipstick. Diagnosis? - Correct Answer Preeclampsia" "A woman 31 weeks pregnant presents after a large gush of fluid from her vagina 1 hour ago but no contractions. Sterile speculum exam reveals fluid pooling in the vaginal vault, with a fern pattern. Ultrasound & fetal heart monitoring reveal no fetal distress. Management? - Correct Answer Expectant management" "A pregnant woman presents reporting that she has not been receiving routine prenatal care due to a lapse in insurance. Her last pregnancy was complicated by gestational diabetes & preeclampsia. What diagnostic is done for gestational diabetes? - Correct Answer Oral glucose challenge, O G T T at 24 and 28 weeks of pregnancy" "What is a risk factor for the development of ovarian cancer? - Correct Answer Infertility" "A woman is diagnosed with pelvic inflammatory disease & is admitted to the hospital for severe pain & intractable vomiting. What is the antibiotic regimen? - Correct Answer Cefotetan and doxycycline: Patients admitted should be treated with a second-generation cephalosporin, such as cefotetan or cefoxitin & doxycycline. Patients who are treated in an outpatient setting should get an IM dose of ceftriaxone & an oral course of doxycycline." "What is the most common anatomical site of an ectopic pregnancy? - Correct Answer Fallopian tube" "A woman presents 6 months postpartum after her 4th vaginal delivery. She has been experiencing a bulging sensation in her vaginal area & episodes of urinary incontinence. Treatment? - Correct Answer Vaginal pessary" "A postmenopausal woman presents with new-onset vaginal bleeding. She went into menopause at 53 and has not bled since, until now. What is the initial test to evaluate the endometrium? - Correct Answer Transvaginal ultrasound" "A woman reports galactorrhea from both breasts, amenorrhea, & worsening peripheral vision. She is found to have elevated prolactin level but is not on any medications known to inhibit dopamine. Diagnostic study to be ordered? - Correct Answer MRI of the brain with & without contrast" "A woman presents for a progressive feeling of heaviness & bulging in her vagina with urinary incontinence. On pelvic exam, a bulge is noted on her anterior vaginal wall when she performs the Valsalva maneuver. Diagnosis? - Correct Answer Cystocele" "What is the treatment for vulvovaginal candidiasis? - Correct Answer Fluconazole" "A woman is seen 6 months after she has delivered a healthy baby. She is currently breastfeeding. She would like to resume oral contraceptive pills & has a history of hirsutism & deep vein thrombosis. Which is a reason to recommend an alternative form of contraception? - Correct Answer History of deep vein thrombosis" "What bacteria are classically increased in bacterial vaginosis? - Correct Answer Gardnerella vaginalis" "A woman with an intact uterus suffers from severe vaso-motor menopausal symptoms that interfere with sleep & cause significant fatigue. Treatment? - Correct Answer Combined estrogen and progestin pills" "What is first-line pharmacologic treatment for bacterial vaginosis, B V? - Correct Answer Metronidazole" "What clinical symptoms or signs is most suggestive of a breast fibroadenoma? - Correct Answer Mobile well-defined mass" "What is a risk factor for cervical cancer? - Correct Answer Exposure to diethylstilbestrol DES is a synthetic estrogen that was used during pregnancy to prevent miscarriages & premature birth." "A woman in her 35th week is rushed to labor & delivery due to hypertension of 172/100, proteinuria, right upper quadrant pain, & nausea. A CBC & peripheral smear are obtained. What other tests should be ordered to confirm HELLP syndrome? - Correct Answer Serum aspartate aminotransferase & bilirubin Serum aspartate aminotransferase, AST, and bilirubin are needed to evaluate liver function when making the diagnosis of HELLP syndrome." "What pregnancy would be at risk for causing Rh incompatibility? - Correct Answer Rh-negative mother and Rh-positive fetus" "An obese perimenopausal woman presents with abnormal uterine bleeding. She has a history of polycystic ovarian syndrome. What is the gold standard for diagnosis of endometrial hyperplasia? - Correct Answer Endometrial sampling" "What diagnoses is likely in a woman presenting in her 18th week of pregnancy with hypertension, emesis, proteinuria, and a beta-human chorionic gonadotropin level of > 100,000? - Correct Answer Hydatidiform mole: A disorder arising from aberrant development of placental trophoblastic tissue" "A woman complains of vaginal discharge that is yellow-green & frothy. She also complains of vaginal irritation and pain with intercourse. A wet mount shows motile flagellated protozoa. Diagnosis? - Correct Answer Trichomoniasis" "A teen presents requesting emergency contraception after unprotected intercourse the night prior. What can be offered to this patient? - Correct Answer Oral levonorgestrel, a progestin: A commonly utilized form of emergency contraception that is available OTC as either one 1.5 mg dose or two 0.75 mg tablets taken 12 hours apart." "What is a contraindication to mifepristone use in a patient needing first-trimester medication abortion? - Correct Answer Chronic adrenal failure & long-term corticosteroid use are contraindications to mifepristone use as the drug is a glucocorticoid receptor antagonist." "A woman 23 weeks gestation presents with severe abdominal pain & vaginal bleeding. The uterus is rigid & tender. Fetal heart tones reveal a pulse of 90. What is a risk factor for this condition? - Correct Answer Hypertension: Abruptio placentae is when the placenta prematurely detaches from the uterine wall after 20 weeks gestation & prior to delivery of the infant. Risk factors include smoking, cocaine use, trauma, hypertension," "A 46-year-old presents with years of abnormal uterine bleeding. She is a everyday smoker. Biopsy reveals normal endometrial tissue, transvaginal ultrasound reveals a normal, 6 cm uterus without leiomyomata or endometrial polyps. Treatment for her bleeding? - Correct Answer Levonorgestrel, progestin, intrauterine device" "A woman presents to the clinic with recurrent breast pain. She states the pain is worse just prior to the onset of menses each month. Treatment? - Correct Answer Reassurance & simple analgesics" "A woman 12 weeks gestation presents with vaginal bleeding & crampy pelvic pain. Pelvic exam reveals that the cervical os is dilated & products of conception are visualized through the cervical os. Diagnosis? - Correct Answer Inevitable abortion" "A woman at 18 weeks gestation presents with headaches, worsened peripheral & facial edema, & oliguria. What differentiates preeclampsia from gestational hypertension? - Correct Answer Proteinuria" "What finding is most common in pelvic inflammatory disease? - Correct Answer Lower abdominal pain" "A postmenopausal woman presents with abnormal bleeding. She has no pelvic pain. She had breast cancer that was treated with tamoxifen. Exam: normal-appearing cervix & normal size uterus. Explanation? - Correct Answer Endometrial cancer. FYI. Uterine leiomyoma aka fibroids, are benign growths that most commonly cause menorrhagia along with enlargement of the uterus, & pelvic pain." "A woman complains of a 3 month history of intense vulvar itching. Exam reveals a thick red plaque on the right labia majora without scarring or adhesions. Diagnosis? - Correct Answer Vulvar cancer" "A woman presents with irregular periods since she was a teenager. She has visible hair growth to the upper lip and chin, as well as some acne on her face. Labs reveal a slightly elevated fasting blood sugar. Diagnosis? - Correct Answer P C O S" "What education should be given to pregnant women with a history of previous lactational mastitis to help to reduce the risk of lactational mastitis with their current pregnancy? - Correct Answer Take Lactobacillus probiotic in the third trimester" "A woman presents with a concern for a lump in her vulvar area that is not very painful but is uncomfortable during sexual intercourse. On exam, a smooth 3 cm mass is palpated in the left lower vestibular area. Diagnosis? - Correct Answer Bartholin gland cyst" "A woman at 36 weeks gestation presents with concerns about her blood pressure, severe headache & blurry vision. Vitals: BP: 180/120. Urine dipstick shows a protein level of 2+. She is diagnosed with preeclampsia. Management? - Correct Answer Induce delivery" "An older woman presents with concern for G I upset. She has been feeling bloated and has stomach pain all the time, especially after eating. On exam, abdominal distention & ascites are noted & there is concern for a left adnexal mass. Diagnostic test? - Correct Answer Pelvic ultrasound" "A woman is admitted for a spontaneous vaginal delivery. Contractions are 4 minutes apart, her cervix is 8 cm dilated. She has dilated over 1.5 cm in the last hour. What stage of labor is she in? - Correct Answer Stage 1, active. Latent: Gradual cervical change, ends at 5 cm. Active: Rapid cervical change, begins at 6 cm." "A woman 37 weeks pregnant presents reporting an episode of gushing vaginal fluid while at home. She has not started contractions. After a sterile speculum examination is performed what confirms a diagnosis of premature rupture of the membranes? - Correct Answer Nitrazine test" "A woman presents with a painless ulcer with indurated borders on the right labia majora & non tender inguinal lymphadenopathy. Treatment? - Correct Answer Penicillin G isfirst-line for syphilis." "What is first-line treatment for the management of dysfunctional uterine bleeding? - Correct Answer Estrogen-progestin contraceptives" "A woman presents to deliver a full-term fetus. Vaginal examination shows fetus is noted to have a longitudinal lie and brow presentation is determined by palpation of the anterior fontanelle. Which sutures intersect to form this fontanelle? - Correct Answer Coronal, frontal, and sagittal" "An older woman states that she can feel a bulge down there and is worried it is something serious. She has been having frequent nocturia & stress incontinence. The anterior wall of the vagina collapses into the vaginal canal. Diagnosis? - Correct Answer Cystocele" "A woman is brought into labor & delivery complaining of contractions. Her estimated gestational age is 34 weeks. What exam findings would support a diagnosis of preterm labor? - Correct Answer Regular, painful contractions with cervical dilation of 3 cm" "A premenopausal woman was evaluated for abnormal uterine bleeding & diagnosed with endometrial hyperplasia without atypical cells. She desires children in the future. Preferred first-line treatment? - Correct Answer Levonorgestrel, progestin,-releasing intrauterine device Endometrial hyperplasia without atypical cells is treated with progestins." "What lab findings is diagnostic of menopause? - Correct Answer Elevated follicle-stimulating hormone and low estradiol" "What describes the third stage of labor? - Correct Answer The stage of labor between delivery of the baby and delivery of the placenta" "A woman presents for a routine obstetric visit. Her fundal height is palpable at the umbilicus. What is the gestational age of the pregnancy based on the patient's fundal height? - Correct Answer 20 weeks" "During a vaginal delivery, the shoulders of the fetus become impacted and delay the progression of the birth. Treatment? - Correct Answer McRoberts maneuver" "A woman who is currently breastfeeding presents with a temperature of 101°. Her left breast is edematous & red with a 4 cm diameter area of tender, fluctuant induration in the upper outer quadrant. Treatment approach? - Correct Answer Needle aspiration & empirical oral antibiotics. The mainstay of breast abscess treatment is drainage of the pus & antibiotics." "What is measured during a fetal non stress test? - Correct Answer Fetal heart rate & uterine contractions" "What is the most appropriate therapy to treat pre-menstrual syndrome? - Correct Answer Citalopram" "What is a risk factor for endometrial carcinoma? - Correct Answer P C O S" "What is the treatment of choice for threatened abortion? - Correct Answer Expectant management" "What is the best antibiotic regimen to treat cervicitis in pregnancy? - Correct Answer Ceftriaxone & azithromycin Patients with gonorrhea are treated with 500 milligrams of ceftriaxone I M & 1 gram azithromycin P O in pregnancy or a weeklong course of doxycycline in not pregnant patients. Azithromycin/doxycycline are used because they cover for Chlamydia, a common co pathogen." "A woman complains of pelvic pain and painful, heavy menstrual cycles. A pregnancy test is negative. On exam, a uniformly enlarged and boggy uterus is palpated. Diagnosis? - Correct Answer Adenomyosis" "A woman who is at 39 weeks gestation with a breech fetus is requesting vaginal delivery. What is a contraindication for this patient to undergo an attempt of external cephalic version? - Correct Answer Hyperextended fetal head" "A woman is admitted to the labor & delivery unit with regular contractions. A cervical exam is completed to ascertain the position of the fetus head. Detection of the fetal head at what maternal anatomic markers indicates the head is engaged? - Correct Answer The ischial spine" "A woman at eight weeks gestation presents with pelvic pain & vaginal bleeding. Pelvic exam reveals a dilated cervix. No products of conception are seen. Pelvic ultrasound shows no fetal cardiac activity. Diagnosis? - Correct Answer Inevitable abortion" "A woman at 41 weeks gestation has a normal spontaneous vaginal delivery. Due to shoulder dystocia during delivery, an episiotomy was performed. Where would the expected episiotomy incision be found? - Correct Answer Mediolaterally towards the ischial tuberosity" "What is the best drug therapy in patients with gestational diabetes mellitus that is not controlled with dietary changes? - Correct Answer Insulin" "A woman at 33-weeks gestation presents for admission with contractions every five minutes. Her cervix is 3 cm dilated. What treatment has the best potential to reduce morbidity & mortality associated with preterm delivery? - Correct Answer Betamethasone" "A non-smoking woman present to discuss birth control. She is starting college & does not want a child until well after she finishes school. What is the most appropriate contraception given her current reproductive plans? - Correct Answer Implant: Women who seek longer-term contraception & who have no plans for pregnancy in the next year should be counseled about long-acting contraception nt or the I U D." "What is a risk factor for the development of breast cancer? - Correct Answer Late menopause is a risk factor for the development of breast cancer, which is thought to be due to prolonged estrogen stimulation throughout life, especially in hormone receptor-positive breast cancer." "A woman at 30 weeks of gestation presents with painless vaginal bleeding. Pelvic ultrasound shows the placenta covering the internal cervical os. Diagnosis? - Correct Answer Placenta previa is a complication of pregnancy defined by the presence of placental tissue that extends over the internal cervical os." "A woman was diagnosed with cyclic breast pain and initially treated with physical support & ibuprofen. She returns stating that her pain has not improved, & she wants to try other pharmacologic treatment. She is not interested in having children ever. Next step? - Correct Answer Tamoxifen" "A woman is on a fetal heart monitor in labor & delivery. Fetal heart monitor abruptly changes revealing severe prolonged bradycardia with variable decelerations. In the event of a prolapsed umbilical cord, what can be done to reduce pressure on the cord while preparing for emergency delivery? - Correct Answer Elevating the fetal head" "What is most important to rule out when considering a diagnosis of endometritis in a postpartum female who recently underwent cesarean section delivery? - Correct Answer Surgical site infection"