1
A 28-year-old female patient presents for contraception. Her past medical history is
significant for pelvic inflammatory disease (PID) 6 months ago as well as a seizure
disorder, for which she takes phenobarbital. She requests “the pill” because she states
she is “already taking a pill every day anyway.” Which of the following is the most
appropriate contraceptive for this patient?
A. Nexplanon B. Loestrin FE 1/20
C. Seasonale D. Copper (IUD)
Some antiepileptic medications can be teratogenic, so ensuring the best possible
efficacy of contraception is important. For this patient, Nexplanon, an etonogestrel
contraceptive implant that is effective for up to 3 years, is the best option.
Contraindications include pregnancy, liver disease, history of stroke or ischemic heart
disease, undiagnosed vaginal bleeding, history of breast cancer, and systemic lupus
erythematous with antiphospholipid antibodies. A copper IUD is contraindicated in
patients with active PID or a history of PID within the past year. Loestrin FE 1/20 and
Seasonale are combined oral contraceptives. Phenobarbital can decrease the efficacy
of oral contraceptives, so they would not be the best choice for this patient.
Which of the following is most strongly associated with the risk of developing breast
cancer?
A. Alcohol consumption of more than two to three drinks per week
B. Adherence to a Mediterranean diet
C. Multiparity and breastfeeding
D. First pregnancy at age younger than 25 years
Evidence points to a strong relationship between alcohol consumption and several
malignancies, including breast cancer. Diets low in saturated fat, such as the
Mediterranean diet, are associated with an overall decreased risk, as is multiparty and
breastfeeding. Pregnancy at age 30 years or older is associated with increased risk.
A 35-year-old woman smokes approximately 10 cigarettes per day. She started
smoking at age 18 years. She has a new male sexual partner and is interested in
contraception. She was recently treated for gonorrhea and chlamydia. She is using
condoms inconsistently. The urine pregnancy test is negative. She denies a history of
hypertension, blood clots, liver disease, heart disease, and diabetes. Her last menstrual
period was 5 days ago. Which of the following contraceptive methods is recommended?
A. Oral contraceptive pills B. Copper intrauterine device (IUD)
C. Etonogestrel implant (Nexplanon) D. Vaginal ring (NuvaRing)
An etonogestrel implant (Nexplanon) is the best option for this patient. It is a
progesterone-only method. The 35-year-old patient is a smoker, so she cannot take oral
contraceptives, which contain estrogen/progesterone. An IUD is contraindicated until
the patient is retested (4-6 weeks after treatment) to ensure that her gonorrhea and
chlamydia infections are gone. The vaginal ring (NuvaRing) contains estrogen and
progestin; it is contraindicated for this patient.
This study source was downloaded by 100000901307859 from CourseHero.com on 10-16-2025 09:41:10 GMT -05:00
https://www.coursehero.com/file/250618452/Leik-female-GU-docx/
, 2
A 22-year-old patient presents for an annual gynecological exam and testing. The Pap
test result shows ASC-US. Which of the following is the best management for this
patient?
A. Check for high-risk HPV B. Repeat Pap test in 12
months
C. Refer patient for colposcopy D. Refer patient for endometrial biopsy
The appropriate follow-up for a 22-year-old with a Pap smear result of ASC-US is to
perform a repeat Pap test in 12 months. HPV testing is not recommended for this age
group with ASC-US. A colposcopy is not recommended for ASC-US, as most cases
clear spontaneously in young patients who are not immunocompromised. An
endometrial biopsy is not appropriate follow-up for ASC-US, since it does not involve
the endometrium.
Which of the following best describes primary amenorrhea?
A. Absence of menarche by age 12 years with breast development
B. Absence of menarche by age 15 years with breast development
C. Absence of menses after 3 or more months of regular menses
D. Absence of menses after 6 or more months of irregular menses
Primary amenorrhea is the absence of menarche by age 15 years with breast
development. The absence of menses after at least 3 consecutive months is secondary
amenorrhea. All patients with secondary amenorrhea should be ruled out for pregnancy.
Which of the following is the most common cause of primary amenorrhea?
A. Pregnancy B. Polycystic ovary
syndrome
C. Turner syndrome D. Hypothyroidism
Turner syndrome [45,X or monosomy X] is the most common cause of primary
amenorrhea in the United States. Pregnancy is the most common cause of secondary
amenorrhea. PCOS can cause oligomenorrhea or amenorrhea, but the amenorrhea is
usually secondary. Hypothyroidism is more likely to cause secondary amenorrhea.
A 27-year-old female patient who has never been pregnant presents with complaints of
irregular menses and states that she wants to conceive. She reports that her mast
menstrual period was a few months ago and lasted 2 days. Menarche was at 12 years,
and her menses used to occur every month, but in the past several years they have
occurred only a few times a year. Upon physical examination, hirsutism, acne, and a
BMI of 31 are noted. Which of the following is the most likely diagnosis?
A. Congenital adrenal hyperplasia B. 5 alpha-reductase
deficiency
C. Turner syndrome D. Polycystic ovary
syndrome
Polycystic ovary syndrome is perhaps the most common endocrinopathy encountered in
gynecology settings. It is a multisystem disorder that affects lipids, glucose/insulin,
adiposity, cardiovascular health, and reproductive health. Patients with the condition
often present with a specific phenotype whereby they have terminal hair on their face
and areola, acne, acanthosis nigricans, adiposity, scalp hair thinning, and
This study source was downloaded by 100000901307859 from CourseHero.com on 10-16-2025 09:41:10 GMT -05:00
https://www.coursehero.com/file/250618452/Leik-female-GU-docx/
A 28-year-old female patient presents for contraception. Her past medical history is
significant for pelvic inflammatory disease (PID) 6 months ago as well as a seizure
disorder, for which she takes phenobarbital. She requests “the pill” because she states
she is “already taking a pill every day anyway.” Which of the following is the most
appropriate contraceptive for this patient?
A. Nexplanon B. Loestrin FE 1/20
C. Seasonale D. Copper (IUD)
Some antiepileptic medications can be teratogenic, so ensuring the best possible
efficacy of contraception is important. For this patient, Nexplanon, an etonogestrel
contraceptive implant that is effective for up to 3 years, is the best option.
Contraindications include pregnancy, liver disease, history of stroke or ischemic heart
disease, undiagnosed vaginal bleeding, history of breast cancer, and systemic lupus
erythematous with antiphospholipid antibodies. A copper IUD is contraindicated in
patients with active PID or a history of PID within the past year. Loestrin FE 1/20 and
Seasonale are combined oral contraceptives. Phenobarbital can decrease the efficacy
of oral contraceptives, so they would not be the best choice for this patient.
Which of the following is most strongly associated with the risk of developing breast
cancer?
A. Alcohol consumption of more than two to three drinks per week
B. Adherence to a Mediterranean diet
C. Multiparity and breastfeeding
D. First pregnancy at age younger than 25 years
Evidence points to a strong relationship between alcohol consumption and several
malignancies, including breast cancer. Diets low in saturated fat, such as the
Mediterranean diet, are associated with an overall decreased risk, as is multiparty and
breastfeeding. Pregnancy at age 30 years or older is associated with increased risk.
A 35-year-old woman smokes approximately 10 cigarettes per day. She started
smoking at age 18 years. She has a new male sexual partner and is interested in
contraception. She was recently treated for gonorrhea and chlamydia. She is using
condoms inconsistently. The urine pregnancy test is negative. She denies a history of
hypertension, blood clots, liver disease, heart disease, and diabetes. Her last menstrual
period was 5 days ago. Which of the following contraceptive methods is recommended?
A. Oral contraceptive pills B. Copper intrauterine device (IUD)
C. Etonogestrel implant (Nexplanon) D. Vaginal ring (NuvaRing)
An etonogestrel implant (Nexplanon) is the best option for this patient. It is a
progesterone-only method. The 35-year-old patient is a smoker, so she cannot take oral
contraceptives, which contain estrogen/progesterone. An IUD is contraindicated until
the patient is retested (4-6 weeks after treatment) to ensure that her gonorrhea and
chlamydia infections are gone. The vaginal ring (NuvaRing) contains estrogen and
progestin; it is contraindicated for this patient.
This study source was downloaded by 100000901307859 from CourseHero.com on 10-16-2025 09:41:10 GMT -05:00
https://www.coursehero.com/file/250618452/Leik-female-GU-docx/
, 2
A 22-year-old patient presents for an annual gynecological exam and testing. The Pap
test result shows ASC-US. Which of the following is the best management for this
patient?
A. Check for high-risk HPV B. Repeat Pap test in 12
months
C. Refer patient for colposcopy D. Refer patient for endometrial biopsy
The appropriate follow-up for a 22-year-old with a Pap smear result of ASC-US is to
perform a repeat Pap test in 12 months. HPV testing is not recommended for this age
group with ASC-US. A colposcopy is not recommended for ASC-US, as most cases
clear spontaneously in young patients who are not immunocompromised. An
endometrial biopsy is not appropriate follow-up for ASC-US, since it does not involve
the endometrium.
Which of the following best describes primary amenorrhea?
A. Absence of menarche by age 12 years with breast development
B. Absence of menarche by age 15 years with breast development
C. Absence of menses after 3 or more months of regular menses
D. Absence of menses after 6 or more months of irregular menses
Primary amenorrhea is the absence of menarche by age 15 years with breast
development. The absence of menses after at least 3 consecutive months is secondary
amenorrhea. All patients with secondary amenorrhea should be ruled out for pregnancy.
Which of the following is the most common cause of primary amenorrhea?
A. Pregnancy B. Polycystic ovary
syndrome
C. Turner syndrome D. Hypothyroidism
Turner syndrome [45,X or monosomy X] is the most common cause of primary
amenorrhea in the United States. Pregnancy is the most common cause of secondary
amenorrhea. PCOS can cause oligomenorrhea or amenorrhea, but the amenorrhea is
usually secondary. Hypothyroidism is more likely to cause secondary amenorrhea.
A 27-year-old female patient who has never been pregnant presents with complaints of
irregular menses and states that she wants to conceive. She reports that her mast
menstrual period was a few months ago and lasted 2 days. Menarche was at 12 years,
and her menses used to occur every month, but in the past several years they have
occurred only a few times a year. Upon physical examination, hirsutism, acne, and a
BMI of 31 are noted. Which of the following is the most likely diagnosis?
A. Congenital adrenal hyperplasia B. 5 alpha-reductase
deficiency
C. Turner syndrome D. Polycystic ovary
syndrome
Polycystic ovary syndrome is perhaps the most common endocrinopathy encountered in
gynecology settings. It is a multisystem disorder that affects lipids, glucose/insulin,
adiposity, cardiovascular health, and reproductive health. Patients with the condition
often present with a specific phenotype whereby they have terminal hair on their face
and areola, acne, acanthosis nigricans, adiposity, scalp hair thinning, and
This study source was downloaded by 100000901307859 from CourseHero.com on 10-16-2025 09:41:10 GMT -05:00
https://www.coursehero.com/file/250618452/Leik-female-GU-docx/
