Module 2- Rosh Review
1. A 32-year-old woman with fluctuating menstrual intervals presents to the primary care clinic for an
evaluation. She is not currently pregnant but has had two normal pregnancies with healthy births. Vital
signs include a BP of 120/82 mm Hg, HR of 75 bpm, RR of 17/minute, and T of 98.6°F. On pelvic
examination, the left adnexa is appreciably larger than the right on palpation. There is no cervical motion
tenderness, bleeding, or vaginal discharge. Which one of the following conditions is most likely suggested
by her ovarian enlargement?
a. Benign cystic teratoma
b. Endometriosis
c. Functional ovarian cyst
d. Ovarian carcinoma
e. Stromal cell ovarian neoplasm
2. A 60-year-old woman presents to the clinic with severe vulvar itching and burning that has persisted for 8
months. She reports she has been treated with diflucan three separate times and terconazole externally
without complete resolution of symptoms. Physical exam reveals labial agglutination, ivory white plaques
with purpura, and excoriations in a figure-eight pattern around the vulva and perianal area. Wet prep
shows negative whiff, negative hyphae, negative clue cells, and positive lactobacillus. Which of the
following is the most likely diagnosis?
a. Atrophic vaginitis
b. Lichen sclerosus
c. Psoriasis
d. Vulvovaginal candidiasis
3. A 26-year-old woman presents with yellow vaginal discharge after starting a relationship with a new sexual
partner. Physical exam reveals purulent discharge from the external os of the cervix. Microscopy reveals
gram-negative diplococci. What is the most likely diagnosis
a. Bacterial vaginosis
b. Chlamydial cervicitis
c. Gonococcal cervicitis
d. Mycoplasma genitalium cervicitis
e. Trichomonas vaginitis
4. Which of the following diagnostic studies should be ordered for an adolescent suspected of having an
ovarian cyst?
a. Computed tomography
b. Magnetic resonance imaging
c. Ultrasound
d. X-ray
,5. A 32-year-old woman reports her menstrual periods are increasing in length more often. They used to last
about 4 days, but for the past 3 months, she has noticed they last about 9 days, even though she still cycles
every 28 days. She also reports heavier blood flow in the first 3 days of these new 9-day periods. She has no
other concerning health history and does not take any medications. Vital signs are a BP of 110/70 mm Hg,
HR of 90 bpm, RR of 12/min, and T of 98.9°F. Which of the following terms best characterizes this abnormal
uterine bleeding?
a. Amenorrhea
b. Intermenstrual bleeding
c. Perimenopausal bleeding
d. Polymenorrhea
e. Prolonged menstrual bleeding
6. A 35-year-old woman presents for routine gynecologic screening. Cervical cytology shows atypical
squamous cells of undetermined significance. Reflex human papillomavirus testing is positive for strain 16.
Which of the following is the best next step in management?
a. Ablation
b. Colposcopy
c. Excision
d. Repeat cytology with HPV co-test in one year
7. A 49-year-old woman presents to the office with irregular menses and a shorter duration between
menstrual cycles. She has associated sleep disturbances and hot flashes, as well. Menarche was age 11, and
she has had regular menstrual cycles typically lasting about 27 days. Now she is having cycles that are 23 to
25 days in length. Which of the following diagnostic tests would be most helpful in establishing the
diagnosis?
a. Follicle-stimulating hormone level
b. Pelvic ultrasound
c. Prolactin level
d. Thyroid-stimulating hormone level
,8. In the clinic, you are evaluating a 15-year-old girl who is reporting increased vaginal discharge for several
months. She had her menarche at 12 years of age and since then has had irregular periods. She uses
tampons during her menses. She notes thick yellowish vaginal discharge in between her periods. She
reports no burning, pain, or pruritus. She started to be sexually active for the past month with one partner.
She uses condoms for contraception. On examination, you note Tanner stage 5 pubic hair and white
discharge with no cervical erythema. You examine the discharge and obtain a pH of 4, with a negative whiff
test and absence of clue cells on microscopy. You perform a pregnancy test, which is negative. Which of
the following is the best next step?
a. Advise her to stop using tampons
b. Encourage her to douche after her period
c. Prescribe ceftriaxone, doxycycline, and metronidazole
d. Provide her with reassurance
e. Send culture for Gardnerella vaginalis
9. A 60-year-old postmenopausal woman presents with painless vaginal bleeding. Her last Papanicolaou
smear, performed 2 years ago, was unremarkable. Her pelvic exam in the office reveals a small amount of
blood at the cervical os. Which of the following is the most appropriate diagnostic test?
a. Colposcopy
b. Dilation and curettage
c. Endometrial biopsy
d. Hysteroscopy
e. Transabdominal ultrasonography
10. A 19-year-old woman presents to the clinic with a three-week history of abnormal vaginal discharge that is
thin and grayish in color and accompanied by mild dysuria and a vaginal odor. What is the likely diagnosis
for this patient?
a. Bacterial vaginosis
b. Candidiasis
c. Chlamydia
d. Gonorrhea
11. A 54-year-old woman presents with chest and neck flushing. She states this began 6 months ago. The
“warm feeling,” as she describes it, is becoming more frequent and seems to occur mainly in the evening.
She has not had any recent infections. There are no dermatologic lesions seen on physical examination. Her
last menstrual period was 14 months ago. Which hormone most likely causes these symptoms when it
declines?
a. Estradiol
b. Follicle-stimulating hormone
c. Progesterone
d. Prolactin
e. Thyroid-stimulating hormone
, 12. Which of the following factors is associated with an increased risk of ovarian cancer?
a. Early age at menopause
b. Infertility treatment
c. Late age of menarche
d. Nulliparity
13. A 23-year-old woman presents to the clinic with a complaint of irregular menstrual cycles over the last
year. She is not currently on any birth control. On exam, you note the patient has an overweight BMI, as
well as acne and hirsutism. Which of the following is the best way to diagnose the suspected condition?
a. Abdominal and pelvic CT scan
b. Rotterdam criteria
c. Serum total testosterone
d. Transvaginal ultrasound
14. What is the most important first step when evaluating a 15-year-old girl with a four-month history of
secondary amenorrhea?
a. Checking weight
b. Measuring follicle-stimulating hormone
c. Measuring human chorionic gonadotropin levels
d. Measuring thyroid-stimulating hormone
15. A 62-year-old woman reports a tender, itchy, red breast. She states she first noticed an erythematous area
6 weeks ago, and since then, the involved area has spread rapidly. Examination of the breast reveals the
findings seen above with associated warmth of the skin and axillary lymphadenopathy. Which of the
following is the best diagnosis?
a. Breast abscess
b. Eczema of the breast
c. Inflammatory breast cancer
d. Mastitis
1. A 32-year-old woman with fluctuating menstrual intervals presents to the primary care clinic for an
evaluation. She is not currently pregnant but has had two normal pregnancies with healthy births. Vital
signs include a BP of 120/82 mm Hg, HR of 75 bpm, RR of 17/minute, and T of 98.6°F. On pelvic
examination, the left adnexa is appreciably larger than the right on palpation. There is no cervical motion
tenderness, bleeding, or vaginal discharge. Which one of the following conditions is most likely suggested
by her ovarian enlargement?
a. Benign cystic teratoma
b. Endometriosis
c. Functional ovarian cyst
d. Ovarian carcinoma
e. Stromal cell ovarian neoplasm
2. A 60-year-old woman presents to the clinic with severe vulvar itching and burning that has persisted for 8
months. She reports she has been treated with diflucan three separate times and terconazole externally
without complete resolution of symptoms. Physical exam reveals labial agglutination, ivory white plaques
with purpura, and excoriations in a figure-eight pattern around the vulva and perianal area. Wet prep
shows negative whiff, negative hyphae, negative clue cells, and positive lactobacillus. Which of the
following is the most likely diagnosis?
a. Atrophic vaginitis
b. Lichen sclerosus
c. Psoriasis
d. Vulvovaginal candidiasis
3. A 26-year-old woman presents with yellow vaginal discharge after starting a relationship with a new sexual
partner. Physical exam reveals purulent discharge from the external os of the cervix. Microscopy reveals
gram-negative diplococci. What is the most likely diagnosis
a. Bacterial vaginosis
b. Chlamydial cervicitis
c. Gonococcal cervicitis
d. Mycoplasma genitalium cervicitis
e. Trichomonas vaginitis
4. Which of the following diagnostic studies should be ordered for an adolescent suspected of having an
ovarian cyst?
a. Computed tomography
b. Magnetic resonance imaging
c. Ultrasound
d. X-ray
,5. A 32-year-old woman reports her menstrual periods are increasing in length more often. They used to last
about 4 days, but for the past 3 months, she has noticed they last about 9 days, even though she still cycles
every 28 days. She also reports heavier blood flow in the first 3 days of these new 9-day periods. She has no
other concerning health history and does not take any medications. Vital signs are a BP of 110/70 mm Hg,
HR of 90 bpm, RR of 12/min, and T of 98.9°F. Which of the following terms best characterizes this abnormal
uterine bleeding?
a. Amenorrhea
b. Intermenstrual bleeding
c. Perimenopausal bleeding
d. Polymenorrhea
e. Prolonged menstrual bleeding
6. A 35-year-old woman presents for routine gynecologic screening. Cervical cytology shows atypical
squamous cells of undetermined significance. Reflex human papillomavirus testing is positive for strain 16.
Which of the following is the best next step in management?
a. Ablation
b. Colposcopy
c. Excision
d. Repeat cytology with HPV co-test in one year
7. A 49-year-old woman presents to the office with irregular menses and a shorter duration between
menstrual cycles. She has associated sleep disturbances and hot flashes, as well. Menarche was age 11, and
she has had regular menstrual cycles typically lasting about 27 days. Now she is having cycles that are 23 to
25 days in length. Which of the following diagnostic tests would be most helpful in establishing the
diagnosis?
a. Follicle-stimulating hormone level
b. Pelvic ultrasound
c. Prolactin level
d. Thyroid-stimulating hormone level
,8. In the clinic, you are evaluating a 15-year-old girl who is reporting increased vaginal discharge for several
months. She had her menarche at 12 years of age and since then has had irregular periods. She uses
tampons during her menses. She notes thick yellowish vaginal discharge in between her periods. She
reports no burning, pain, or pruritus. She started to be sexually active for the past month with one partner.
She uses condoms for contraception. On examination, you note Tanner stage 5 pubic hair and white
discharge with no cervical erythema. You examine the discharge and obtain a pH of 4, with a negative whiff
test and absence of clue cells on microscopy. You perform a pregnancy test, which is negative. Which of
the following is the best next step?
a. Advise her to stop using tampons
b. Encourage her to douche after her period
c. Prescribe ceftriaxone, doxycycline, and metronidazole
d. Provide her with reassurance
e. Send culture for Gardnerella vaginalis
9. A 60-year-old postmenopausal woman presents with painless vaginal bleeding. Her last Papanicolaou
smear, performed 2 years ago, was unremarkable. Her pelvic exam in the office reveals a small amount of
blood at the cervical os. Which of the following is the most appropriate diagnostic test?
a. Colposcopy
b. Dilation and curettage
c. Endometrial biopsy
d. Hysteroscopy
e. Transabdominal ultrasonography
10. A 19-year-old woman presents to the clinic with a three-week history of abnormal vaginal discharge that is
thin and grayish in color and accompanied by mild dysuria and a vaginal odor. What is the likely diagnosis
for this patient?
a. Bacterial vaginosis
b. Candidiasis
c. Chlamydia
d. Gonorrhea
11. A 54-year-old woman presents with chest and neck flushing. She states this began 6 months ago. The
“warm feeling,” as she describes it, is becoming more frequent and seems to occur mainly in the evening.
She has not had any recent infections. There are no dermatologic lesions seen on physical examination. Her
last menstrual period was 14 months ago. Which hormone most likely causes these symptoms when it
declines?
a. Estradiol
b. Follicle-stimulating hormone
c. Progesterone
d. Prolactin
e. Thyroid-stimulating hormone
, 12. Which of the following factors is associated with an increased risk of ovarian cancer?
a. Early age at menopause
b. Infertility treatment
c. Late age of menarche
d. Nulliparity
13. A 23-year-old woman presents to the clinic with a complaint of irregular menstrual cycles over the last
year. She is not currently on any birth control. On exam, you note the patient has an overweight BMI, as
well as acne and hirsutism. Which of the following is the best way to diagnose the suspected condition?
a. Abdominal and pelvic CT scan
b. Rotterdam criteria
c. Serum total testosterone
d. Transvaginal ultrasound
14. What is the most important first step when evaluating a 15-year-old girl with a four-month history of
secondary amenorrhea?
a. Checking weight
b. Measuring follicle-stimulating hormone
c. Measuring human chorionic gonadotropin levels
d. Measuring thyroid-stimulating hormone
15. A 62-year-old woman reports a tender, itchy, red breast. She states she first noticed an erythematous area
6 weeks ago, and since then, the involved area has spread rapidly. Examination of the breast reveals the
findings seen above with associated warmth of the skin and axillary lymphadenopathy. Which of the
following is the best diagnosis?
a. Breast abscess
b. Eczema of the breast
c. Inflammatory breast cancer
d. Mastitis
