NR 602 / NR602 FINAL EXAM 2022 – 100% CORRECT AND VERIFIED

NR 602 / NR602 FINAL EXAM 2022 – 100% CORRECT AND VERIFIED Which one best describes lesions associated with condyloma acuminatum? a. Verruciform b. Plaque-like c. Vesicular d. Bullous ANS - a 39yo female has completed course of amox for strep throat. LMP was 2wks ago, says it was normal. On exam, there's erythema of extern. genitalia w/small amount of white discharge. Micro wet prep reveals few clue cells, but many budding hyphae. No WBCs. Which one would be the most appropriate treatment? a. Metronidazole 500mg BID x7 days b. OTC hydrocortisone 1% cream TID c. Fluconazole tabs 150mg x1 dose d. Erythromycin 500mg TID x10 days ANS - c Woman c/o vaginal itching, white discharge. She is in good health except for recent abx for strep throat. Pelvic reveals tender vulvovaginal area w/edema and nonmalodorous white patches. Which is the most likely cause? a. Bacterial vaginosis b. Trichomonas c. Lactobacillus overgrowth d. Candidiasis ANS - d 18yo female c/o secondary amenorrhea. On exam, there is normal secondary sex characteristics and normal genitalia. Pregnancy is ruled out. What would necessitate further eval? a. Elevated blood cholesterol levels b. Androgen deficiency c. Galactorrhea d. Hirsutism ANS - c 24yo female is dx'd w/primary dysmenorrhea. Which med would be used as first-line to help control symptoms? a. Antianxiety meds b. Progesterone-only contraception c. Oral steroids d. NSAIDs ANS - d Primary amenorrhea is best described as: a. Cessation of menstruation x6mo b. Failure of menstruation to occur by 17ho c. Failure of menstruation to occur by 13yo d. Cessation of menstruation x6mo after menarche ANS - c 25yo female c/o vaginal irritation and discharge. On exam, cervix is easily friable and erythematous. No adnexal tenderness. Wet prep reveals mobile protozoa on NS slide. This most likely represents: a. Trichomonas b. Mucopurulent cervicitis c. Bacterial vaginosis d. Gonorrhea ANS - a 16yo female has h/o secondary amenorrhea. Menarche at 10yo, regular cycles x2yrs, has not menstruated x4yrs. What is most frequent etiology of this problem? a. Eating disorder b. Pregnancy c. Anovulatory cycles d. Stress ANS - a Woman is experiencing vaginal discharge. Wet mount with KOH would be used to confirm: a. Herpes simplex b. Gonorrhea c. Candidiasis d. Chlamydia ANS - c Treatment options for condyloma acuminatum include: a. Imiquimod (Aldera) b. Azithromycin c. Acyclovir d. Metronidazole ANS - a 25yo postmenopausal female c/o pain in upper outer quadrant of L breast x1mo. Best course of action would be: a. Reassure pt that pain is often not presenting symptom of breast cancer. b. Teach pt breast self-exam. c. Order labs as most likely this is secondary to hormonal fluctuation d. Perform breast exam and order mammo ANS - d PID typically presents with all of the following except: a. Dysuria b. Leukopenia c. Cervical motion tenderness d. Abd pain ANS - b Which of the following are of a reproductive and pelvic origin? a. Salpingo-oophoritis (fallopian tube/ovary) secondary to PID b. Gynecologic malignancy c. Adhesions d. Myomata uteri ANS - a 25yo female c/o tender area near her introitus and to the L of her perineum. Very painful sex was first sign. Initially bump was very small, but now is ping-pong ball size. On exam, abscess is present on L medial side of labia minora and there's edema extending into perineum. What is dx? a. Lipoma b. Dermoid cyst c. Bartholin's cyst d. Skene's duct cyst ANS - c 49yo female c/o dark, watery brown vaginal discharge. Which best describes what might be seen on physical exam in pt's with cervical cancer? a. Ulcerated firm cervix b. Vague lower abd pain c. Enlarged tender femoral lymph nodes d. Soft, still shaped cervix ANS - a 22yo female c/o pelvic pain. Exam reveals cervical motion and uterine tenderness. Which supports PID dx? a. Temp 100F b. Absence of WBCs in vag fluid c. Mucopurulent vag discharge d. Lab documentation of cervical infection w/E. coli ANS - c When educating pt about rationale for getting mammo, which statement is false? a. Mammo is cost-effective method to screen for breast cancer b. Mammo detects all breast cancers c. Mammo should be accompanied by breast exam d. Negative mammo should not delay biopsy of clinically suspicious mass ANS - b When educating women about breast cancer risk factors, which statement is incorrect? a. Pregnancy after 35yo b. Late menopause after 57yo c. Fibrocystic breast dz d. H/o maternal breast cancer ANS - c Which of the following statements is accurate regarding the usefulness of mammo in screening and detection of breast cancer? a. Mammo shouldn't be done if there is any breast pain or nipple retraction b. All women 40yo should have mammo on annual basis c. Mammo should be done annually for all women of child-bearing age d. Mammos should be performed annually after initial pregnancy, especially if women doesn't breastfeed ANS - b Which would be considered normal surface characteristic of the cervix during a speculum exam? a. Small, yellow, raised around area on cervix b. Friable, bleeding tissue opening of the cervical os c. Red patch areas w/occasional white spots d. Irregular, granular surface w/red patches ANS - a What is the most common cause of dysfunctional uterine bleeding? a. Endocrine disorders b. Stress c. Anovulation d. Anatomical abnormality ANS - c PMS occurs with greatest frequency and severity in the: a. Late luteal phase b. Midfollicular phase c. Proliferative phase d. Early luteal phase ANS - a Which is not a common cause of irregular menstrual bleeding? a. Endocrine disorders b. Stress c. Anovulation d. Anatomical abnormality ANS - c What is considered the primary etiology of primary dysmenorrhea? a. Ovarian cysts b. Prostaglandin production c. Endometriosis d. Adenomyosis ANS - b 28yo female c/o breast tenderness, fatigue, abd bloating, fluid retention, irritability 1wk before her menses onset. What is most important info to obtain from this pt to determine if the pt has PMS? a. Severity of symptoms b. Occurrence of symptoms in menstrual cycle c. Frequency and number of symptoms over past 4mo ANS - b 35yo woman c/o 6mo h/o hypermenorrhea, backache, pelvic pressure. On exam, you discover 12wk size uterus w/irregular contour. What does this represent? a. Uterine cancer b. Dysfunctional uterine bleeding c. Uterine fibroid d. Fecal impaction ANS - c Female c/o vaginal itching and white discharge. Denies sexual activity or douching. In good health except for recurrent strep throat. Pelvic reveals tender vulvovag area w/edema and white patches. No odor. What is the most likely cause? a. Bacterial vaginosis b. DM c. Allergy to personal hygiene product d. Candidiasis after abx treatment ANS - d 32yo woman c/o postcoital bleeding. Which would not be included in the initial assessment? a. Pap smear b. Uterine biopsy c. Pelvic ultrasound d. CBC w/diff ANS - b What phase of menstrual cycle begins with menses cessation and ends w/ovulation? a. Ovulatory phase b. Follicular phase c. Proliferative phase d. Luteal phase ANS - b What phase of menstrual cycle begins with ovulation and ends w/menstruation? a. Ovulatory phase b. Follicular phase c. Proliferative phase d. Luteal phase ANS - c Name 4 structural abnormalities that are causes of dysfunctional uterine bleeding. ANS - PALM: Polyps Adenomyosis Leiomyoma Malignancy Name 5 non-structural abnormalities that are causes of dysfunctional uterine bleeding. ANS - COEIN: Coagulopathy Ovulatory disorders Endometrial Iatrogenic Not classified What is abnormal/dysfunctional uterine bleeding? ANS - Acute or chronic bleeding from uterine corpus; abnormal in regularity, volume, frequency, or duration; occurs in pregnancy absence. What is acute DUB? ANS - Episode of sufficient quantity to require immediate intervention to prevent further blood loss What is chronic DUB? ANS - Present for the majority of the last 6mo What is the most common benign tumor of the genital tract? ANS - Leiomyomas? (Hollier CPG p. 772) Name some risk factors for DUB. ANS - Anovulation Hormone replacement anovulation Obesity Nulliparity 35yo DM Personal/fam h/o coagulation disorder Liver disorder Anticoagulant therapy/chemo What are some subjective findings for DUB? ANS - Heavy bleeding Bleeding 7 days Cycles closer than 21 days Pain Post-coital bleeding Passing clots/tissue Dizziness Hot flashes Temp intolerance Uterine/cervical tenderness What are some objective findings for DUB? ANS - Excessive bleeding on exam Hypotension Tachycardia Diaphoresis Vag atrophy Mass Trauma Enlarged uterus/adnexa Hirsutism Thyromegaly Bruising Galactorrhea What are some diff dx's for DUB? ANS - PALM-COEIN Traumatic injury Pregnancy-related bleeding (ectopic, SAB, placenta previa/abruptio)