FNP LEIK 2024/2025 Problem Solving Exam
Questions and With Distinction level Marking
scheme
All of the following are complications of severe preeclampsia
except: - correct answer Placenta previa
Severe preeclampsia can cause placental abruption, but not
placenta previa (placenta implants over internal os). Serious
complications include hypertensive encephalopathy, liver failure,
kidney failure, pulmonary edema, seizures, retinal detachment,
disseminated intravascular coagulation, and death.
Fetal TORCH infections: - correct answer he acronym
TORCH stands for Toxoplasma gondii, other infections, rubella,
cytomegalovirus, and herpes. Although several of the conditions
listed in the other answer options can also cause fetal problems,
they do not comprise the TORCH disorders.
Which is a MINOR criterion that is not required for diagnosis of
PID? - correct answer Oral temp >101F (38C)
Pelvic inflammatory disease (PID) is a clinical diagnosis. The
presence of at least one of the major criteria (cervical motion
tenderness, adnexal tenderness, uterine tenderness) when
combined with the history is highly suggestive of PID. Minor
criteria are not necessary, but they help to support the diagnosis
of PID (oral temperature >101°F [>38°C]), mucopurulent
cervical or vaginal discharge, elevated sedimentation rate,
elevated C-reactive protein, large amount of WBCs on saline
,microscopy of the vaginal fluid, or laboratory documentation of
cervical infection with Neisseria gonorrhoeae or Chlamydia
trachomatis).
A 28-year-old multipara who is at 32 weeks gestation presents to
your office complaining of a sudden onset of small amounts of
bright-red vaginal bleeding. She has had several episodes and
appears anxious. On exam, her uterus is soft to palpation. Which
of the following is most likely? - correct answer Placenta
Previa
Placenta previa occurs when the placenta implants abnormally,
partially, or wholly, in the lower segment of the uterus or over the
internal os. A classic presentation is painless bright-red vaginal
bleeding in the second and/or third trimester. Do not perform
digital cervical in any pregnant women with bleeding until the
position of the uterus is known (abdominal ultrasound). Avoid
vaginal exam, sexual intercourse, or rectal exam if placenta
previa is suspected.
A 30-year-old woman who is sexually active complains of a large
amount of milk-like vaginal discharge for several weeks. A
microscopy slide reveals a large number of cells that have
blurred margins. Very few white blood cells are seen. The vaginal
pH is at 6.0. What is most likely? - correct answer In
bacterial vaginosis (BV), the normal hydrogen peroxide-
producing lactobacilli are replaced by an overgrowth of
anaerobic bacteria. BV is a vaginosis (does not cause
inflammation) rather than a vaginitis. No symptoms may be
present or the patient's history may include strong vaginal odor
("fishy" odor) and increased vaginal discharge (milky white, thin,
adherent discharge or dull gray discharge). Findings include
alkaline pH greater than 4.5, the presence of clue cells (wet
,smear using microscopy), and positive "whiff test" (a strong
"fishy" odor when vaginal discharge is mixed with one drop of
potassium hydroxide [KOH]). Clue cells are squamous epithelial
cells dotted with large numbers of bacteria that obscure borders.
A young primigravida reports to you that she is starting to feel
the baby's movements in her uterus. This is considered to be
which of the following? - correct answer Presumptive sign
Presumptive signs are sensations that are felt by the mother, but
they could also be caused by other conditions. They are some of
the earliest symptoms of pregnancy, such as nausea, fatigue,
breast tenderness, amenorrhea, and quickening (16 to 20
weeks).
You are reviewing a Pap smear result for a 25-year-old woman.
Which of the following cells should be obtained in a Pap smear
sample to be classified as a satisfactory specimen? - correct
answer An optimal Pap smear sample contains sufficient
mature and metaplastic squamous cells to indicate adequate
sampling from the transformation zone and sufficient
endocervical cells to indicate that the upper limit of the
transformation zone was sampled, and to provide a sample for
screening for adenocarcinoma and its precursors.
Which of the following findings is most likely in young
primigravidas with pregnancy-induced hypertension? - correct
answer Common signs and symptoms of pregnancy-induced
hypertension include edema of the face and the upper
extremities, weight gain, blurred vision, elevated blood pressure,
proteinuria, and headaches.
, Precocious puberty is defined as the onset of secondary sexual
characteristics before the age of: - correct answer Before 8
yo in girls, before 9 yo in boys
A patient diagnosed with bacterial vaginosis should be advised
that her male sexual partner: - correct answer Bacterial
vaginosis is a bacterial infection, but is not considered a sexually
transmitted disease for which the partner needs treatment.
Studies show that men rarely carry this infection.
A 25-year-old woman presents with severe right-sided pelvic pain
that began 48 hours ago. She reports small amounts of vaginal
bleeding. The pain is aggravated by jumping or any movement
that jars her pelvis. The best initial intervention is which of the
following? - correct answer Severe right-sided pain with
vaginal bleeding in a 25-year-old patient requires an evaluation
for pregnancy by initially performing a urine hCGtest, which can
be done quickly in the primary care clinic. A serum hCGtest can
also be drawn at the same visit. If a ruptured ectopic pregnancy
is suspected, call 911
A postmenopausal woman complains of random episodes of
vaginal bleeding for the past 6 months. Which of the following is
recommended management for this condition? - correct
answer Random episodes of vaginal bleeding in a
postmenopausal woman are not normal. Endometrial biopsy is
needed to evaluate a specimen of the endometrial lining for
abnormal cells, which may indicate cancer.
A 44-year-old woman who is undergoing treatment for infertility
complains of not having had a menstrual period for a few
months. The night before, she started spotting and is now having
Questions and With Distinction level Marking
scheme
All of the following are complications of severe preeclampsia
except: - correct answer Placenta previa
Severe preeclampsia can cause placental abruption, but not
placenta previa (placenta implants over internal os). Serious
complications include hypertensive encephalopathy, liver failure,
kidney failure, pulmonary edema, seizures, retinal detachment,
disseminated intravascular coagulation, and death.
Fetal TORCH infections: - correct answer he acronym
TORCH stands for Toxoplasma gondii, other infections, rubella,
cytomegalovirus, and herpes. Although several of the conditions
listed in the other answer options can also cause fetal problems,
they do not comprise the TORCH disorders.
Which is a MINOR criterion that is not required for diagnosis of
PID? - correct answer Oral temp >101F (38C)
Pelvic inflammatory disease (PID) is a clinical diagnosis. The
presence of at least one of the major criteria (cervical motion
tenderness, adnexal tenderness, uterine tenderness) when
combined with the history is highly suggestive of PID. Minor
criteria are not necessary, but they help to support the diagnosis
of PID (oral temperature >101°F [>38°C]), mucopurulent
cervical or vaginal discharge, elevated sedimentation rate,
elevated C-reactive protein, large amount of WBCs on saline
,microscopy of the vaginal fluid, or laboratory documentation of
cervical infection with Neisseria gonorrhoeae or Chlamydia
trachomatis).
A 28-year-old multipara who is at 32 weeks gestation presents to
your office complaining of a sudden onset of small amounts of
bright-red vaginal bleeding. She has had several episodes and
appears anxious. On exam, her uterus is soft to palpation. Which
of the following is most likely? - correct answer Placenta
Previa
Placenta previa occurs when the placenta implants abnormally,
partially, or wholly, in the lower segment of the uterus or over the
internal os. A classic presentation is painless bright-red vaginal
bleeding in the second and/or third trimester. Do not perform
digital cervical in any pregnant women with bleeding until the
position of the uterus is known (abdominal ultrasound). Avoid
vaginal exam, sexual intercourse, or rectal exam if placenta
previa is suspected.
A 30-year-old woman who is sexually active complains of a large
amount of milk-like vaginal discharge for several weeks. A
microscopy slide reveals a large number of cells that have
blurred margins. Very few white blood cells are seen. The vaginal
pH is at 6.0. What is most likely? - correct answer In
bacterial vaginosis (BV), the normal hydrogen peroxide-
producing lactobacilli are replaced by an overgrowth of
anaerobic bacteria. BV is a vaginosis (does not cause
inflammation) rather than a vaginitis. No symptoms may be
present or the patient's history may include strong vaginal odor
("fishy" odor) and increased vaginal discharge (milky white, thin,
adherent discharge or dull gray discharge). Findings include
alkaline pH greater than 4.5, the presence of clue cells (wet
,smear using microscopy), and positive "whiff test" (a strong
"fishy" odor when vaginal discharge is mixed with one drop of
potassium hydroxide [KOH]). Clue cells are squamous epithelial
cells dotted with large numbers of bacteria that obscure borders.
A young primigravida reports to you that she is starting to feel
the baby's movements in her uterus. This is considered to be
which of the following? - correct answer Presumptive sign
Presumptive signs are sensations that are felt by the mother, but
they could also be caused by other conditions. They are some of
the earliest symptoms of pregnancy, such as nausea, fatigue,
breast tenderness, amenorrhea, and quickening (16 to 20
weeks).
You are reviewing a Pap smear result for a 25-year-old woman.
Which of the following cells should be obtained in a Pap smear
sample to be classified as a satisfactory specimen? - correct
answer An optimal Pap smear sample contains sufficient
mature and metaplastic squamous cells to indicate adequate
sampling from the transformation zone and sufficient
endocervical cells to indicate that the upper limit of the
transformation zone was sampled, and to provide a sample for
screening for adenocarcinoma and its precursors.
Which of the following findings is most likely in young
primigravidas with pregnancy-induced hypertension? - correct
answer Common signs and symptoms of pregnancy-induced
hypertension include edema of the face and the upper
extremities, weight gain, blurred vision, elevated blood pressure,
proteinuria, and headaches.
, Precocious puberty is defined as the onset of secondary sexual
characteristics before the age of: - correct answer Before 8
yo in girls, before 9 yo in boys
A patient diagnosed with bacterial vaginosis should be advised
that her male sexual partner: - correct answer Bacterial
vaginosis is a bacterial infection, but is not considered a sexually
transmitted disease for which the partner needs treatment.
Studies show that men rarely carry this infection.
A 25-year-old woman presents with severe right-sided pelvic pain
that began 48 hours ago. She reports small amounts of vaginal
bleeding. The pain is aggravated by jumping or any movement
that jars her pelvis. The best initial intervention is which of the
following? - correct answer Severe right-sided pain with
vaginal bleeding in a 25-year-old patient requires an evaluation
for pregnancy by initially performing a urine hCGtest, which can
be done quickly in the primary care clinic. A serum hCGtest can
also be drawn at the same visit. If a ruptured ectopic pregnancy
is suspected, call 911
A postmenopausal woman complains of random episodes of
vaginal bleeding for the past 6 months. Which of the following is
recommended management for this condition? - correct
answer Random episodes of vaginal bleeding in a
postmenopausal woman are not normal. Endometrial biopsy is
needed to evaluate a specimen of the endometrial lining for
abnormal cells, which may indicate cancer.
A 44-year-old woman who is undergoing treatment for infertility
complains of not having had a menstrual period for a few
months. The night before, she started spotting and is now having
