Download Book Chapter practice questions and more Quizzes Gynecology in PDF only on Docsity!
Elsevier1.
ID: 26574065928 You are a practitioner in a GYN practice and you are meeting with a 25-year-old female patient who has experienced amenorrhea for the last 6 months. This patient had a negative pregnancy test and is not lactating. What lab work would you consider ordering for this patient? A. Chemistry B. Progesterone level Incorrect C. Follicle-stimulating hormone and luteinizing hormone Correct D. Lipid panel Pregnancy or lactation-induced amenorrhea must be excluded in all women of childbearing age before any other diagnostic evaluation is initiated. Next, follicle-stimulating hormone (FSH) and LH should be checked (anovulation); thyroid-stimulating hormone (TSH) concentration is determined to evaluate for hypothyroidism; and prolactin levels are obtained to check for hyperprolactinemia or possibly an early presentation of acromegaly, which produces excess prolactin and growth hormone. Awarded 0.0 points out of 1.0 possible points.
ID: 26574065933 You are a practitioner in a GYN practice and you are evaluating a patient with a Bartholin cyst. The patient has no medical history and has never had a cyst or abscess in that area of the body before. What would be your treatment plan for this patient? A. Complete removal of the entire gland B. Perform an incision and drainage of the cyst and place a Word catheter. Correct C. Prescribe oral antibiotics for treatment. D. Aspirate the fluid inside the cyst for a culture and have the patient follow-up in one week. Incision and drainage is a commonly used management strategy for Bartholin gland cysts and abscesses and was once the mainstay of treatment, but incision and drainage alone is not recommended as recurrence risk is high. A Word catheter placed through the incision into the gland after I&D is performed allows continued drainage and reepithelialization of a tract for future drainage. Removal of the entire gland, once a standard procedure, is now recommended only when there is suspicion of malignancy or a recurrent abscess. Current surgical
practices emphasize preservation of the gland’s function. Awarded 1.0 points out of 1.0 possible points.
ID: 26574065938 You are a practitioner in a GYN practice and you are evaluating a 46-year-old female patient with acute mastitis. The patient is not lactating and has no systemic symptoms. You prescribed an appropriate oral antibiotic and advised the patient to return to the office if the infection did not resolve with the antibiotics. Failure to respond to the treatment would make you concerned for what? A. Antibiotic resistance B. Metastasized ovarian malignancy C. An abscess Incorrect D. Breast malignancy Correct In lactating women, the differential diagnosis for mastitis includes breast engorgement, which is usually bilateral. Other differential diagnoses include duct ectasia, periductal mastitis, breast abscess, and granulomatous mastitis. In non-lactating women, inflammatory breast cancer can mimic acute mastitis or cellulitis. Failure to respond to appropriate antibiotic therapy is a concerning sign for a malignant neoplasm. Awarded 0.0 points out of 1.0 possible points.
ID: 26574065943 Which of the following conditions is often associated with chronic pelvic pain in women? A. Endometriosis Correct B. End-stage renal disease C. Frequent urinary tract infections Incorrect D. Gallstones Endometriosis is one of the most common structural causes of CPP, occurring in approximately 70% of women with endometriosis, and is the most common comorbidity in women seeking medical care for CPP. Most often, women diagnosed with CPP in the setting of endometriosis are nulliparous, in their 20s to 30s, with symptoms associated with their menstrual cycle, including dysmenorrhea or pain. Awarded 0.0 points out of 1.0 possible points.
ID: 26574065948 You are a practitioner in a GYN practice and you are evaluating a 50-year-old female patient with chronic pelvic pain but no known cause.
Prolonged untreated AUB can lead to iron deficiency anemia and can result in fatigue, weakness, unexplained weight loss, mood swings, and impaired cognitive functioning, limiting patient’s quality of life. For women in whom initial medical management with hormonal therapies is ineffective or those with severe bleeding or contraindications to medical management, surgical interventions including endometrial ablation, uterine artery embolization, and hysterectomy may be necessary, with implications for future childbearing. Hysterectomy is the definitive treatment for AUB but is costly and associated with potential complications such as high blood loss, infection, thromboembolic events, and injury to bowel, bladder, and ureters. Awarded 1.0 points out of 1.0 possible points.
ID: 26574065963 What would you expect to find on examination of a female patient with primary dysmenorrhea? A. Dilated cervix B. Absent ovary C. Enlarge uterus Incorrect D. Normal exam findings Correct Physical examination findings are normal in primary dysmenorrhea. The diagnosis is based on a careful history and exam. It is appropriate to perform only an abdominal examination in young women with a typical history of low anterior pelvic pain beginning in adolescence and associated specifically with the menstrual cycle. However, a pelvic examination should be performed in patients who are sexually active, have severe lower abdominal or pelvic pain, and/or have not responded to empiric treatment for dysmenorrhea. Awarded 0.0 points out of 1.0 possible points.
ID: 26574065968 Dyspareunia can affect any woman who is sexually active but often occurs after A. a gynecological examination. B. menopause. Correct C. a urinary tract infection. D. the week after a menstrual period. Incorrect Dyspareunia affects sexually active woman of all ages but may become increasingly evident at times of major transition in a woman’s life, including the onset of sexual activity, childbirth, and menopause. Awarded 0.0 points out of 1.0 possible points.
ID: 26574065973 You are a practitioner in an emergency department and you are evaluated a 32-year-old female patient who is 10 weeks pregnant and presents with abdominal pain and vaginal bleeding. What diagnosis should you consider? A. Ectopic pregnancy Correct B. Chlamydia infection C. Urinary tract infection D. Appendicitis Symptoms of unruptured ectopic pregnancy can be vague and subacute; amenorrhea is a common presentation (>78% in one study), but the most common presentation of ectopic pregnancy in most studies is abdominal pain and bleeding. The most common symptom of a ruptured ectopic pregnancy is also abdominal pain. Awarded 1.0 points out of 1.0 possible points.
ID: 26574065978 You are a practitioner in an emergency department and you are caring for a 28-year-old female with a confirmed ectopic pregnancy. You prepare the patient for hospital admission and surgery because you know that a ruptured ectopic pregnancy can result in A. acute kidney failure. B. massive bleeding and an immediate threat to life. Correct C. decrease the oxygen supply to the fetus. D. chronic pelvic pain. A ruptured ectopic pregnancy can result in acute, massive bleeding and poses an immediate threat to life. Rupture is more likely at higher presenting levels of hCG and with multiple ovulation or ovulation induction, but even ectopic gestations with initially low hCG levels treated with methotrexate may progress to rupture. Misdiagnosis, which is more likely in rare types of ectopic gestation, can result in sudden death secondary to internal hemorrhage and infection. Awarded 1.0 points out of 1.0 possible points.
ID: 26574065983 You are a practitioner in a GYN practice and you are meeting a patient for the first time. The 20-year-old female would like to discuss contraception options. Which of the following questions would be appropriate to ask? A. When was your last Pap testing? B. Have you had recent routine blood work with your primary care provider? Incorrect
ID: 26574065998 What hormone primary affects the physiologic changes associated with menopause? A. Progesterone B. Follicle-stimulating hormone C. Estrogen Correct D. Testosterone The primary driver for the physiologic changes associated with menopause is the dramatic decline in estrogen levels, causing several short- and long-term physical changes including cycle irregularity, VMS (hot flashes), urogenital atrophy (vaginal dryness, urinary incontinence, pelvic floor dysfunction), mood changes, and poor sleep and sexual functioning. Awarded 1.0 points out of 1.0 possible points.
ID: 26574066203 You are a practitioner in a GYN practice and you are meeting with a 24-year-old female patient with a history of HPV. You note that the patient has not received any doses of the HPV vaccination series. Why would you want to recommend the patient receive this vaccine? A. The vaccine could help with the treatment of HPV. B. The vaccine could help with the prevention of other sexually transmitted infections. C. The vaccine could protect from other types of HPV. Correct D. It would be unnecessary to recommend this vaccine to this patient. For maximum efficacy, the best time to administer the HPV vaccine is prior to the onset of sexual activity, though vaccination should not be withheld or delayed in either males or females because of sexual debut. Individuals already infected with a type of uro-ano-genital HPV are candidates for the vaccination (if they have not yet begun the series) as they can be afforded protection from those types of HPV that they have not yet contracted. Awarded 1.0 points out of 1.0 possible points.
ID: 26574066208 You are a practitioner in a community health center and you are counseling a 21-year-old female patient who is sexually active. You are discussing pelvic inflammatory disease and what the risk factors are. Which of the following would not be a risk factor for PID? A. Younger than 25 years Incorrect
B. Having an IUD for contraception Correct C. Having multiple sexual partners D. Living in an area with a high prevalence of sexually transmitted infections Risk factors for PID include being younger than 25 years, having multiple sexual partners, not currently or consistently using contraception, early age of sexual debut, and living in an area with a high prevalence of sexually transmitted infections (STIs). Awarded 0.0 points out of 1.0 possible points.
ID: 26574066213 As a health care provider, when speaking to a woman regarding sexual health, you must maintain an understanding nonjudgmental attitude. The best way to create a comfortable environment for the patient to discuss any concerns is to A. provide the patient with examples of concerns from previous patients. B. allow the patient to begin the conversation. C. avoid this topic unless the patient specifically asks to discuss it. D. ask open-ended questions to normalize sexual concerns. Correct It is important for clinicians to recognize that most women will not initiate a discussion of their sexual concerns. Research indicates that sexual health is not routinely discussed with their health care providers. An open, understanding, nonjudgmental attitude is necessary to create a comfortable environment for patients to discuss this topic. Inclusion of sexual health questions in the history and review of systems legitimizes that sexual issues are appropriate to discuss. Asking open-ended questions (e.g., “Many women experience sexual changes after menopause. What changes have you noticed?”) normalizes sexual concerns. Awarded 1.0 points out of 1.0 possible points.
ID: 26574066218 You are a practitioner in a primary care practice and are beginning prenatal care for a 28-year-old female who is 9 weeks pregnant. Which of the following is not necessary to screen for? A. Tobacco, alcohol, and other substance use B. Intimate partner violence C. Up to date with appropriate vaccinations D. Health insurance Correct
