• Abnormal uterine bleeding (AUB) has multiple causes. When a woman presents and
reports menstrual irregularity with amenorrhea, which is the most
... [Show More] common cause of
amenorrhea?
Ectopic pregnancy
Adenomyosis
Coagulopathy
Anovulation
• The Tanner scale of sexual maturity rating allows for accurate classification of physical
pubertal maturation. During the examination of your patient, you notice that the pubic
hair is increased in quantity, is darker, and is present in the typical female triangle but in
a smaller quantity. Which of the following Tanner stages does this description meet?
Tanner stage I
Tanner stage II
Tanner stage III
Tanner stage IV
• A twenty-five-year-old patient presents with urinary frequency and urgency. These
symptoms have been occurring for three days without fever. A patient with interstitial
cystitis would most likely describe their symptoms as _______.
urinary urgency and frequency in the morning and at night
pain with urination with scant bleeding
terminal dysuria
urinary urgency only
• The most common cause of chronic pelvic pain for women in the prime of their
reproductive years is
PID
Fibroids
CORRECT Endometriosis
Endometritis
• A fifty-two-year-old female patient comes in for her annual well-woman examination. Her LMP
was fourteen months ago without any breakthrough bleeding. She has also developed some
hirsutism. You would document this as __.
secondary amenorrhea
menopause
perimenopause
polycystic ovary syndrome (PCOS)
• Polycystic ovaries predispose women to a higher incidence of:
Adrenal tumors
Ovarian cancer
Endometrial cancer
Endometriosis
• A definitive diagnosis of endometriosis cannot be made until which of these is completed?
CT scan
Transvaginal ultrasound
Exploratory laparoscopy
MRI
• After a thorough history, you note that Marie resides in a community with very high risk
factors. These include poverty, violence, and lack of recreational facilities. She tells you that she
“hangs out” at a convenience store near the apartment complex she lives at with her mother.
“All the group hangs there,” she reports proudly. She shares that she has been menstruating for
two years now although she has irregular cycles. She also lets you know that she has had coitus
only one time and that he “pulled out.” She does not want to get pregnant, and this is why she
is here today.
What is your management plan for Marie today?
Student Answer: CORRECT You will assess all predisposing factors that lead to premarital sex and the negative
consequences, tell Marie to be careful, and prescribe birth-control pills.
CORRECT One by one, you will plan to carefully address the risks (red flags) in Marie’s history. Your goal will be to clarify
and address misconceptions, as well as share valuable sex education in a sensitive, nonjudgmental way. You will let her know
you are her advocate and are very protective of her health. Without preaching, you want her to be aware of the negative
possibilities of premarital, unprotected sexual activities. You will also share a clear understanding of the risk of STIs with Marie.
CORRECT After processing all of the history Marie has shared, you will write a referral for psychiatric evaluation and tell
her she needs ongoing counseling for her behavior at such a young age and she likely needs to learn to cope within her
environment (home and community).
CORRECT Your goal is to include healthy sexual-health decision making, including decisions regarding abstinence, birthcontrol efficacy and choice, and condom use. Depending on the need, you may include a referral to an effective program for
teens (for example, a program that deals with STI prevention and or a family-based intervention program if available).
• A well-woman visit for an adolescent should include which of the following?
A general health history and physical examination, including a breast examination, pelvic with Pap smear, screening tests,
counseling, immunizations, risk factors, and patient concerns
A general health history focusing on reproductive and sexual health concerns (menses, gynecologic, and pregnancy
related) and psychosocial (family related, peer related, emotional, and physical as well as related to abuse, drug use, and
alcohol use) concerns
Physical exam, screening tests, and immunizations as indicated by the health history and gynecologic considerations
for an external-only inspection of the genitalia
CORRECT Both b and c
• A seventeen-year-old presents with an appointment for unilateral breast tenderness and
swelling. Which of the following would be the most likely etiology for this problem?
Breast cancer
Mastitis
Fibrocystic breast
Fibroadenoma
• You are completing a pelvic exam on thirty-two-year-old Nancy. You detect a left adnexal mass
on the bimanual exam. With an adnexal mass, the practitioner must always suspect ________
until proven otherwise.
Pelvic inflammatory disease (PID)
Malignancy
Pregnancy
Polycystic ovary disease X
• Majority of urinary tract infections do not require consultation or a referral to a specialist and
are routinely treated in primary care practices. Which of the following scenarios would indicate
that a consultation or referral is indicated?
The presence of secondary sexually transmitted illness
A patient with two episodes occurring in one year
Patients that remain symptomatic after three days of treatment
Patients that show urine human chorionic gonadotropin (HCG) positive
• . Long-acting progestins may be used in patients as a contraceptive method. One of the longacting progestins is Depo-Provera. Which of the following best describes the mechanism of
action of long-acting progestins in contraception?
Decrease in cervical mucus production and thinning of the circle os
Thickening of cervical mucus and suppression of gonadotropin levels
Increased gonadotropin levels and thinning of the circle os
Anovulation caused by increased gonadotropin levels
• Iris is a thirty-two-year-old married woman with three children. She comes in for information
on using the copper T intrauterine device (IUD) for contraception. Which of the following would
be a contraindication to using this appliance?
Prior ectopic pregnancy
• TeYou are counseling an eleven-year-old girl, Amanda, and her mother about human
papillomavirus vaccine (HPV), Gardasil. Amanda is Tanner stage IV at this visit. In counseling this
family, you tell them that HPV vaccine ______.
is a series of three doses, six months apart
will protect Amanda from all strains of HPV
can cause seizures in some children
is not indicated in her age group as she is not yet sexually active
• Urinary tract infections are commonly seen in primary care. A twenty-five-year-old female
presents with a new onset of dysuria and suprapubic pain for the last twenty-four hours. The
examination reveals only mild tenderness without any peritoneal signs on the lower abdomen.
A urinalysis reveals the presence of WBCs. The urine is sent for a culture and sensitivity. In
addition to Escherichia coli one might typically expect to see the presence of which bacterium?
Klebsiella
Staphylococcus aureus
Staphylococcus saprophyticus
Pseudomonas
• Which of the following conditions is not an absolute contraindication to estrogen-containing
contraception?
Migraine headaches
Hypercoagulable state
Thromboembolism
History of coronary artery diseaseDefinition
• Natasha is an eleven-year-old girl brought to your office for an annual well-child visit. When
discussing the onset of puberty with Natasha and her mother, you would emphasize which of
the following?
Breast buds develop before pubic hair.
Breast development delayed beyond twelve years of age may be considered pathological.
The average age of menarche is nine years.
It usually takes about three and half years to go from breast buds to menarche.
• A woman is experiencing a milky white nipple discharge. Galactorrhea is usually a finding with
which other diagnosis?
Fibrocystic breast disease
Mastalgia
Hyperprolactinemia
Breast cancer
• You are completing a pelvic exam on thirty-two-year-old Nancy. You detect a left adnexal mass
on the bimanual exam. With an adnexal mass, the practitioner must always suspect ________
until proven otherwise.
Pelvic inflammatory disease (PID)
Malignancy
Pregnancy
Polycystic ovary disease X
A nurse practitioner is educating a patient who has just been diagnosed with polycystic ovary syndrome
(PCOS). She needs to be aware that PCOS is associated with which of the following clinical
manifestations?
Excessive menstrual flow
Dry, flaking skin
Obesity
Hair loss
Anticholinergic medications are a type of treatment for which type of incontinence?
Urge incontinence
sixty-five-year-old obese female with type II diabetes mellitus presents to your office with a complaint of
vaginal itching and burning for two weeks. She has not been sexually active for five years. She has tried
douching with an OTC cream with no relief. On physical examination, the vulva is deep red with some
thick white adherent material. Which of the following conditions would be the most likely cause of her
symptoms?
Herpes simplex
Lichen planus
Atrophic vaginitis
Fungal infection
One important principle of antiretroviral therapy is
Response to drug therapy is monitored by HIV RNA levels.
A thirty-two-year-old woman presents to your practice with a chief complaint of postcoital bleeding.
Which of the following would not be included in the initial assessment of this patient?
pap
Question 100. Question :
The World Health Organization (WHO) has determined absolute contraindications to estrogen
containing contraceptives. Which of the following is not an absolute contraindication?
Student Answer: History of cerebrovascular accident (CVA)
CORRECT Greater than age of thirty-five years
Hypertension with vascular disease
INCORRECT Active viral hepatitis
A twenty-five-year-old patient presents with irregular bleeding after being on oral contraceptives for six
months. It is important to rule out which of the following?
Chlamydial cervicitis
Uterine fibroids [Show Less]