Module 1 BBB Practice Questions

Question 1

Why do adolescence have more irregular menses?

Answer 1

Their HPO axis is underdeveloped. It may be 1-2 years before their period is regular.

Question 2

When would we be using Tanner staging?

Answer 2

When a teen/adolescent or parent asks if they are normal or concerned about their development.

Question 3

When should testing begin for an adolescent that has not started their menstrual cycle?

Answer 3

At age 13 without any sex characteristics or age 15 with characteristics but no menarche.

Question 4

Does the evidence support routine pelvic exams?

Answer 4

The evidence does not support routine pelvic exams as screening tests. It is not recommended without symptoms or concerns during a well exam.

Question 5

There are a few organizations that recommend against routine pelvic exam, but ACOG doesn’t recommend for or against. What should you as the provider do?

Answer 5

Use shared decision-making!

Question 6

If a patient is not getting a routine pelvic exam, what should the time be used for?

Answer 6

Health maintenance. I.E. discussing diet, exercise, safety, vaccinations, stress levels, etc.

Question 7

Which patient needs a speculum exam?
A) Sexually active teen who wants contraception
B) Virginal teen who has dysmenorrhea
C) 32-year old who is due for a cervical screening
D) 45-year old who is here for a well visit, but is up to date on PAP
E) 18-year old with a new sexual partner but no abnormal discharge or dyspareunia

Answer 7

C

Question 8

Your patient reports a menstrual cycle that lasts 34 days and is very regular. When do they typically ovulate?

Answer 8

Day 20

Question 9

When the BBT rises, does this mean you are fertile?

Answer 9

No, it indicates that ovulation has happened

Question 10

What causes primary dysmenorrhea?

Answer 10

Prostaglandins and an absence of pathology

Question 11

How can we differentiate between primary and secondary dysmenorrhea?

Answer 11

Age-more likely to be primary if close in age to menarche
Symptoms: Change in symptom pattern may indicate secondary

Question 12

Describe the symptoms of primary dysmenorrhea.

Answer 12

Abdominal cramping, GI symptoms, Back pain, leg pain,

Question 13

What is first line management for primary dysmenorrhea?

Answer 13

-NSAIDs 2-3 days before the period starts-decreases the level of prostaglandins and the amount of bleeding
-Heat, aerobic exercise 30m 3 times a week (can decrease by up to 80%)
-CHC
**Review table in chapter 25

Question 14

When in the menstrual cycle does PMS/PMDD occur?

Answer 14

The luteal phase, the week before the period starts

Question 15

If someone didn’t ovulate, would you expect them to have PMS symptoms?

Answer 15

No

Question 16

How can we differentiate PMS from depression?

Answer 16

The timing of the symptoms. They will be fine most of the time and then struggle right before their cycle.

Question 17

How can we differentiate PMS from PMDD?

Answer 17

The severity of symptoms.

PMS: they are coping but want something to be done.
PMDD: they are not functioning. Ex. suicidal, homicidal

Question 18

A patient presents to you with symptoms of PMS, what will help us determine how to care for this patient?

Answer 18

Daily record of symptoms for 2 months AND/OR ask what symptoms bother them the most

Question 19

What management options do we have for PMS?

Answer 19

-SSRI: often the first line. Can take daily or on the first day of symptoms until the menstrual cycle begins
-CBT
-Exercise
-Adequate sleep
-Supplements: Ca, tumeric,