Module 3 Kelsey Chapter 5 Flashcards
A lesion associated with secondary syphilis is:
A) condyloma acuminata.
B) condyloma lata.
C) molluscum contagiosum.
D) inguinal bubo.
condyloma lata.
Patients with secondary syphilis may present with localized or diffuse mucocutaneous lesions on the palms and soles, mucous patches, and condyloma lata. They may also have generalized lymphadenopathy along with flulike symptoms (low-grade fever, headache, sore throat, malaise, arthralgias).
A 24-year-old patient presents for a routine wellness visit without any complaints. On physical examination, you note a 2-cm, nontender, fluctuant mass at the inferior aspect of the left labia. The most likely diagnosis is:
A) Bartholin’s gland cyst.
B) epidermal inclusion cyst.
C) vestibulitis.
D) vulvar carcinoma.
Bartholin’s gland cyst.
The Bartholin’s glands are located at the inferior aspects of the labia (4 o’clock and 8 o’clock). Cysts within these glands are generally unilateral, 1 to 3 cm in size, nontender (unless there is an abscess), and fluctuant.
A sexually active 18-year-old female presents with postcoital spotting, dysuria, and a yellow discharge. On examination, you find her cervix is erythematous and bleeds with contact. The most likely diagnosis is:
A) cervical cancer.
B) chlamydia.
C) primary syphilis.
D) tampon injury.
chlamydia.
Symptoms of chlamydia may include postcoital bleeding; intermenstrual bleeding or spotting; symptoms of urinary tract infection—dysuria, frequency; vaginal discharge; and abdominal pain. Physical findings may include mucopurulent endocervical discharge; an edematous, tender cervix with easily induced bleeding; and slight tenderness upon palpation of suprapubic area.
An examination finding that is considered a minimum criterion for empirical treatment of PID in a sexually active young woman presenting with lower abdominal or pelvic pain is:
A) adnexal mass.
B) cervical motion tenderness.
C) fever > 101°F (> 38.4°C).
D) vaginal discharge.
cervical motion tenderness.
The minimum criterion for empirical treatment of PID in sexually active young women and other women at risk for STIs with a complaint of pelvic or lower abdominal pain includes the presence of one or more of these three findings on pelvic examination: uterine tenderness, adnexa tenderness, cervical motion tenderness.
A patient with latent syphilis may present with:
A) a maculopapular rash.
B) an indurated painless ulcer.
C) condyloma lata.
D) no signs of infection.
no signs of infection.
Patients with latent syphilis show no signs of infection; detection is through serologic testing.
Females exposed to DES in utero are at increased risk for:
A) breast cancer.
B) ovarian cancer.
C) vaginal cancer.
D) vulvar cancer.
vaginal cancer.
Females exposed to DES in utero are at increased risk for clear cell carcinoma of the vagina (although rarely; the risk is 1 in 1000).
DES=Diethylstilbestrol (DES) aka estrogen
The most commonly used method of ART is:
A) GIFT.
B) ICSI.
C) IVF.
D) ZIFT.
IVF.
IVF is the most commonly used ART, with a success rate of 15% to 20%. IVF comprises a series of complex procedures wherein the oocytes are extracted, fertilized in the laboratory, and then transferred through the cervix into the uterus.
ART=Assisted Reproductive Technology
A 36-year-old is seen in your office on day 18 of her cycle for her routine annual examination. She has no complaints. The pelvic examination reveals a 9-cm firm pelvic mass anterior to the uterus. The most likely diagnosis is:
A) benign cystic teratoma.
B) ectopic pregnancy.
C) endometrioma.
D) follicular cyst.
benign cystic teratoma.
Benign cystic teratomas usually measure between 5 and 10 cm in diameter and are composed of well-differentiated tissue from all three germ layers. They are often located anterior to the uterus. Patients are usually asymptomatic but may experience acute pain if the teratoma twists or ruptures.
Which of the following statements concerning ovarian cancer is true?
A) BRCA1 gene mutations increase risk but BRCA2 gene mutations do not.
B) The lifetime risk of ovarian cancer in the general population is 1% to 2%.
C) Ovarian cancer rates are highest among women age 30 to 45 years.
D) Use of oral contraceptives for more than 5 years increases the risk for developing ovarian cancer.
The lifetime risk of ovarian cancer in the general population is 1% to 2%.
The lifetime risk for ovarian cancer in the general population is 1% to 2%. The presence of BRCA1 or BRCA2 gene mutations increases this risk. The use of oral CHCs for more than 5 years decreases the risk.
Which of the following treatments for genital warts may be used during pregnancy?
A) Imiquimod cream
B) Podophyllin resin
C) Podofilox gel
D) Trichloroacetic acid
Trichloroacetic acid
For the treatment of genital warts in pregnancy, the CDC recommends trichloroacetic or bichloroacetic acid (80% to 90% solution). Imiquimod cream, podophyllin resin, and podofilox gel should not be used during pregnancy.
A 22-year-old female presents with complaint of malodorous vaginal discharge and vulvar itching. On examination, a watery, yellowish-green vaginal discharge is noted, along with vulvar and vaginal erythema. The most likely findings on a wet-mount examination will be:
A) clue cells.
B) lactobacilli.
C) pseudohyphae.
D) trichomonads.
trichomonads.
Symptoms of trichomoniasis include copious, malodorous, yellowish-green discharge; vulvar irritation; pruritus; and occasionally dysuria, urgency, frequency of urination, and postcoital and intermenstrual bleeding. Onset of symptoms often occurs after menses. In addition to vaginal discharge, physical examination findings may include erythema and edema of the vagina, a friable cervix, and punctate lesions (strawberry spots) on the surface of the cervix.
Which of the following components of the PLISSIT model would best describe instructing a couple on the use of water-soluble lubrication for dyspareunia caused by vaginal dryness?
A) Permission giving
B) Limited information
C) Specific suggestions
D) Intensive therapy
Specific suggestions
The PLISSIT model (P = permission giving, LI = limited information, SS = specific suggestions, IT = intensive therapy) may be used by clinicians who are not sex therapists when counseling patients with sexual dysfunction. Instructing a couple on the use of water-soluble lubrication for dyspareunia caused by vagina dryness constitutes a specific suggestion.
The most common benign neoplasm of the cervix is:
A) Bartholin’s gland cyst.
B) squamous papilloma.
C) pedunculated myoma.
D) polyp.
polyp.
Polyps are the most common benign neoplasm of the cervix. They are seen most often in perimenopausal and multigravida women between the ages of 30 and 50 years.
PCOS predisposes women to an increased incidence of:
A) adrenal tumors.
B) endometriosis.
C) endometrial cancer.
D) ovarian cancer.
endometrial cancer.
Women with PCOS are at risk for future development of endometrial cancer related to chronic anovulation and unopposed estrogen.
Disorders of pelvic support may be associated with all of the following except:
A) obesity.
B) neuromuscular injury during childbirth.
C) pelvic surgery.
D) frequent UTIs.
frequent UTIs.
Disorders of pelvic support result from weakness in supporting structures that include the pelvic diaphragm, ligaments, and fascia. Causes include neuromuscular injury at childbirth, which results in denervation injury of the muscular floor, as well as conditions that cause chronic increase in abdominal pressure—obesity, straining, chronic lung disease (coughing); nerve function altered by diabetes, pelvic surgery, neurologic disorders; and hypoestrogenism.
Leiomyomata arising from tissue within the uterine wall are described as:
A) interstitial.
B) pedunculated.
C) subserosal.
D) submucosal.
interstitial.
Leiomyomata can be found in different areas within and around the uterine cavity and surrounding ligaments. Submucosal myomas protrude into the uterine cavity. Subserosal myomas bulge through the outer uterine wall. Intraligamentous myomas are found within the broad ligament. Interstitial (intramural) myomas stay within the uterine wall; they are the most common form of myoma. Pedunculated myomas are found on a thin pedicle or stalk attached to the uterus.
Leiomyomata=fibroid
Another name for a dermoid cyst is:
A) benign cystic teratoma.
B) follicular cyst.
C) hyperplastic endometrioma.
D) Müllerian cyst.
benign cystic teratoma.
A dermoid cyst is also known as a benign cystic teratoma. It is the most common ovarian germ cell tumor.
A 16-year-old patient comes to the office because she has never had a menstrual period. She has normal breast development, scant pubic hair, and a blind vaginal pouch with no palpable uterus or ovaries. The most likely diagnosis is:
A) androgen insensitivity/resistance syndrome.
B) Müllerian agenesis.
C) Sheehan’s syndrome.
D) Turner’s syndrome.
androgen insensitivity/resistance syndrome.
Androgen insensitivity/resistance syndrome is a genetically transmitted androgen receptor defect. The individual is a genotypic male (46XY) but a phenotypic female or has both female and male characteristics. The individual has normally developed breasts with small nipples and areola, scanty or absent pubic hair, a blind vaginal pouch, and no uterus or ovaries. Testes are present and may be partially descended or intra-abdominal.
Characteristics of Turner’s syndrome include:
A) uterus absent, ovaries absent.
B) uterus absent, ovaries present.
C) uterus present, ovaries absent.
D) uterus present, ovaries present.
uterus present, ovaries absent.
Physical characteristics found in persons with Turner’s syndrome include lack of breast development, scant pubic hair, normal uterus and vagina, absent or streak ovaries, short stature, webbed neck, and shield chest with widely spaced nipples. Cardiac and renal anomalies may also be present.
Which of the following contraceptive methods has also been FDA approved for treatment of endometriosis?
A) Combination oral contraceptive pills
B) Levonorgestrel IUS
C) Progestin-only contraceptive pills
D) Subcutaneous 104 DMPA
Subcutaneous 104 DMPA
Subcutaneous 104 DMPA is an FDA-approved medication for treatment of endometriosis. Other medical management includes analgesics (NSAIDs are the first choice), GnRH agonists, and danazol to induce regression of endometrial implants; IM DMPA has also been found to be effective.
With which of the following conditions would you expect to see a positive progestin challenge test?
A) Androgen insensitivity syndrome
B) Asherman’s syndrome
C) PCOS
D) Turner’s syndrome
PCOS
A positive progestin challenge test indicates the woman who is not having menses has adequate production of estrogen, is able to develop a proliferative endometrium, and has an unobstructed outflow tract.
Primary dysmenorrhea can best be treated with:
A) dopamine agonists.
B) GnRH agonists.
C) prostaglandin inhibitors.
D) tricyclic antidepressants.
prostaglandin inhibitors.
Prostaglandin synthetase inhibitors, which are NSAIDs, are the treatment of choice for primary dysmenorrhea. They work best if they are begun at the onset of menses and are continued for 48 to 72 hours. Agents shown to be effective include mefenamic acid, naproxen sodium, ibuprofen, and indomethacin.
Treatment of molluscum contagiosum includes:
A) azithromycin 1 g orally in a single dose.
B) erythromycin base 500 mg orally four times a day for 21 days.
C) trichloroacetic or bichloroacetic acid (80% to 90% solution).
D) cryotherapy with liquid nitrogen.
cryotherapy with liquid nitrogen.
Molluscum contagiosum usually resolves spontaneously without scarring. Treatment options include superficial incision, expressing contents with a comedo extractor, curettage with cautery, and cryotherapy with liquid nitrogen (most often used if the patient has multiple lesions).
Molluscum contagiosum: virus with multiple lesions that are dome-shaped, round, and pinkish-purple in color.
Which of the following statements concerning herpes genitalis is true?
A) Suppressive therapy does not reduce viral shedding.
B) Systemic symptoms are uncommon during recurrences.
C) Topical acyclovir is as effective as oral acyclovir for recurrences.
D) Transmission of the virus is unlikely to occur during the prodromal phase.
Systemic symptoms are uncommon during recurrences.
A recurrent genital herpes infection usually takes a milder course and does not present with systemic symptoms such as fever, malaise, and headache.
A 66-year-old woman with a history of pruritus presents with an ulceration of the vulva. The most likely diagnosis is:
A) chancroid.
B) secondary trauma.
C) syphilis.
D) vulvar carcinoma.
vulvar carcinoma.
The most common signs and symptoms of vulvar carcinoma include pruritus (most common); pain; burning; bleeding lesions that may be darkly or irregularly pigmented, white or red, multifocal or singular, and flat, wartlike, or scaly; erythematous irritated ulceration; and odorous discharge that may be tinged with blood.
The definitive diagnosis of endometriosis is made with:
A) CT scan.
B) laparoscopy.
C) serum CA-125.
D) transvaginal ultrasound.
laparoscopy.
Direct visualization with laparoscopy or laparotomy reveals classic implants with endometriosis, classified as Stage I—minimal, Stage II—mild, Stage III—moderate, and Stage IV—severe.
A 22-year-old female has a Pap test report of HSIL. Recommended first steps in follow-up would include:
A) colposcopy.
B) co-testing with Pap and HPV tests in 1 year.
C) reflex HPV test now.
D) repeating just the Pap test in 6 months.
colposcopy.
The ASCCP recommendation for follow-up of an HSIL Pap test result in women ages 21 to 24 is colposcopy.
A 24-year-old woman presents with a complaint of a nontender mass in her left breast that does not change with the menstrual cycle. On examination, you note a freely movable, 0.5 cm × 1 cm, firm, rubbery nontender mass. The most likely diagnosis is:
A) fibroadenoma.
B) fibrocystic breast changes.
C) intraductal papilloma.
D) cystosarcoma phyllodes.
fibroadenoma.
Fibroadenomas are firm, well-delineated, freely movable, smooth, rubbery, round, typically marble-sized, nontender masses. They usually occur on a unilateral basis.
A 26-year-old woman presents with multiple, painless, umbilicated papules on her mons pubis. The most likely diagnosis is:
A) condyloma acuminata.
B) condyloma lata.
C) lymphogranuloma venereum.
D) molluscum contagiosum.
molluscum contagiosum.
Molluscum contagiosum presents with characteristic light-colored papules with umbilicated centers on the trunk, lower extremities, abdomen, inner thigh, or genital area.
PMS is suspected when a woman experiences symptoms only during:
A) ovulation.
B) the luteal phase.
C) the LH surge.
D) the follicular phase.
the luteal phase.
PMS is the cyclic occurrence of a group of distressing physical and psychological symptoms in the luteal phase that begins about 5 to 7 days before menses and resolves within about 4 days after onset of menses.
Recommendations for repeat testing after treatment for chlamydia with doxycycline include:
A) test of cure 1 to 2 weeks after treatment if non-adherence is suspected.
B) test of cure 3 to 4 weeks after treatment for all patients.
C) test for possible reinfection 1 month after treatment.
D) test for possible reinfection 3 months after treatment.
test for possible reinfection 3 months after treatment.
A test of cure is not recommended for nonpregnant women after treatment for chlamydia with a CDC-recommended regimen. A majority of post-treatment infections are reinfection. The CDC recommends retesting the patient 3 months after treatment ends.
Characteristic “strawberry spots” on the cervix may be seen with:
A) BV.
B) chlamydia.
C) herpes genitalis.
D) trichomoniasis.
trichomoniasis.
A classic (although not always present) examination finding with trichomoniasis is punctate red lesions on the cervix often called strawberry spots.
