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Flashcards in Womens health Deck (192):
1

What T score reflects a patient who has osteopenia?

Between -1.0 and -2.5

2

What T-score reflects a patient with osteoporosis?

-2.5 or less

3

When and what test screens for osteoporosis?

Age 65, DXA scan and if negative, repeat in 2-5 years. If positive, then repeat in 1-2 years.

4

What tanner stage does breast development (breast buds) start?

Tanner stage II
It ends at stage V

5

At what age do you start Pap smear?

21 years old and repeat every 3 years

6

When is Pap smear and HPV co testing started?

Age 30 through 65 and repeat every 5 years.

7

What is normal vaginal pH?

4.0-4.5

8

What medication treats BV?

Metronidazole (Flagyl) BID for 7 days

9

Strawberry cervix is indicative of?

Trichomonas

10

What medication treats trichomonas?

Metronidazole (Flagyl) 2g POx 1 dose or 500mg BID for 7 days

11

What is dyspareunia?

Pain during intercourse

12

A disease of the skin in which white spots appear on the skin and change over time. This is usually found in the vaginal area.

Linchen sclerosis

13

Sexually active female who has not had a period in 6 to 7 weeks complains of lower abdominal/pelvic pain or cramping. Pain worsens when supine or with jarring. If ruptured, pain worsens and can be referred to the right shoulder. Medical history of pelvic inflammatory disease, tubal ligation, or previous a topic pregnancy. Leading cause of death for women in the US in the first trimester of pregnancy.

Ectopic pregnancy

14

Middle aged to older female with a dominant mass on one breast that feels hard and is irregular in shape. The mass is attached to the skin, surrounding breast tissue or is immobile. Among the most common locations are the upper outer quadrant of the breast i.e. the tail of Spence. Skin changes maybe seen such as Peau d’orange, dimpling, and retraction. Mass is painless or maybe accompanied by serous or bloody discharge. The nipple may be displaced or become fixed.

Dominant breast mass/breast cancer

15

Older female reports a history of chronic scaly red colored rash resembling eczema on the nipple that does not heal. Some women complaining of itching. The skin lesion slowly enlarges and evolves to include crusting, alteration, and or bleeding on the nipple.

Paget’s Disease of the breast (ductal carcinoma in situ)

16

Recent or acute onset of red, swollen, and warm area in the breast of a younger woman. Can mimic mastitis. Often there is no distinct lump on the affected breast. Symptoms develop quickly. The skin maybe pitted or appear bruised. More common and African-Americans. A rare but very aggressive form of breast cancer.

Inflammatory breast cancer

17

Older woman with complaints of vague symptoms such as abdominal bloating and discomfort, low back pain, pelvic pain, urinary frequency, and constipation. By the time it is diagnosed, the cancer has already metastasized. If metastasis, symptoms depend on area affected. Symptoms maybe bone pain, abdominal pain, headache, blurred vision, others.

Ovarian cancer

18

In what Tanner are stage does breast development start

Tanner stage two and ends at stage five

19

Where is the majority of breast cancer located

The upper outer quadrant of the breasts called the tail of Spence

20

What is the diagnostic test for breast cancer

Tissue biopsy

21

Is a cervical ectropion benign

Yes. Adolescence have a large ectropion which is an immature cervix

22

Patients with what condition have high androgen levels and multiple cysts on their ovaries which causes acne, hirsutism, and ogliomenorrhea

PCOS

23

What is the diagnostic test for cervical cancer

Biopsy of the cervix

24

When is the best time to perform a Pap test

Between 10 and 20 days after the last Menses

25

What should the patient avoid about two days before the pap test

Douching and vaginal foams/medication

26

When should a baseline Pap smear be done

Age 21 and repeat every three years

27

If a patient age to 20 or younger had an abnormal Pap smear of undetermined significance when should the pap be repeated

12 months

28

If the patient has an abnormal Pap of undetermined significance that is 21 years or older what should be done next

Order Pap smear with reflex HPVDNA testing. If Pap is abnormal, HPV strain testing is done automatically by the lab.

29

What types of HPV are oncogenic

Types 16 and 18. Referral for colposcopy and cervical biopsy

30

If A patient Pap smear had atypical glandular cells of undetermined significance what should be done next

Refer for endometrial biopsy

31

If a patient’s Pap results was a low-grade squamous intraepithelial lesion and high grade squamous epithelium lesion what should be done next

HPV Testing and refer for Colposcopy and biopsy

32

What are the two FDA approved vaccines that are very effective in preventing persistent infection with the oncogenic HPV strain

Gardasil & Cervarix

33

What is used to help with a diagnosis of fungal infection of the hair skin and nails

Potassium hydroxide slide

34

A test for BV. A positive result occurs when a strong fishlike owner is released after 1 to 2 drops of KOH are added to the slide

Whiff test

35

Used as an adjunct for evaluating herpatic infections i.e. oral, genital, skin. A positive smear will show large amounts of abnormal nuclei in the squamous epithelium cells not commonly used

Tzanck smear

36

What type of birth control pills are used for acne

Triphasic pills such as ortho Tri-Cyclen

37

What type of birth control pill is safe for breast-feeding women

Progesterone only pills. Use on day one of menstrual cycle.
Micronor

38

What are absolute contraindications to birth-control pills

Any condition that increases the risk of blood clotting such as history of thrombophlebitis or thromboembolic disorders such as DVT, genetic coagulation defects such as factor V Leiden disease, major surgery with prolonged immobilization, smoker over the age of 35. Any condition that increases the risk of strokes such as headaches with focal neurological symptoms, history of CVA and TIA, hypertension, migraine headache with aura. Inflammation and or acute infections of the liver with elevated liver function test, and hepatic adenomas or carcinoma, cholestatic jaundice of pregnancy. Known or suspected cardiovascular disease such as coronary artery disease, diabetes with vascular component. Some reproductive condition or cancers, known or suspected pregnancy, undiagnosed genital bleeding, breast, real, or ovarian cancer.

39

Mnuemonic for absolute contraindications for oral contraceptives

My CUPLETS
My: migraines with aura
C: CAD or CVA
U: undiagnosed genital bleeding
P: pregnant or suspect pregnancy 🤰
L: liver tumor or active liver disease
E: estrogen dependent tumor
T: thrombus or emboli
S: smoker age 35 or older

40

Advantages of oral contraceptives and after five or more years of use

Decreased incidence of dysmenorrhea and cramps, PID, iron deficiency anemia, acne and hirsutism, ovarian cyst, heavy and or
Irregular period.

41

Before starting oral contraceptives what must be ruled out

Pregnancy

42

All patients must be instructed to use what during the first two weeks after starting the pill

Back up condoms

43

Does a patient that takes an oral contraceptive need to follow up

Yes within 2 to 3 months to check blood pressure and for side effects and patients questions

44

How do you treat menstrual cramps

NSAIDs such as Alleve, naprosyn

45

What are possible causes of secondary dysmenorrhea

Endometriosis, PID, fibroids

46

What constitutes primary amenorrhea

Absence of menses by age 15, often secondary to dysfunction of the hypothalamus, pituitary, ovaries, uterus, or vagina. Refer to reproductive endocrinology.

47

What are the variables of secondary dysmenorrhea

Onset usually after age 25, abnormal uterine bleeding and, variable symptoms such as nausea, Vomiting, diarrhea, and back pain. Dyspareunia (pain during intercourse), symptoms often worsen over time. Causes are endometriosis, fibroids, PID or infection, adenomyosis

48

How do you manage dysmenorrhea

Get a good history both medical and menstrual. Physical exam to identify a cause. Pelvic exam may differ if young, not sexually active adolescents with mild symptoms. Consider a pelvic ultrasound to look for adnexal masses, fibroids, other pelvic pathology. If secondary, address underlying cause

49

Can intrauterine contraception help with dysmenorrhea symptoms

Yes

50

How long does Mirena last

Five years

51

How long does Skyla last

3 years because skyla=smaller

52

If a patient comes in with abnormal uterine bleeding and how is this constituted

Any bleeding beyond 12 months since last menstrual period in a post menopausal woman. Even one drop of blood is concerning. Referred to OB/GYN to rule out cancer

53

How do you define a post menopausal woman

A woman that did not have her period for more than one year

54

What is the mnuemonic for abnormal uterine bleeding

P: polyps greater than 30 years
A: adenomyosis greater than 30 years
L: leiomyoma/fibroids greater than 30 years
M: malignancy/hyperplasia greater than 40 years, obesity, DM, PCOS greater than 50 years
C: coagulopathy any age
O: ovulatory dysfunction any age
E: endometrial disorders any age
I: iatrogenic medications any age
N: not classified

55

If a patient misses one day of birth control what must They do next

Take two pills for the next two days to catch up and finish the birth control pill pack. Use condoms for the current pill cycle.

56

What should a patient do if they miss two consecutive days of birth control

Take two pills the next two days to catch up and finish the birth control pill pack. Use condoms for the current pill cycle.

57

What drugs interact with oral contraceptives and will cause the patient to use an alternative form of birth control such as condoms when taking these drugs and for one pill cycle afterwards

Anticonvulsants such as phenobarbital and phenytoin, antifungal, certain antibiotics such as ampicillin, tetracycline, and rifampin. Saint Johns wort which may cause a breakthrough bleeding

58

When should emergency contraception such as the morning after pill be taken

Most effective if taken within the first 24 hours. Rule out pre-existing pregnancy first. Effective up to 72 hours after unprotected sex.

59

what is the mnuemonic for pill danger signs

ACHES
A: abdominal pain
C: chest pain
H: headache
E: eye problems change in vision
S: severe leg pain

60

What type of contraception results in higher levels of estrogen which increases the risk of blood clots and DVT

Contraceptive patch i.e. Ortho Evra

61

What are contraindications for intrauterine device

Active PID or history of PID within the last year, suspected or with STD or pregnant, uterine or cervical abnormality, undiagnosed vaginal bleeding or uterine/cervical cancer, history of ectopic pregnancy

62

How long does a dose of Depo-Provera last

Each dose by injection lasts three months. Check for pregnancy before starting dose. Start in first five days of cycle because females are less likely to ovulate at these times. Women on Depo-Provera for at least one year or longer will have amenorrhea because of severe uterine atrophy from lack of estrogen. Do not recommend to women who want to become pregnant within 12 to 18 months. Causes the late return to fertility. It takes up to one year from most women to start ovulating.

63

What is the black box warning for Depo-Provera

Avoid long term use i.e. more than two years. Increases risk of osteopenia/osteoporosis that may not be fully reversible. Using Depo-Provera for more than two years is discouraged.

64

What contraceptive should be avoided in anorexia nervosa patients

Avoid using Depo-Provera in this population because it will further increase their risk of osteopenia/osteoporosis. Recommend calcium with vitamin D and weight-bearing exercises for patients on this medication. Consider testing for osteopenia/osteoporosis using a DXA scan

65

What are the rules for using a diaphragm with contraceptive gel and cervical cap

The diaphragm must be used with spermicidal gel. After intercourse leave diaphragm inside vagina for at least 6 to 8 hours. Can remain inside vagina for up to 24 hours. Need additional spermicide before every act of intercourse.

66

Patients that use diaphragm are at Increased risk of

UTIs and toxic shock syndrome

67

Monthly hormonal cycle induces breast tissue to become engorged and painful. Symptoms occur two weeks before the onset of menses and are at their worst right before the menstrual cycle. Resolves after menses start. Commonly starts in women in their 30s.

Fibrocystic breast

68

Adults to middle aged woman complains of the cyclic onset of bilateral breast tenderness and breast lumps that start from a few days before her period For many years. Once menstruation starts, the tenderness disappears and the size of the breast lumps decrease. During breast examination, the breast lumps are tender and feel rubbery, and are mobile to touch. Denies dominant mass, skin changes, nipple discharge, or enlarged nodes

Fibrocystic breast

69

What is the treatment plan for fibrocystic breast

Stop caffeine intake. Vitamin E and evening prime rose capsules daily. Wear bras with good support. Must refer if the patient has a dominant mass, skin changes, or fixed mass

70

What are some risks and complications of PCOS

Endometrial cancer, infertility, diabetes, metabolic syndrome, obesity, cardiovascular disease, and hyperlipidemia.

71

Signs and symptoms include ogliomenorrhea, amenorrhea, hyperandrogenism i.e. acne, hirsutism, cystic ovaries, infertility, mental health issues. Patient Can skip months of period. It takes two years to have a solid, healthy menstrual period established. These patients need to have babies earlier in life.

PCOS

72

Insulin resistance is the pathophysiology of

PCOS

73

How do you diagnose polycystic ovarian syndrome

Rotterdam criteria which is two of three:
Oligomenorrhea
Hyperandrogenism
Cystic ovaries

74

Complications associated with PCOS include

Uterine/endometrial cancer, diabetes, cardiovascular disease, infertility

75

Acne, hirsutism, alopecia, acanthosis nigricans, amenorrhea, oligomenorrhea, infertility, hyperinsulinemia and mood disorders in adults are all symptoms of

PCOS

76

What is the PCOS diagnostic work up and differential

Bodyweight, BMI greater than 30, waste greater than 35 inches, blood pressure, ultrasound of ovaries/uterus hyperplasia greater than 10 mm, CBC, lipid’s low HDL, high trigs/LDL, LFTs, TSH, oral glucose tolerance hemoglobin A-1 C DM=>6.4 at risk => or equal to 5.6-6.4, total testosterone for PCOS =>60, tumor > 200, free T for PCOS = 2-3, pregnancy 🤰 test hcg, prolactin 3-27ng/ml consider DHEA-S, LH/FSH ratio >3, but may be normal in PCOS

77

How do you manage a patient with PCOS

Discuss fertility planning, FastTrack fertility, letrozole preferred, not clomid,

78

What are problems associated with PCOS

Infertility and 40% of females, spontaneous abortion, gestational diabetes, preeclampsia/hypertension

79

What are lifestyle modifications for PCOS patients

Weight loss greater than 5%, exercise and stress reduction

80

If a patient with PCOS does not desire pregnancy how are they managed

Combination hormonal contraceptives, low androgen progestins are safer i.e. Levonorgestrel, Norethindrone, Norgestimate which helps androgen symptoms and prevents uterine cancer. Metformin

81

For most women HPV clears spontaneously within how many months if the patient is less than 24 years old

8 to 24 months

82

How is cervical cancer develops

Persistent HPV infection over many years

83

What are high-risk subtypes for cervical cancer

16, 18, 45, 31, 33, 52, 58, 35

84

When should HPV vaccination be given

Give prior to onset of sexual activity i.e. coitarche. This is the age of first penile vaginal sex. Give routinely at 9 to 12 years for boys and girls in three injections spaced out at the first month, then second month, then six months.If Series is incomplete, finished with new vaccine. May benefit if greater than 26 years old but no recommendations yet

85

What are the screening guidelines for cervical cancer screening for ages 21 to 29

First Pap at age 21 and repeat every three years up to age 30

86

What are the screening guidelines for cervical cancer screening age greater than 30

Pap and HPV is the primary screening. Repeat every five years if both negative. Pap only every three years.

87

What is the cervical cancer screening guidelines for age 65 and over

May stop if negative history times 10 years

88

What are the cervical cancer screening guidelines after a hysterectomy

For benign disease it can be discontinued. If not benign, three annual negative tests then discontinue ACS. Ongoing screening for 20 years even if older than 65

89

What are the guidelines for ASC (atypical squamous cells) for ages 21-24

Watch and wait. Repeat pap at 12 mos. if negative, routine screening. If positive then refer for colposcopy.

90

What are the guidelines of ASC-US age over 24

Reflex HPV and if positive refer for colposcopy

91

What are the guidelines if a patient is found to have ASC-H

Colposcopy for all

92

What are risk factors for bacterial vaginosis

New sexual partner, not using condoms, douching, copper are you see which can throw off the vaginal flora

93

Itching, burning, dysuria, vaginal pH of 4.0 to 4.6, negative with test, and buds and pseudohyphae on KOH

VV Candidiasis

94

Malodorous discharge, pH of the vagina is greater than 4.6 with a positive whiff test

BV

95

Malodorous discharge, dysuria, vaginal pH of 5.0 to 6.0, positive or negative with test

Trich

96

If a patient has recurrent used infections what should they be screened for

Diabetes, pregnancy test, HIV

97

If a patient is on Diflucan or vaginal medication, what must they do for precaution

Delay sexual intercourse until symptoms improve

98

What treatment for Vulvovaginal candidiasis relieve symptoms most rapidly

Topical antifungal

99

What is a male yeast infection

Balanitis

100

If a patient is on an antibiotic and is prone to yeast infections what should be recommended

daily yogurt or lactobacillus pills

101

Does a sexual partner need to be treated for BV

No because it’s not a sexually transmitted disease

102

What population with BV are at a higher risk for injury uterine infection and premature labor

Pregnant women

103

If a what’s near shows clue cells and very few white blood cells what must be considered

BV

104

What is the normal vaginal pH

4.0 to 4.5

105

What is considered an alkaline vaginal pH

Greater than 4.5

106

How do you treat BV

Flagyl or metronidazole b.i.d. for seven days. Do not drink alcohol while on this medication. Abstain from sexual intercourse until treatment is done

107

Uni cellular protozoan parasite with flagella that infects genitourinary tissue in both males and females. Infection causes inflammation, itching, burning of the vagina/urethra

Trichomonas

108

Adult female complains of very pruitic, reddened Vulvovaginal vaginal area. May complain of dysuria. Copious grayish green and bubbly vaginal discharge. Most males and sex partners may have symptoms urethritis or maybe asymptomatic

Trichomonas

109

When strawberry cervix is found from small points of bleeding on cervical surface with a swollen and vulvar and vaginal area with a vaginal pH of greater than 5.0 what must be considered

Trichomonas

110

Microscopic shows mobile Uni cellular organisms with flagella and large amount of white blood cells

Trichomonas

111

How do you treat trichomonas

Flagyl or metronidazole to grams PO or 500 mg b.i.d. for seven days. Treat sexual partner. Avoid sex until both partners complete treatment.

112

This occurs in postmenopausal women and they show nonspecific signs and symptoms such as watery, yellow or white, malodorous vaginal discharge

Atrophic vaginitis

113

Vaginal irritation or burning, dyspareunia or pain with intercourse, urinary tract symptoms, thinning of vaginal epithelium, loss of elasticity, loss of Rugae, vaginal pH greater than or equal to five is consistent with

Atrophic vaginitis

114

What is the treatment for atrophic vaginitis

Estrogen PV, Osphena as an alternative to estrogen, DHEA PV

115

A 60-year-old woman has begun to have a small amount of blood escaping from the vagina. What is the most common cause of malignancy when is One found?

Endometrial cancer

116

Atrophic vaginitis occurs due to

Lack of estrogen and estrogen dependent tissue of the urogenital tract and results in atrophic changes in the vulva and vagina of menopausal women.

117

Disease of low bone mass with micro architectural disruption

Osteoporosis

118

What are risk factors for osteoporosis

Caucasian/Asian, family history, advanced age, previous fracture, long-term glucocorticoid therapy, low bodyweight less than 127 pounds, cigarette smoking, excess alcohol and

119

What is a T score reflects osteoporosis

-2.5 or less

120

What is a T score that reflects osteopenia

Between -1.0 & -2.5

121

How do you screen for osteoporosis and at what age

Screening starts at age 65 and the screening choice is a DEXA scan. Screening that recommended pre-menopause unless risk factors present

122

How do you manage osteoporosis

Weight bearing exercise, stop cigarette smoking, stop excess alcohol, avoid cortical steroids and anti-convulsant is one possible, take calcium daily at 1200 mg a day plus if vitamin D deficient replace with vitamin D3. The preferred calcium choice is food

123

What medications can be prescribed for osteoporosis

Oral by phosphonate’s are considered first line for most patients because they inhibit bone resolution and it remains active in the bone for weeks, months and maybe years. It also increases bone mass and reduces risk of fracture.
Alendronate (Fosamax) weekly
Risendronate (Actonel) weekly
Ibandronate (Bonita) monthly. Does not avoid hip fracture risk
These medications need to be taken for 5 years to prevent fracture.

124

What are the most common breast masses

Fibroadenomas and cysts. Benign complaints can mimic breast cancer. Refer to breast specialist

125

What are the diagnostic studies for breast masses

Ultrasound for any female/male less than 30 years, with focal mass or symptom. First line in pregnancy or less than 30 years. To assess mass identified on mammogram

126

What is a diagnostic test for any female or male greater than 30 with a breast complaint

Mammogram

127

What is the value of a breast ultrasound

Differentiates fluid filled cyst from solid mass

128

85% of breast cancer occurs in women that are what age

Greater than 50 years

129

What are risk factors for breast cancer

Gender and age especially greater than 65 years, genetic predisposition BRCA one, to genetic mutation, obesity, family history, reproductive history of low parity, estrogen exposure with early menarche less than 12 years, late menopause greater than 55 years, estrogen medications

130

What is screening for average risk patients for breast cancer

Mammogram start at age 45. May begin aged 40-44. Then yearly. At age 55+, screen every 2 years. Yearly screening may be offered. Clinical and self breast exam not recommended

131

What is a great option for contraception for all ages with fewer contra indications

Long acting reversible contraceptives such as ParaGard, Mirena, Skyla

132

Patients with gastric bypass, celiac disease, hyperthyroidism, ankylosing spondylitis, rheumatoid arthritis and others are at risk for

Osteoporosis

133

Low calcium intake, vitamin D deficiency, in adequate physical activity, alcoholic, high caffeine intake, and smoking are lifestyle risk factors for

Osteoporosis

134

When should a DEXA scan be repeated

You do a baseline scan and repeat in 1 to 2 years if on a treatment regimen in order to assess the efficacy of the medication. It’s not on treatment, repeat DEXA into 2-five years

135

What can biphosphonates cause as an adverse reaction

Esophagitis, esophageal perforation, gastric ulcers, reactivation/bleeding peptic ulcer disease. Patients need to report sore throat, dysphasia, or Midsternal pain immediately

136

When is the best time to take a biphosphonate

Take immediately upon awakening in the morning with a full glass of plain water. Take tablet sitting or standing and wait at least 30 minutes before laying down. Do not crash, split, or two tablets. Swallow the tablets whole. Never take these drugs with other medications such as juice, coffee, antacids, vitamins.

137

what are contraindications for biphosphonates

Inability to sit upright, esophageal motility disorder’s, history of peptic ulcer disease or history of gastrointestinal bleeding

138

If I doses of biphosphonate are given what can happen

Osteonecrosis of the jaw more likely if on IM dose. Watch for complaints of Jaw heaviness, pain, swelling, and loose teeth

139

Estrogen replacement therapy increases the risk of

Heart disease, DVT, breast and endometrial cancer

140

What type of birth control pill contains iron during the last seven days of the pill cycle instead of a placebo pill

Loestrin FE

141

Low-dose birth-control pills contain how much of ethinyl estradiol

20-25 mcg

142

What type of birth control pill is indicated for the treatment of acne

Desogen ortho-tricyclin and Yaz

143

What type of birth control needs to be avoided in anorexic or bulimic patience because of a very high-risk of osteoporosis

Depo-Provera

144

Women taking Seasonale will have how many periods per year

Four

145

What is considered a relative contraindication of birth control

Migraine

146

What is considered an absolute contraindication of birth control

A history of a blood clot that resolved

147

Squamous epithelium cells that have blurred edges due to the number of bacteria on the cell surface is consistent with what

Clue cells in BV

148

If an ovary is palpable but must be ordered

Intravaginal ultrasound

149

If a patient has a hard irregular mass that is not mobile on the breast what must be for what must be ruled out

Breast cancer

150

Which NSAID is effective for menstrual pain

Mefenamic acid (ponstel)

151

What type of medication can elevate total T4 levels and triglycerides/lipids

Birth control pills

152

What is not the best birth control method for a woman who wants to become pregnant in 12 to 18 months

Depo-Provera

153

In reproductive aged teens and women who present with acute pelvic pain or Lower abdominal pain what test must always be performed

Pregnancy test

154

A 28 year-old female presents with a slightly tender 1.5 cm lump in her right breast. She noticed it 2 today’s ago. She has no associated lymphadenopathy and there is no nipple discharge. How should she be managed

Re-examination after her next menses

155

A patient asks the NPs advice about an herb to help with her hot flashes. The NP knows that these

May be a contraindication in patients with a history of breast cancer

156

A 22-year-old female has been diagnosed with PCOS. What is a common finding

Elevated insulin levels

157

A 22-year-old female states that she has multiple sexual partners and in consistently uses barrier protection. Which form of birth control should the nurse practitioner avoid prescribing in this patient

Intrauterine device because when a patient has multiple sexual partners they are at an increased risk for PID

158

What hormone increases during menopause

Follicle-stimulating hormone

159

A female should be told to take her oral contraceptive pill at bedtime if she experiences

Nausea

160

A patient who takes oral contraceptive pills is at an increased risk of

Gallbladder disease

161

Hot flashes that occurred during menopause are thought to be related to

Fluctuating estrogen levels

162

Does ovarian cancer present with postmenopausal bleeding

No

163

At what age are Pap smears discontinued in women

After the age of 65

164

What is the diagnostic test of choice to differentiate a solid from a fluid filled breast mass

Ultrasound

165

To palpate an indirect inguinal hernia in a woman, have her stand and palpate in the labia majora and

Palpate upward to just lateral to the pubic tubercle’s

166

The most common causes of sexual problems in females are related to

Psychosocial factors

167

When performing a vaginal exam with a speculum, the use of the upper blade as of a tractor could expose a

Rectocele

168

Upon examination of the cervix, and an irregular Cauliflower like growth was noted around the cervical os.This finding is most suggestive of

Carcinoma of the cervix

169

A female patient presents with a profuse, yellowish, green discharge that is malodorous. The vaginal discharge is most consistent with

Trichomonas

170

If urethritis or inflammation of the para urethral glands is expected in a female patient, the index finger should be inserted into the vagina and

Milk the urethra gently from the inside outward

171

Upon examination of the vagina, a small, red, benign tumor is noted at the posterior part of the urethral meatus. This finding is consistent with a

Urethral caruncle

172

Upon examination of the vagina, the entire anterior vaginal wall, together with the bladder and urethra create a bulge. This condition is most consistent with a

Cystourethrocele

173

Chronic pelvic pain refers to pain that does not respond to therapy and lasts more than how many months

Six months

174

When examining the cervix, a translucent nodule is noted on the cervical surface. This finding is consistent with

A retention cyst

175

When performing a rectal exam on a female, a hard nodular rectal shelf is palpable at the tip of the examiners finger. This finding is suggestive of

Metastatic tissue in the rectouterine pouch

176

Examination of a female patients right breast reveals a retraction of the nipple and areola. This finding is consistent with

Breast cancer

177

If performed correctly and in a timely fashion, what is the most it definitive for the diagnosis of breast cancer. Diagnostic test

Breast tissue sample

178

The vaginal mucosa lies in transverse folds called the

Rugae

179

When performing a vaginal exam with a speculum, the use of the lower blade as a retractor during bearing down could expose an anterior wall defect such as a

Cystocele

180

Can a female diagnosed with a 2nd° uterine prolapse, the cervix is located

In the introit us

181

Retraction of the nipple and areola suggest

An underlying breast mass

182

Postcoital bleeding suggests

Cervical cancer

183

The deep red area located around the cervical os is known as

The columnnar epithelium

184

Uterine enlargement may suggest

Pregnancy, uterine myoma’s or fibroids, or malignancy

185

The most common type of hernia in a woman is the

Indirect inguinal hernia

186

A 22-year-old patient has a single, nontender, freely movable lump in her right breast. She denies any nipple discharge. Which of the following diagnoses is the clinical presentation most consistent with

Fibroadenoma

187

In comparing sensitivity to specificity, sensitivity refers to a

True positive

188

Can a woman taking calcium take it with milk

No

189

Does weight loss reduce osteoporosis risk

No

190

Why is it important that a post menopausal woman with an intact uterus receive combined estrogen – progestin hormone replacement therapy rather than estrogen alone

Prolonged use of unopposed estrogen’s increases the risk of endometrial cancer

191

A 50-year-old patient has abnormal vaginal bleeding with heavy periods and intermenstrual watery discharge with a small amount of blood. What is the most likely diagnosis

Endometrial cancer

192

Hormone replacement therapy is related to an increased risk of

Stroke