Care of Women

Question 1

What are the gynecologic history components of the comprehensive reproductive health visit?

Answer 1

1) Menstrual
2) Obstetric
3) Contraceptive
4) Sexual
5) STI/STD
6) Cervical cytology
7) Procedures

Question 2

What are the physical exam components of the comprehensive reproductive health visit?

Answer 2

1) Thyroid
2) Breast
3) Abdomen
4) External pelvic
5) Pap smear and/or cultures as indicated
6) Bimanual vaginal exam
7) Digital rectal exam, as indicated

Question 3

Risk factors that warrant screening in the sexually active female:

Answer 3

1) Sex at early age
2) Three or more lifetime partners
3) Partner change since last exam
4) Hx of STD or STI
5) Male sexual partner that has other partners
6) Condyloma/HPV present
7) HIV or other disorders of immune deficiency

Question 4

When is a pelvic exam necessary?

Answer 4

1) Age 21
2) Women with symptoms (pain, discharge, bleeding)
3) Pregnancy
4) Infertility evaluation

Question 5

When is a pelvic exam NOT necessary?

Answer 5

1) Before age 21
2) To initiate birth control
3) To screen for STI in women with no symptoms

Question 6

Lymphadenopathy is often present with what common STI?

Answer 6

Herpes

Question 7

Order of the specimens:

Answer 7

1) DNA probe for STD/STI (gonorrhea, chlamydia, HSV)
2) Pap
3) Cultures (GBS)
4) Wet mount (BV, VVC, trich)

Question 8

What is the normal menstrual cycle?

Answer 8

21-35 days (average is 25-30)

Question 9

What is the average duration of menses?

Answer 9

3-8 days

Question 10

What is the average amount of blood loss during menses?

Answer 10

40-80 ml

Question 11

What do you call prolonged or excessive uterine bleeding at irregular, noncyclic intervals?

Answer 11

Menometrorrhagia

Question 12

What do you call bleeding of variable amounts between regular cycles?

Answer 12

Intermenstrual bleeding or “breakthrough” bleeding

Question 13

What day is considered Day 1 of the menstrual cycle?

Answer 13

The first day of bleeding

Question 14

Pap screening guidelines:

Answer 14

1) At age 21
2) 21-30 screen every three years
3) After 30, Pap and HPV every 5 years (if both normal
4) No Pap after hysterectomy (if no cervix and no CA)
5) If cervix present then Pap until 65
6) Follow regardless of HPV vaccine

Question 15

What is the most common complaint necessitating a gynecologic exam?

Answer 15

Discharge

Question 16

What are some of the common diagnoses linked to different types of discharge?

Answer 16

1) BV: profuse, grey-white, homogenous
2) Trich: profuse, watery, white, green or yellow, frothy
3) Candida: cheesy or clumpy white
4) Physiologic: white to clear, no odor, no itching, changes with cycle

Question 17

Signs and symptoms of trichomoniasis:

Answer 17

Positive whiff when KOH added
pH > 5.0
Mobile, flagellated protozoans
Strawberry cervix
Frothy discharge

Question 18

Signs and symptoms of BV:

Answer 18

Positive whiff when KOH added
pH > 5.0
Clue cells (fried egg with pepper)
Milky discharge

Question 19

Signs and symptoms of candida:

Answer 19

pH about 4.5
Hyphae and spores (spaghetti and meatballs)
Thick cheesy discharge

Question 20

Signs and symptoms of herpes:

Answer 20

Painful ulcerations
Oozing lesions that crust over
Diagnosis by clinical exam

Question 21

What two levels are elevated in 90% of UTI?

Answer 21

1) Leukocyte esterase

2) Nitrites

Question 22

Under what conditions should a urine culture be obtained?

Answer 22

1) Fever
2) Acute illness
3) Hx of frequent UTI
4) Failed therapy
5) Pregnancy