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RRPA History and Physical II > Chapter 19 (Exam 3) > Flashcards

Chapter 19 (Exam 3) Flashcards

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1
Q 
Posteriorly, the labia minor meets as two ridges that fuse to form the 
A. Fourchette
B. Vulva
C. Clitoris
D. Perineum
E. Perineal body
A

A. Fourchette

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2
Q 
What structures are located at the 5 o'clock and 7 o'clock positions of the vaginal orifice and open onto the sides of the vestibule in the groove between the labia minor and the hymen?
A. Skene glands
B. Perineal bodies
C. Labia majora
D. Bartholin glands
E. Labia minora
A

D. Bartholin glands

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3
Q 
During sexual excitement, how is the vaginal Introits lubricated?
A. Bartholin glands secrete mucus
B. Clitoris produces moisture
C. Skene glands secrete fluid
D. Urethral surfaces secrete water
E. Hymen secretes mucus
A

A. Bartholin glands secrete mucus

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4
Q 
The opening of the cervix is referred to as the 
A. introitus
B. pouch of Douglas
C. Cervical isthmus 
D. Cervical os
E. Anterior fornix
A

D. Cervical os

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5
Q 
The vaginal mucosa of a woman of childbearing years should appear
A. Transversely rugated
B. Moist and excoriated
C. Dry and papular
D. Smooth and pink
E. Moist with vertical ridges
A

A. Transversely rugated

Between puberty and menopause, the vagina is transversely rugated; after menopause, it loses its rugation.

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6
Q 
The adnexa of the uterus are composed of the 
A. Corpus and cervix
B. Fallopian tubes and ovaries
C. Uterosacral and broad ligaments
D. Round ligaments and ovaries
E. Vagina and fundus
A

B. Fallopian tubes and ovaries

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7
Q 
During ovulation, the cervical mucus becomes more 
A. Scant
B. Bloody
C. Yellow 
D. Stringy
E. Odorous
A

D. Stringy

During ovulation the cervical mucus is increased and is stringy and elastic (spinnbarkeit)

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8
Q 
The pelvic joint that separates most appreciably during late pregnancy is the 
A. Sacroiliac
B. Symphysis pubis
C. Sacrococcygeal
D. Iliofemoral
E. Sacrosciatic notch
A

B. Symphysis pubis

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9
Q 
Pregnancy-related cervical changes include 
A. Flattening and lengthening
B. Thinning and reddening
C. Hardening and pallor
D. Shortening and reddening
E. Softening and bluish coloring
A

E. Softening and bluish coloring

During pregnancy, the cervix softens (Goodell sign) and then appears bluish (Chadwick sign).

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10
Q

The conventional definition of menopause is
A. 3 months with no menses
B. 1 year with no menses
C. 6 months of progressively shorter menses
D. 3 consecutive anovulatory cycles
E. The cessation of ovulation

A

B. 1 year with no menses

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11
Q

Which systemic feature is related to the effects of menopause?
A. Increased intrabdominal fat deposition
B. Decreased LDL levels
C. Cold intolerant
D. Decreased cholesterol levels
E. Decreased risk of cardiovascular disease

A

A. Increased intrabdominal fat deposition

Systemic effects of menopause include increased intraabdominal body fat, increased LDL and cholesterol levels, and hot flashes.

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12
Q 
Which factor is associated with an increased risk of cervical cancer?
A. Endometriosis
B. Low parity
C. HPV vaccination
D. High socioeconomic status
E. Early parity
A

E. Early parity

Women who were younger than 17 years when they had their first full-term pregnancy are almost 2 times more likely to get cervical cancer later in life than women who were not pregnant until they were 25 years or older.

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13
Q 
The risk of ovarian cancer is increased by a history of 
A. Low-fat diet
B. Cigarette smoking
C. Age between 35 and 50
D. Thin body habitus
E. Nulliparity
A

E. nulliparity

There is a relationship between nulliparity and an increased risk of ovarian cancer. Although the risk increases with age, most ovarian cancers develop after menopause; half are found in women older than 63 years. The other choices have no relationship with ovarian cancer.

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14
Q 
The form of gynecologic cancer that is increased in women who have taken tamoxifen is 
A. Vaginal
B. Cervical
C. Ovarian
D. Endometrial
E. Perineal skin
A

D. Endometrial

Tamoxifen is an antiestrogen drug that acts like an estrogen in the uterus.

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15
Q 
The mother of an 8y/o reports that she has recently noticed a discharge stain on her daughter's underwear. Both the mother and daughter appear nervous and concerned. You would need to ask questions to assess the child's 
A. Drug ingestion
B. Fluid intake
C. Risk for sexual abuse
D. Hormone responsiveness
E. Fat intake
A

C. Risk for sexual abuse

Vaginal discharge in a child could be related to a chemical irritation from soaps, lotions, or powders or to urinary tract infections. Concerned parents or children should be assessed for the risk of sexual abuse.

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16
Q

When you enter the exam room of a patient who is scheduled for a pelvic exam, you note that she seems very anxious. You should
A. Tell her there is nothing to be afraid of
B. Try to determine the source of anxiety
C. Avoid eye contact
D. Proceed as though nothing is wrong
E. Reschedule for another time

A

B. Try to determine the source of anxiety

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17
Q 
The female patient should ideally be in which position for the pelvic exam?
A. Fowler 
B. Prone
C. Lateral-supine
D. Lithotomy
E. Trendelenburg
A

D. Lithotomy

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18
Q 
During a pelvic exam, you ask the patient to perform the valsalva maneuver while you observe for bulging and urinary incontinence, to test for the presence of 
A. Cystocele
B. Rectocele
C. Vaginal prolapse
D. Rectal prolapse
E. Hymenal remnants
A

A. Cystocele

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19
Q 
When you plan to obtain cytologic studies, speculum introduction may be facilitated by 
A. Valsalva maneuver
B. Lubrication with warm water
C. Use of plastic speculum
D. Opening the blades completely
E. Lubrication with gel
A

B. Lubrication with warm water

It is generally thought that gel lubrication may interfere with cytologic studies; therefore, most clinicians lubricate the speculum with warm water.

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20
Q

Which of the following findings indicates a possible gonococcal infection?
A. Vaginal prolapse
B. Discharge from urethra or Skene glands
C. Irregular urethral orifice in midline
D. Irregular vaginal edges at introitus
E. Bulging of anterior or posterior vaginal wall

A

B. Discharge from urethra or Skene glands

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21
Q 
When performing a gynecological exam, the examiner should change gloves after touching the patient's
A. Anal area
B. Bartholin glands
C. Skene glands
D. Cervix
E. Urethra
A

A. Anal area

22
Q 
During digital examination of the vagina, the cervix is noted to be positioned posteriorly. Upon bimanual exam of this woman, you would expect to palpate a(n) \_\_\_\_ uterus. 
A. Retroverted
B. Anteverted
C. Midline
D. Laterally deviated
E. Retroflexed
A

B. Anteverted

23
Q 
The presence of cervical motion tenderness may indicate
A. Pregnancy
B. Nulliparity
C. Pelvic inflammatory disease
D. Vulvovaginitis
E. Malignancy
A

C. PID

Painful cervical motion tenderness suggests a pelvic inflammatory disease or a ruptured tubal pregnancy. The cervix is expected to move 1 to 2 cm without discomfort under normal conditions

24
Q

Which one of the following is a proper technique for use of a speculum during a vaginal exam?
A. Allow the labia to spread; insert the speculum slightly open
B. Press the introitus upward; insert the closed speculum horizontally
C. Press the introitus downward; insert the closed speculum obliquely
D. Spread the labia; insert the closed speculum horizontally
E. Insert one finger; insert the opened speculum

A

C. Press the introitus downward; insert the closed speculum obliquely

Gently insert a finger of one hand to push the introitus down to relax the pubococcygeal muscle. Then hold the closed speculum with the other hand and insert the speculum past your finger obliquely.

25
Q 
During a routine vaginal exam, you insert the speculum and visualize the cervix. The cervix projection into the vaginal vault is approximately 5cm. Upon bimanual exam, you would expect to find the uterus
A. In the midline position
B. In the retroverted position
C. In the anteverted position
D. Deviated to the left or right
E. In the retroflexed position
A

D. Deviated to the left or right

Normally, the cervix protrudes into the vagina 1 to 3 cm. Longer projections suggest a pelvic or uterine mass. A pelvic mass would cause the uterus to be deviated to the right or left, but an anteverted, retroverted, or retroflexed uterus would still be in the midline regardless of its position.

26
Q 
Small, pale yellow, raised and rounded areas are visualized on the surface of the cervix. You should 
A. chart this as nabothian cysts
B. Chart this as a friable cervix
C. Obtain a viral culture
D. Test the pH of the cervical os
E. Chart this as an eroded cervix
A

A. chart this as nabothian cysts

This describes nabothian cysts, which are retention cysts of the endocervical glands and are considered a normal variant. No further testing is warranted.

27
Q 
An examiner rotated a brush several times into the cervical os. The brush was withdrawn and stroked lightly on a glass slide. The slide was sprayed with fixative. Which type of specimen requires this technique for collection?
A, Gonococcal culture
B. Cytology smear
C. Haemophilus smear
D. Trichomonas smear
E. Fungal cultures
A

B. Cytology smear

28
Q 
When collecting specimens, which sample should be obtained first?
A. Chlamydia swab
B. Gonococcal culture
C. Pap smear
D. Wet mount 
E. Potassium hydroxide prep
A

C. Pap smear

A Pap smear is performed first; then other tests for gonorrhea, Chlamydia, Trichomonas, bacterial vaginosis, or candidiasis are done. Pap smear results are affected by the presence of blood, and vaginal infections result in more friable tissues; therefore, the Pap smear should be done first.

29
Q 
Dacron swabs are necessary when testing for which condition?
A. Candidiasis
B. Pregnancy
C. Trichomonas
D. Bacterial vaginosis
E. Chlamydia
A

E. Chlamydia

DNA probe for gonorrhea and Chlamydia uses a Dacron swab because a wooden cotton-tipped applicator may interfere with the test results.

30
Q 
The visualization of a large proportion of "clue cells" on your wet mount slide exam suggests
A. Trichomonal infection
B. Bacterial vaginosis
C. Candidiasis
D. Gonorrhea
E. Cervical cancer
A

B. Bacterial vaginosis

Clue cells are present in bacterial vaginosis. Hyphae are present in candidiasis, and flagella are present in trichomonal infection. Gonorrhea and cervical cancer cannot be identified on a wet mount.

31
Q 
The presence of a fishy odor after dropping KOH on a wet mount slide containing vaginal mucus suggests
A. Bacterial vaginosis
B. Yeast infection
C. Chlamydial infection
D. Pregnancy
E. Gonorrhea
A

A. Bacterial vaginosis

32
Q 
A fixed uterus may indicate
A. Adhesions
B. Postmenopause
C. Pregnancy
D. Premenopause
E. A normal finding
A

A. Adhesions

33
Q 
The assessment of which structure is not part of the bimanual exam?
A. Cervix
B. Bladder
C. Uterus
D. Ovaries
E. Adnexa
A

B. Bladder

34
Q

The rectovaginal exam is an important component of the total pelvic exam because it
A. Is the most direct cervical exam route
B. Is a more comfortable exam for the posthysterectomy patient
C. Is an alternate source for cytology specimens
D. Allows the examiner to reach almost 2.5cm higher into the pelvis
E. Provides better evaluation of the bladder

A

D. Allows the examiner to reach almost 2.5cm higher into the pelvis

35
Q 
Prominent labia minor are a normal finding in 
A. Adolescents
B. Menopausal women
C. Newborns
D. Pregnant women
E. Postmenopausal women
A

C. Newborns

Newborn genitalia findings are the result of maternal hormones. Both the labia majora and minora are swollen, with the minora often being more prominent.

36
Q 
Swollen and bruised genitalia in a newborn are most likely related to 
A. Breech delivery
B. Congenital defect
C. Infection
D. Maternal hormones
E. Enlarged clitoris
A

A. Breech delivery

Although the genitalia of a newborn girl can be swollen because of maternal hormones, swelling and bruising are more likely from a breech delivery.

37
Q 
The most common cause of a foul vaginal discharge in children is a(n)
A. Rectocele
B. Foreign body
C. Infection
D. Rupture hymen
E. Accident
A

B. Foreign body

38
Q

A 3y/o girl is being seen because of a foul vaginal odor. To inspect the vaginal vault, you should first
A. Insert a pediatric vaginal speculum
B. Place your hand firmly against the labia and spread your fingers
C. Insert a cotton-tipped applicator and press down
D. Pull the labia anteriorly and slightly to the side
E. Place the child prone and in the fetal position

A

D. Pull the labia anteriorly and slightly to the side

Applying anterior labial traction allows the hymenal opening to become visible as well as the interior of the vagina, almost to the cervix. The presence of a foreign body will be visible with this maneuver.

39
Q 
A mother brings her 8y/o daughter to the clinic because the child says it hurts to urinate after she fell while riding her bicycle. Upon inspection, you find posterior vulvar and gross perineum bruising. These findings are consistent with
A. Chronic masturbation
B. Congenital defects
C. Acute UTI
D. Sexual abuse
E. Malignancy
A

D. Sexual abuse

A straddle injury from a bicycle seat is usually evident over the symphysis pubis; injuries resulting from sexual molestation are generally more posterior and may involve the perineum grossly.

40
Q 
When a woman is not sexually active, cervical cancer screening should begin
A. At menarche
B. By 15
C. By 18
D. By 21
E. By 30
A

D. By 21

41
Q 
Softening of the uterine isthmus occurring between 6-8 weeks of pregnancy is the \_\_\_\_\_ sign. 
A. Homan
B. McDonald
C. Piskacek
D. Hegar
E. Chadwick
A

D. Hegar

42
Q 
Fundal height to the level of the umbilicus normally occurs around week \_\_\_\_ of pregnancy. 
A. 10
B. 16
C. 20
D. 24
E. 30
A

C. 20

43
Q 
During a pelvic exam for a postmenopausal woman, you would expect to assess
A. A wider and longer vaginal vault
B. Absence of vaginal wall rugation
C. A non palpable cervical os
D. A more mobile cervix
E. Palpable ovaries
A

B. Absence of vaginal wall rugation

Expected findings in the pelvic examination for an older woman include a narrower and shorter vagina, absence of rugation, a less mobile cervix, and a palpable cervical os. The ovaries are rarely palpable because of atrophy.

44
Q

What accommodations should be used in the position of a hearing-impaired woman for a pelvic exam?
A. Patient should assume the “M” or “V” position
B. Patient should be in the diamond-shaped position
C. Head of the table should be elevated
D. Lithotomy position with obstetric stirrups should be used
E. Patient should be in the knee-chest position

A

C. Head of the table should be elevated

The woman with a hearing impairment will need to see the clinician or an interpreter during the examination; therefore, her head should be elevated.

45
Q 
Asking the woman to close the introitus during a pelvic exam is a test for 
A. Endometriosis
B. Rectocele
C. Cervical polyps
D. Muscle tone
E. Cystocele
A

D. Muscle tone

Test for muscle tone is to have the woman squeeze the vaginal opening around your finger. A rectocele can be seen as a bulge on the posterior wall. A cystocele will be seen as bulge on the anterior wall. Endometriosis is suggested with tender nodules along the uterosacral ligaments. Cervical polyps can be inspected without squeezing.

46
Q 
Which of the following is a normal component of physiologic vaginitis seen on a wet mount?
A. 3-5 WBCs
B. Clue cells
C. Branching hyphae
D. Spores
E. Motile flagellates
A

A. 3-5 WBCs

47
Q 
The vaginal discharge of a woman with a typical Trichomonal vaginalis infection is 
A. Homeogenous and gray with a low pH
B. Scant and curdy with a low pH
C. Profuse and frothy with a high pH
D. Profuse and curdy with a low pH
A

C. Profuse and frothy with a high pH

Trichomonal infection produces a profuse, frothy discharge with a pH of 5 to 6.6 (normal is less than 4.5).

48
Q

A young, sexually active woman comes to the urgent care clinic complaining of suprapubic abdominal pain. She is afebrile with rebound tenderness to the right side. There is no dysuria or vaginal discharge or odor. A pelvic exam is done. She has pain with cervical motion, and you palpate a painful mass over the left adnexal area. Your prioritized action is to
A. Swab for gonococcal infection and then dip her urine
B. Obtain a surgical consult immediately
C. Remove the foreign body
D. Dip her urine and then swab for Chlamydia
E. Diagnose ovarian cyst and schedule follow-up

A

B. Obtain a surgical consult immediately

The presenting symptoms of a tubal pregnancy are a surgical emergency. The only diagnostic test should be a pregnancy test.

49
Q

A cervical polp usually appears as a
A. Grainy appearance at the ectocervical junction
B. Bright-red soft protrusion from the endocervical canal
C. Transverse or stellate scar
D. Hard granular surface at or near the os
E. Flesh-colored, firm protrusion at the cervical os

A

B. Bright-red soft protrusion from the endocervical canal

50
Q 
Mittelschmerz may occur in which phase of the menstrual cycle?
A. Menstrual
B. Postmenstrual
C. Ovulation
D. Secretory
E. Luteal
A

C. Ovulation

Mittelschmerz, lower abdominal pain associated with ovulation, may also be accompanied by tenderness on the side where ovulation took place that month

RRPA History and Physical II (11 decks)

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