Chapter 19: Female Genitalia

Question 1

Posteriorly, the labia minora meet as two ridges that fuse to form the
a. fourchette.
b. vulva.
c. clitoris.
d. perineum.

Answer 1

ANS: A
The labia minora join posteriorly to form the fourchette.

Question 2

A cervical polyp usually appears as a
a. grainy area 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.

Answer 2

ANS: B
Cervical polyps are bright red, soft, and fragile. They usually protrude from the endocervical
canal.

Question 3

Which structure is located posteriorly on each side of the vaginal orifice?
a. Skene glands
b. Clitoris
c. Perineum
d. Bartholin glands

Answer 3

ANS: D
Bartholin glands are found posteriorly on each side of the vaginal orifice.

Question 4

During sexual excitement, how is the vaginal introitus lubricated?
a. The Bartholin glands secrete mucus.
b. The clitoris produces moisture.
c. The Skene glands drain fluid.
d. The urethral surfaces secrete water.

Answer 4

ANS: A
The Bartholin glands secrete mucus into the introitus for lubrication during sexual stimulation.

Question 5

The vaginal mucosa of a woman of childbearing years should appear
a. smooth and pink.
b. moist and excoriated.
c. dry and papular.
d. transversely rugated.

Answer 5

ANS: D

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

Question 6

The adnexa of the uterus are composed of the
a. corpus and cervix.
b. fallopian tubes and ovaries.
c. uterosacral and broad ligaments.
d. vagina and fundus.

Answer 6

ANS: B
The fallopian tubes and ovaries are collectively referred to as the adnexa of the uterus.

Question 7

A bluish color to the cervix during pregnancy is called (the)
a. McDonald sign.
b. Spinnbarkeit.
c. Goodell sign.
d. Chadwick sign.

Answer 7

ANS: D
The Chadwick sign is a bluish color to the cervix during pregnancy. The Goodell sign is an increase in vascularity and softening of the cervix. Spinnbarkeit refers to the quality of elastic mucus during mittelschmerz, and the McDonald sign is fundal flexing on the cervix.

Question 8

The pelvic joint that separates most appreciably during late pregnancy is the
a. sacroiliac.
b. symphysis.
c. sacrococcygeal.
d. iliofemoral.

Answer 8

ANS: B
Of the four pelvic joints, the one that moves appreciably later in pregnancy is the symphysis
pubis.

Question 9

Pregnancy-related cervical changes include
a. flattening and lengthening.
b. thinning and reddening.
c. hardening and pallor.
d. softening and bluish coloring.

Answer 9

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

Question 10

Mrs. Robinson, a 49-year-old patient, presents to the office complaining of missing her
menstrual period. She asks about menopause. You explain to her that the conventional
definition of menopause is
a. the first day of the last menstrual period.
b. 1 year with no menses.
c. the last day of the last menstrual period.
d. the cessation of ovulation.

Answer 10

ANS: B
Menopause is defined as 1 year without menses.

Question 11

Which systemic feature is related to the effects of menopause?
a. Increased abdominal fat distribution
b. Decreased LDL levels
c. Cold intolerance
d. Decreased cholesterol levels

Answer 11

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

Question 12

Ms. A, age 32, states that she has a recent history of itchy vaginal discharge. Ms. A has never
been pregnant. Her partner uses condoms and she uses spermicide for birth control. Which of
the following data are most relevant to Ms. A’s problem?
a. Bowel habits
b. Douching routines
c. Menstrual flow
d. Nutritional factors

Answer 12

ANS: B
When obtaining history of present illness information for the woman with a vaginal discharge,
you should inquire about her douching habits. Douching is not only medically unnecessary
but it can also mask, or even worsen, conditions such as bacterial vaginosis or a yeast
infection.

Question 13

Which risk factor is associated with cervical cancer?
a. Endometriosis
b. Low parity
c. Multiple sex partners
d. Obesity

Answer 13

ANS: C
Cervical cancer is associated with certain HPV strains. Multiple sex partners increase the risk
of HPV infection.

Question 14

The risk of ovarian cancer is increased by
a. the use of oral contraceptives.
b. cigarette smoking.
c. age between 35 and 50 years.
d. early age at first intercourse.

Answer 14

ANS: A
There is a relationship between the number of menstrual cycles and risk of ovarian cancer.
Early menarche and menopause after 50 years of age increase the risk.

Question 15

The form of gynecologic cancer that is increased in obese women is
a. vaginal.
b. cervical.
c. ovarian.
d. endometrial.

Answer 15

ANS: D
Obesity increases a woman’s chance of developing endometrial cancer by twofold to fivefold.

Question 16

The mother of an 8-year-old child 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.

Answer 16

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

Question 17

The female patient should ideally be in which position for the pelvic examination?
a. Fowler
b. Prone
c. Lateral supine
d. Lithotomy

Answer 17

ANS: D
Ideally, the woman should be in a lithotomy position for a pelvic examination.

Question 18

When you plan to obtain cytologic studies, speculum introduction may be facilitated by
a. lubrication with gel.
b. lubrication with warm water.
c. use of a plastic speculum.
d. opening the blades completely.

Answer 18

ANS: B
It is generally thought that gel lubrication may interfere with cytologic studies; therefore, most
clinicians lubricate the speculum with warm water. Although gel lubrication would facilitate
speculum introduction, the gel could interfere with cytologic studies. Use of a plastic
speculum or opening the blades completely would not facilitate speculum introduction.

Question 19

Which one of the following is a proper technique for the use of a speculum during a vaginal
examination?
a. Allow the labia to spread, and insert the speculum slightly open.
b. Insert one finger, and insert the opened speculum.
c. Press the introitus downward, and insert the closed speculum obliquely.
d. Spread the labia, and insert the closed speculum horizontally.

Answer 19

ANS: C
Use two fingers 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 fingers
obliquely.

Question 20

When collecting specimens, which sample should be obtained first?
a. Chlamydial swab
b. Gonococcal culture
c. Pap smear
d. Wet mount

Answer 20

ANS: C
A Pap smear is obtained first and then other samples to test for gonorrhea, chlamydia,
Trichomonas, bacterial vaginosis, or candidiasis are obtained. Pap smear results are affected
by the presence of blood, and vaginal infections result in more friable tissues; therefore, the
Pap smear should be obtained first.

Question 21

The presence of a fishy odor after adding potassium hydroxide to a wet mount slide
containing vaginal mucus suggests
a. bacterial vaginosis.
b. yeast infection.
c. chlamydial infection.
d. pregnancy.

Answer 21

ANS: A
A positive whiff test suggests bacterial vaginosis.

Question 22

The assessment of which structure is not part of the bimanual examination?
a. Cervix
b. Bladder
c. Uterus
d. Ovaries

Answer 22

ANS: B
The bimanual examination consists of assessing the cervix, uterus, adnexa, and ovaries.

Question 23

Mrs. Reilly brings her 6-year-old daughter in with complaints of a foul vaginal discharge
noted in her underpants. The most common cause of a foul vaginal discharge in children is
a(n)
a. accident.
b. foreign body.
c. infection.
d. ruptured hymen.

Answer 23

ANS: B
A foul vaginal discharge in the preschool-age girl is most likely indicative of the presence of a
foreign body.

Question 24

A 3-year-old 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 the child prone and in the fetal position.
c. insert a cotton-tipped applicator and press down.
d. pull the labia forward and slightly to the side.

Answer 24

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

Question 25

A mother brings her 8-year-old daughter to the clinic because the child says it hurts to urinate
after she fell while riding her bicycle. On inspection, you find posterior vulvar and gross
perineum bruising. These findings are consistent with
a. chronic masturbation.
b. congenital defects.
c. acute urinary tract infection.
d. sexual abuse.

Answer 25

ANS: D
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

Question 26

What accommodations should be used for the position of a hearing-impaired woman for a
pelvic examination?
a. The patient should assume the M or V position.
b. Her legs should be farther apart.
c. The head of the table should be elevated.
d. The lithotomy position with obstetric stirrups should be used.

Answer 26

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

Question 27

Asking the woman to close the introitus during a pelvic examination is a test for
a. endometriosis.
b. rectocele.
c. cervical polyps.
d. sphincter tone.

Answer 27

ANS: D
The test for sphincter 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. Endometriosis is suggested with tender nodules along the uterosacral ligaments. Cervical polyps can be inspected without
squeezing.

Question 28

Itchy, painful, small red vesicles are typical of
a. condyloma acuminatum.
b. condyloma latum.
c. herpes simplex lesions.
d. syphilitic chancre.

Answer 28

ANS: C
Herpetic lesions are painful, itchy red vesicles; condyloma acuminatum are warty lesions on
the genitalia; condyloma latum are secondary syphilis lesions that appear as flat, round, or
oval papules covered by a gray exudate; and a chancre is a painless ulcer.

Question 29

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
and no vaginal discharge or odor. A pelvic examination 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.

Answer 29

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