Genitourinary/Gynecological Disorders

Question 1

UTIs are the most common pediatric urinary tract problems seen in primary care. Which of the following statements is not true regarding UTIs?

a) symptoms are often nonspecific, especially in infancy
b) urine culture is required for definitive diagnosis
c) trimethoprim-sulfamethoxazole is drug of choice for most children
d) radiologic studies are rarely indicated with first infection

Answer 1

d) radiologic studies are rarely indicated with first infection

Renal US and VCUG indicated if

Question 2

A 2 yo girl presents with symptoms of painful urination, frequency, and occasional incontinence over the past week. When seen in your office, she has a temp of 101.6. Which of the following would be your approach in establishing a definitive diagnosis?

a) clean-catch midstream collection of specimen for urine analysis
b) clean-catch midstream collection of specimen for urine culture
c) straight catheterization collection of specimen for urine culture
d) voiding cystourethrogram

Answer 2

c) straight catheterization collection of specimen for urine culture

Question 3

The most likely organism to cause a UTI in the pediatric population is:

a) Staphylococcus saprophyticus
b) Klebsiella
c) Chlamydia
d) E. coli

Answer 3

d) E. coli

Question 4

One of the most commonly suggested reasons for primary enuresis is:

a) certain medications such as theophylline
b) genitourinary abnormalities
c) family disruptions and stress
d) delayed maturation of voiding inhibitory reflex

Answer 4

d) delayed maturation of voiding inhibitory reflex

Question 5

A 7 yo female comes to you for a PE prior to participation in soccer. Her mother is concerned that she “still has accidents at night”. You determine that she has primary nocturnal enuresis and your first recommendation is to:

a) avoid use of criticism and punishment
b) use a sticker/star chart
c) treat with medication
d) purchase an enuresis alarm

Answer 5

a) avoid use of criticism and punishment

Question 6

The incidence of cryptochidism at one year of age is about 1%. The best explanation for this is:

a) examination of the scrotum begins at this age
b) a child can usually stand making palpation of the testes easier
c) spontaneous resolution often occurs in the first year
d) surgical repair can now be done in the neonatal period

Answer 6

c) spontaneous resolution often occurs in the first year

Question 7

Communicating hydrocele is best differentiated from the noncommunicating type by the fact that:

a) there is no association with hernia
b) it usually resolves on its own
c) the fluid is static in the scrotum
d) frequently develops into hernia

Answer 7

d) frequently develops into hernia

Question 8

In counseling parents when their child is diagnosed with mild hypospadias, suggest that the following may be part of the management:

a) circumcision
b) radiography
c) consult with pediatric urology
d) surgical correction at 2 years of age

Answer 8

c) consult with pediatric urology

Question 9

On PE of a 2 yo uncircumcised male you note that the foreskin is retracted and discolored. there is swelling of the glans. The most likely diagnosis is:

a) phimosis
b) balanitis
c) UTI
d) paraphimosis

Answer 9

d) paraphimosis

Question 10

Meatal stenosis, narrowing of the distal urethra, is seen following:

a) orchiopexy
b) circumcision
c) epididymitis
d) hypospadias repair

Answer 10

b) circumcision

Question 11

During a track meet, a 14 yo male pole-vaulter falls to the ground screaming in pain. He complains of intense, searing pain in his right scrotum. He vomits twice while waiting for the ambulance. He most likely has:

a) orchitis
b) hydrocele
c) acute epididymitis
d) testicular torsion

Answer 11

d) testicular torsion

Question 12

During a track meet, a 14 yo male pole-vaulter falls to the ground screaming in pain. He complains of intense, searing pain in his right scrotum. He vomits twice while waiting for the ambulance. He most likely has testicular torsion. Treatment of this disorder is primarily:

a) scrotal elevation
b) ice
c) immediate surgical referral
d) bedrest

Answer 12

c) immediate surgical referral

Question 13

Labial adhesions are a relatively common finding among infants and young girls. Which of the following statements about this condition is true?

a) adhesions are usually present at birth but may be missed on examination
b) highest incidence is from birth to 3 years
c) simple lysis of adhesions is often recommended
d) most cases resolve without intervention

Answer 13

d) most cases resolve without intervention

Question 14

Which of the following statements is true regarding the use of topical application of conjugated estrogen cream with labial adhesions?

a) it is highly successful in resolving most adhesions within 2 months
b) it is no longer recommended because it may stimulate precocious puberty
c) topical applications of bland creams or petroleum jelly are equally effective
d) mechanical lysis is preferred treatment today

Answer 14

a) it is highly successful in resolving most adhesions within 2 months

Question 15

A 12 yo complains of a vaginal discharge for the past 8-9 months. She tells you her underpants are frequently wet. When she wipes after urinating there is “white stuff” on the tissue. She denies urinary problems, genital itching, or odor. She also denies sexual activity. Her menses have not yet started, but she reports she has “started to develop” in her breasts at about age 10. Her vaginal discharge is most likely a result of:

a) a fungal infection
b) poor hygiene
c) retained foreign body
d) physiologic leukorrhea

Answer 15

d) physiologic leukorrhea

Question 16

Your recommendations for a girl with physiologic leukorrhea include which of these?

a) vinegar and water douche
b) placing a sanitary “mini pad” in her underpants
c) a 10 day course of penicillin or erythromycin
d) use of a monilial cream for 1 week

Answer 16

b) placing a sanitary “mini pad” in her underpants

Question 17

Which of the following is not true of dysmenorrhea?

a) onset is usually within the first 2-3 months following menarche
b) a leading cause of school absenteeism in adolescent females
c) systemic symptoms include vomiting and dizziness
d) pain is from start of menses to about 24-48 hours later

Answer 17

a) onset is usually within the first 2-3 months following menarche

Question 18

A 16 yo has symptoms of PMS. She refuses to take NSAIDs preferring instead more “natural” treatments. Her options include:

a) eating foods rich in sodium and fat
b) including more foods or supplements with vitamin C
c) limited fluid intake to avoid “bloating”
d) adequate rest, a healthy diet, and exercise

Answer 18

d) adequate rest, a healthy diet, and exercise

Question 19

In cases of accidental genitourinary trauma which of the following is not commonly seen?

a) extensive tears of the vaginal wall
b) hematuria
c) hematoma of the urethra, scrotum, lower abdomen
d) periurethral lacerations

Answer 19

a) extensive tears of the vaginal wall

Question 20

The most common form of glomerulonephritis in children is:

a) mesangial proliferative
b) poststreptococcal
c) membranoproliferative
d) mesangiostreptococcal

Answer 20

b) poststreptococcal

Question 21

Which of the following signs/symptoms is not associated with acute forms of glomerulonephritis?

a) edema
b) hematuria
c) increased urine output
d) dark urine

Answer 21

c) increased urine output

Question 22

One of your male patients presents with weight loss, abdominal pain, and decreased urine output. On examination, you palpate a right sided mass, noting tenderness in the abdomen and flank. Urinalysis reveals significant leukocytosis. An intravenous pyelogram is ordered, which shows marked delay of emptying from the renal pelvis. The most likely diagnosis is:

a) glomerulonephritis
b) pyelonephritis
c) hydronephrosis
d) UTI

Answer 22

c) hydronephrosis

Question 23

Which of the following is true of renal tubular acidosis (RCA) type 1?

a) genetically transmitted as autosomal recessive disorder
b) distal tube defect affecting secretion of hydrogen ions
c) distal tube defect affecting bicarbonate reabsorption
d) most children remain short in stature in spite of early treatment

Answer 23

b) distal tube defect affecting secretion of hydrogen ions

Question 24

Vulvovaginitis may be caused by all of the following except:

a) poor hygiene
b) herpes simplex virus
c) pinworms
d) condylomata acuminata

Answer 24

d) condylomata acuminata

Question 25

Meatal stenosis can be identified by all of these with the exception of:

a) crying with urination
b) inflammation of glans penis
c) slit-like meatus
d) wide urinary stream

Answer 25

d) wide urinary stream

Question 26

A 14 yo female is seen for complaints of headache and nausea. She is sexually active and uses a condom “sometimes”. She had a period last month but it only lasted 2 days instead of the usual 7. Which are not perceived as risk factors for adolescent pregnancy?

a) early onset of sexual activity
b) familiarity with fertility knowledge
c) sporadic, if any contraceptive use
d) low self-image

Answer 26

b) familiarity with fertility knowledge

Question 27

A urine pregnancy test is positive and confirmed by serology. Which of the following physical findings is not consistent with a gestation of less than 12 weeks?

a) Hegar sign
b) Goodell sign
c) doppler auscultation of fetal heart sounds
d) 4-6 pound weight gain

Answer 27

d) 4-6 pound weight gain

Question 28

Congenital defects are present in approximately 3-5% of infants born in this country. Which of the following factors is the lowest contributor to defects?

a) genetic
b) unknown
c) environmental
d) combination of environmental and genetic

Answer 28

b) unknown

Question 29

Which of the following is the earliest screening test that you would use in managing care during a patient’s first trimester of pregnancy?

a) amniocentesis
b) chorionic villus sampling
c) serum alpha-fetoprotein
d) fetal radiograph

Answer 29

c) serum alpha-fetoprotein

Question 30

A patient in her first trimester expresses to you that she may want to terminate a pregnancy. She has heard that abortion is a simple procedure without complications. Your discussion with her is based on the fact that:

a) adolescents only choose to terminate pregnancy 10% of the time
b) menstrual extraction could be done at this point
c) the risk is high for hemorrhage and fever
d) cervical injury overall from induced abortion is rare

Answer 30

b) menstrual extraction could be done at this point

Question 31

What is not a focus of care in the first few weeks after delivery of a baby by an adolescent mother?

a) social support for the family
b) mother’s goals and education
c) infant’s continued weight gain
d) adaptation of mother to sleep changes

Answer 31

b) mother’s goals and education

Question 32

While child abuse occurs across age barriers, the adolescent parent may be at greater risk for abusing the child because:

a) the pregnancy may be unplanned or unwanted
b) adolescents continue substance abuse after the baby is born
c) the infant mortality rate is low
d) education becomes more important than parenting

Answer 32

a) the pregnancy may be unplanned or unwanted

Question 33

A thick, purulent vaginal discharge that is greenish-yellow is most likely an infection caused by:

a) Chlamydia trachomatis
b) Herpes simplex virus
c) Neisseria gonorrhea
d) Human papilloma virus

Answer 33

c) Neisseria gonorrhea

Question 34

The primary treatment for a Neisseria gonorrhea infection would be:

a) Amoxicillin
b) Ceftriaxone
c) Ofloxacin
d) Penicillin

Answer 34

b) Ceftriaxone

Question 35

The most common sexually transmitted infection if the US is:

a) gonorrhea
b) HIV
c) chlamydia
d) herpes

Answer 35

c) chlamydia

Question 36

Which of the following tests provide the most definitive diagnosis for suspected syphilis?

a) VDRL
b) ART
c) Dark-field microscopy
d) FTA-AB

Answer 36

c) Dark-field microscopy

Question 37

Which of the following is not true regarding the use of acyclovir in the treatment of herpes simplex virus?

a) topical treatment not recommended
b) treatment is equally effective for active primary and recurrent lesions
c) the focus of treatment is decrease in intensity symptom duration, and viral shedding
d) therapy is best when initiated within 6 days of onset of lesions

Answer 37

b) treatment is equally effective for active primary and recurrent lesions

Question 38

Your 15 yo female patient presents with genital lesions. Your workup is based on the knowledge that:

a) HPV is often associated with malignancy
b) HPV manifests itself as molluscum contagiosum
c) most HPV infections cause genital itching and pain
d) syphillis serology should be included to distinguish HPV from condylomata lata

Answer 38

d) syphillis serology should be included to distinguish HPV from condylomata lata

Question 39

After your examination, you determine that your patient has condylomata acuminata. Which of the following is not commonly used to treat these lesions?

a) topical podophyllum resin
b) laser treatment for unresponsive lesions
c) topical acyclovir
d) treatment is often not needed; many lesions regress spontaniously

Answer 39

c) topical acyclovir

Question 40

A 16 yo female patient that is sexually active complains of a “frothy” discharge that “smells weird”. She also has slight itching in her vaginal area. You suspect:

a) trichomoniasis
b) gonorrhea
c) chlamydia
d) herpes

Answer 40

a) trichomoniasis

Question 41

What education needs to be included in prescribing metronidazole to treat trichomoniasis?

a) it is safe for use during pregnancy
b) sexual contact may resume after 48 hours of treatment
c) sexual contacts do not require therapy
d) alcohol should not be used during therapy

Answer 41

d) alcohol should not be used during therapy

Question 42

A patient with a thin, white, malodorous vaginal discharge most likely has:

a) trichomoniasis
b) monilia
c) bacterial vaginosis
d) chlamydia

Answer 42

c) bacterial vaginosis

Question 43

At which point of life is UTI more common in males?

a) toddler
b) adolescent
c) school-age
d) newborn/infant

Answer 43

d) newborn/infant

Question 44

The organism primarily responsible for UTI is:

a) proteus
b) E. coli
c) enterobacter
d) pseudomonas

Answer 44

b) E. coli

Question 45

Most patients with uncomplicated UTI can be treated on an outpatient basis. The first antibiotic you would consider using is:

a) amoxicillin
b) trimethoprim-sulfamethoxazole
c) cephalexin
d) amoxicillin/clavulanate

Answer 45

b) trimethoprim-sulfamethoxazole

Question 46

Cryptorchidism is more prevalent in:

a) term infants
b) premature infants
c) babies at 1 year of age
d) toddlers

Answer 46

b) premature infants

Question 47

A 3 yo boy is in the process of toilet training. The parents come to see you because when the child urinates all the urine goes on the floor. You suspect hypospadias because:

a) it is a rare disorder that would indicate a more serious problem
b) Normally the urine stream is directed from the meatal opening at the tip of the penis, in a straight path
c) the child is circumcised
d) fusion of the urethral folds has occurred

Answer 47

b) Normally the urine stream is directed from the meatal opening at the tip of the penis, in a straight path

Question 48

Which of the following is not used in the management of the child with phimosis?

a) ice packs
b) gentle stretching when bathing
c) circumcision in cases of urinary obstruction
d) good hygiene

Answer 48

a) ice packs

Question 49

An 8 yo girl presents with a 2 week history of a brownish-red, very foul smelling vaginal discharge. It is most likely caused by:

a) sexual abuse
b) accidental vaginal trauma
c) foreign body
d) poor hygiene

Answer 49

c) foreign body

Question 50

Which of the following is not a proposed etiologic factor in PMS?

a) imbalance of water and sodium
b) fluctuation in steroids
c) vitamin B12 deficiency
d) synthesis of prostaglandins

Answer 50

c) vitamin B12 deficiency

Question 51

Treatment of a child with glomerulonephritis would include:

a) vasoconstrictors for hypotension
b) antibiotics for persistent infection
c) increased fluids to maintain hydration
d) avoidance of diuretics

Answer 51

b) antibiotics for persistent infection

Question 52

Which of the following is not a frequent sign of gonorrhea infection:

a) diarrhea
b) urinary symptoms
c) menstrual problems
d) fever

Answer 52

a) diarrhea

Question 53

The most significant finding in the case of chlamydia infection is:

a) the vaginal discharge is gray and frothy
b) most examinations are normal
c) the external genitalia is markedly inflamed
d) infection by chlamydia alone is the rule

Answer 53

b) most examinations are normal

Question 54

One difference between the lesions of primary syphilis (chancre) and HSV genital lesions that may help in differentiating the two is:

a) syphilis chancre is painless while HSV lesions are painful
b) syphilis lesions have a flat edge while HSV lesion edges are more raised
c) syphilis chancres are more likely to ulcerate than HSV lesions
d) erythema and edema is greater with syphilis chancre than HSV lesions

Answer 54

a) syphilis chancre is painless while HSV lesions are painful

Question 55

Education of sexually active adolescents concerning use of condoms to prevent STDs would include:

a) only latex or natural skin condoms should be used
b) polyurethane condoms have inadequate STD protection
c) condom use is only method to prevent STDs and AIDS
d) Only petroleum-based lubricants should be used

Answer 55

c) condom use is only method to prevent STDs and AIDS

Question 56

Which of the following contraceptive methods would be least suitable for adolescents?

a) condoms with spermicides
b) progestin-only mini-pill
c) long-acting progestins
d) estrogen-progestin combination

Answer 56

b) progestin-only mini-pill

Question 57

Which of the following is not an absolute contraindication for oral contraceptives?

a) clotting disorder
b) impaired liver function
c) severe hypertension
d) undiagnosed vaginal bleeding

Answer 57

c) severe hypertension

Question 58

A 10 yo boy comes to the clinic for evaluation of a suspected UTI. Which of the following signs would lead you to include diagnoses other than UTI in the differential?

a) increased frequency
b) penile discharge
c) costovertebral tenderness
d) dysuria

Answer 58

b) penile discharge

Penile discharge may indicate balanitis or a STI.

Question 59

A 10 yo boy comes to the clinic for evaluation of a suspected UTI. The culture indicates sensitivity to trimethoprim/sulfamethoxazole. The boy is treated with this antibiotic for 10 days. The most appropriate follow up would include:

a) obtaining UA in 2 weeks
b) instructing the parents that the child should return to clinic if symptoms persist
c) teaching parents home monitoring with nitrite sticks
d) referring the child for a renal US

Answer 59

d) referring the child for a renal US

Older boys with a first infection should be examined for urinary tract abnormalities.

Question 60

The most important laboratory test to be performed when a UTI is suspected in a school-age child is a:

a) CBC with differential
b) urine dipstick
c) clean catch urine for U/A and culture w/ sensitivities
d) voiding cystourethrogram (VCUG)

Answer 60

c) clean catch urine for U/A and culture w/ sensitivities

Question 61

Jay is a 9 yo boy who has had no significant health problems by history, but his mother is very concerned because he is “wetting himself”. As you begin your H&P you keep in mind that the most common type of enuresis in school age children is:

a) primary nocturnal enuresis
b) occasional daytime enuresis
c) secondary nocturnal enuresis
d) primary diurnal enuresis

Answer 61

a) primary nocturnal enuresis

Primary nocturnal enuresis occurs in 90% of enuretic children (i.e. they are wet only at night during sleep and have never had a sustained period of dryness).

Question 62

Which of the following statements is not true with regard to primary nocturnal enuresis?

a) there is often a positive family history of enuresis
b) it appears to be related to maturational delay
c) some nighttime wetters stop wetting without any form of treatment
d) the incidence is higher in girls than in boys

Answer 62

d) the incidence is higher in girls than in boys

The incidence of primary nocturnal enuresis is three times higher in boys than in girls.

Question 63

Which of the following is not true about the use of imipramine for the treatment of enuresis?

a) it is not generally recommended for this nonfatal disorder due to the potentially lethal side effects
b) the lasting cure rate is approximately 17%
c) imipramine should only be given to children who have had a baseline EEG
d) The most appropriate imipramine treatment group is adolescent boys with both ADHD and persistent nocturnal enuresis

Answer 63

c) imipramine should only be given to children who have had a baseline EEG

Imipramine use is controversial due to dangerous side effects and its relative ineffectiveness. An EEG is not recommended prior to initiating treatment.

Question 64

While examining a 4 mo boy you are unable to palpate one of the testes. The next most appropriate step is to:

a) reassure the parents that this is a normal finding
b) refer the child to an endocrinologist
c) reexamine the baby in 2 months
d) refer the child to a urologist

Answer 64

c) reexamine the baby in 2 months

If spontaneous descent of the testis does not occur by 12 months of age, surgical correction is indicated to reduce the risk of infertility.

Question 65

Which of the following is not true with regard to hypospadias?

a) the meatus is formed along the dorsum of the penis
b) it is one of the most common penile abnormalities
c) circumcision should be deferred
d) a referral for an endocrine evaluation may be indicated

Answer 65

a) the meatus is formed along the dorsum of the penis

In hypospadias, the meatus opens on the ventral surface. In epispadias, which occurs less frequently, the opening is along the dorsal surface.

Question 66

Upon examination of a 2 mo boy you notice a swelling in the right inguinal canal. Your differential diagnosis would not include:

a) diastasis recti
b) hydrocele of the spermatic cord
c) inguinal hernia
d) lymphadenopathy

Answer 66

a) diastasis recti

Diastasis recti is a midline fascial attenuation extending from the umbilicus to the xiphoid process.

Question 67

A 12 yo girl presents to your clinic with symptoms of vaginitis including odor, dysuria, frequency, and discomfort. Which of the following cases of vaginitis is most likely due to sexual transmission?

a) candida
b) chlamydia
c) pinworms
d) gardnerella

Answer 67

b) chlamydia

Chlamydial disease carries a high suspicion for sexual transmission. Garnerella is indigenous vaginal flora. Candida typically occurs after a course of antibiotics. Pinworms is a parasitic disease.

*Chlamydia causes urethritis and cervicitis, not vaginitis. Additinally, chlamydia infections are often asymptomatic.

Question 68

A 12 yo girl presents to your clinic with symptoms of vaginitis including odor, dysuria, frequency, and discomfort. Upon further history, physical examination, and laboratory screening, the girl is diagnosed with Candida albicans vaginitis. Appropriate treatment would include:

a) avoiding bubble baths
b) topical acyclovir
c) ceftriaxone
d) clotrimazole

Answer 68

d) clotrimazole

In Candida albicans local application of clotrimazole, miconazole, and ticonazole appear to be equally effective.

Question 69

A labial adhesion extending from the posterior fourchette to the clitoris is noted during the routine assessment of a 4 yo girl. There is no history of difficulty voiding, dysuria, or discomfort. The most appropriate initial management is to:

a) recommend mechanical lysis using petrolatum ointment
b) prescribe a topical application of estrogen cream
c) refer to a GU specialist
d) reassure parents that no specific treatment is needed at this time

Answer 69

d) reassure parents that no specific treatment is needed at this time

If there is no evidence of UTI, obstruction, or discomfort, and the parents are not unusually concerned, then no treatment is necessary. Usually resolve spontaneously during puberty as estrogen levels begin to rise.

Question 70

Patients with acute nephrotic syndrome may present with all but the following signs:

a) edema
b) hypertension
c) dark amber-colored urine
d) history of weight loss

Answer 70

d) history of weight loss

Children with nephrotic syndrome typically present with edema and inappropriate weight gain.

Question 71

It is important to look for evidence of a preceding streptococcal infection when ruling out acute nephritis. This is best done by:

a) throat culture
b) skin examination
c) ASO titer
d) ESR

Answer 71

c) ASO titer

The antistreptolysin O (ASO) titer is elevated in 80% of patients with a preceding streptococcal infection.

Question 72

An adolescent boy presents to the clinic with a painless mass in the left side of his scrotum. The most likely diagnosis is:

a) epididymitis
b) testicular torsion
c) incarcerated hernia
d) hydrocele

Answer 72

d) hydrocele

A hydrocele is not associated with pain, but the other suggested diagnoses are associated with pain.

Question 73

A foul-smelling vaginal discharge that emits a fishy odor when combined with 10% potassium hydroxide is most likely due to:

a) Gardnerella vaginalis
b) Candida albicans
c) Chlamydia trachomatis
d) N. gonorrhoeae

Answer 73

a) gardnerella vaginalis

BV, often caused by an overgrowth of Garnerella vaginosis, is suspected on the basis of a malodorous vaginal discharge and positive “whiff” test when mixing the discharge with potassium hydroxide.

Question 74

A 17 yo sexually active girl with chancres in the genital area is noted to have a positive Venereal Disease Research Laboratories (VDRL) test. The next step should be to:

a) treat with ceftriaxone
b) perform a specific treponemal antibody test
c) culture for C. trachomatis
d) discuss safer sex practices

Answer 74

b) perform a specific treponemal antibody test

If VDRL is positive, a specific treponemal test such as FTA-ABs should be done to confirm the diagnosis. Treatment is with benzathine penicillin G.

Question 75

The most common bacterial cause of a sexually transmitted infection is:

a) N. gonorrhoeae
b) Trichomonas vaginalis
c) Chlamydia trachomatis
d) Herpes simplex

Answer 75

c) Chlamydia trachomatis

Chlamydia is the most common bacterial cause of STD with over 4 million cases annually.

Question 76

Which of the following is an absolute contraindication for use of combined hormonal contraceptives in adolescent women:

a) history of thromboembolism
b) diabetes
c) smokes five cigarettes per day
d) sickle cell disease

Answer 76

a) history of thromboembolism

Estrogen containing combined hormonal contraceptives increase hepatic production of extrinsic clotting factors and increase the relative risk for thromboembolic events in women with a h/o DVT/PE.

Question 77

A 15 yo girl who had menarche at 13 yo complains of monthly menstrual pain on the first day of her periods for 1 year. She has never been sexually active. Which of the following is not a characteristic of dysmenorrhea?

a) increased production of uterine prostaglandins
b) pain usually starts within hours of menstrual flow or may precede flow by up to 2 days
c) anovulatory cycles
d) crampy, spasmodic pain in the lower abdominal area, which might radiate to inner thighs

Answer 77

c) anovulatory cycles

Primary dysmenorrhea usually begins within 1-3 years of menarche and is associated with the establishment of ovulatory cycles.

Question 78

Which of the following is a risk factor for adolescent pregnancy?

a) good grades in school
b) asks for contraceptives at the school health clinic
c) plans to study nursing in college
d) unsure if monogamous partner uses condoms

Answer 78

d) unsure if monogamous partner uses condoms

Poor communication with one’s partner is a definite risk factor for adolescent pregnancy.

Question 79

A 16 yo female has been sexually active with a male partner for 6 months. They have used condoms consistently. She is interested in a hormonal contraceptive as well. Your advice includes all of the following except:

a) combined oral contraceptives prevent ovulation
b) transdermal contraceptive patches must be correctly applied and the site rotated
c) the vaginal contraceptive ring must be changed weekly
d) long-acting progestins might cause weight gain

Answer 79

c) the vaginal contraceptive ring must be changed weekly

The vaginal contraceptive ring is worn for 3 weeks, removed, and then a new ring is inserted 1 week later.

Question 80

A healthy 17 yo male is thinking about having sex but asks for more information about condoms. You give him all of the following advice except:

a) male condoms are the most effective barrier method
b) latex condoms are the most recommended and are heat tolerant
c) condoms have a theoretical failure rate of 3%
d) it is only safe to use water based lubricants with condoms

Answer 80

b) latex condoms are the most recommended and are heat tolerant

Heat can cause latex condoms to break down.