Module 3 Canvas Practice Questions

Question 1

After ovulation, progesterone is first produced by which structure?

Answer 1

Corpus luteum

Question 2

T/F: A rise in BBT won’t occur if there is no ovulation.

Answer 2

TRUE!

to have a rise in BBT you need a rise in progesterone. If there has been no ovulation, there is no corpus luteum and so no rise in progesterone.

Question 3

In a 28 day menstrual cycle, the first day of bleeding is day #

Answer 3

1

The first day of bleeding is Day #1 of the menstrual cycle.

Question 4

Progesterone is produced primarily by

a) anterior pituitary
b) endometrial glands
c) corpus luteum
d) hypothalamus

Answer 4

c) corpus luteum

Question 5

The correct sequence of the phases of the Ovarian Cycle is

a) Secretory, follicular, luteal
b) Follicular, ovulatory, luteal
c) Menstrual, follicular, secretory
d) Ovulatory, follicular, luteal

Answer 5

b) Follicular, ovulatory, luteal

the follicles develop, producing estrogen, then one dominates and ovulates. The corpus luteum is created from the remains of the dominant follicle. The corpus luteum then produces progesterone.

Question 6

In a 30 day menstrual cycle, the luteal phase will usually last

Answer 6

14

Question 7

In a 26 day menstrual cycle, ovulation will usually occur on day #

Answer 7

12

Question 8

The basal body temperature rises due to the increase in

Answer 8

Progesterone

Question 9

In a 30 day menstrual cycle, ovulation will usually occur on day #

Answer 9

16

Question 10

Which statement is TRUE about the follicular phase of the ovarian cycle?

a) Estrogen reaches its highest level during the follicular phase which occurs in the second half of the menstrual cycle.
b) The follicular phase usually occurs between days 1 and 14 of the menstrual cycle and is associated with a fall in the level of estrogen.
c) The follicular phase begins on day 1 of the menstrual cycle and ends with the ovulatory phase.

Answer 10

c) The follicular phase begins on day 1 of the menstrual cycle and ends with the ovulatory phase.

Question 11

SATA: Which menstrual cycle phases happen in the ovary?
Follicular Phase
Luteal Phase
Proliferative Phase
Menstrual Phase
Ovulatory Phase
Secretory Phase

Answer 11

Follicular Phase
Luteal Phase
Ovulatory Phase

Question 12

SATA: Which menstrual cycle phases happen in the endometrium?
Follicular Phase
Luteal Phase
Proliferative Phase
Menstrual Phase
Ovulatory Phase
Secretory Phase

Answer 12

Proliferative Phase
Menstrual Phase
Secretory Phase

Question 13

Which hormone most directly stimulates the synthesis of progesterone?

Answer 13

Luteinizing hormone (LH)

Question 14

When estrogen is the dominant hormone

a) the endometrium proliferates.
b) the endometrium sloughs off.
c) the corpus luteum produces progesterone.

Answer 14

a) the endometrium proliferates.

Question 15

During the first half of the menstrual cycle

a) estrogen levels rise.
b) progesterone levels are high.
c) follicle stimulating hormone is high throughout.

Answer 15

a) estrogen levels rise.

Question 16

Estrogen is secreted in the:

Answer 16

Ovaries

Question 17

Hormonal regulation of the menstrual cycle is controlled by:

a) Ovaries, uterus, and cervix
b) Cerebellum, posterior pituitary, and ovaries
c) Hypothalamus, anterior pituitary, and ovaries

Answer 17

c) Hypothalamus, anterior pituitary, and ovaries

Also referred to as the HPO axis.

Question 18

T/F: Irregular menstrual bleeding is common and normal for a year or two after menarche.

Answer 18

True!

Question 19

The dominant ovarian hormone during the second half of the menstrual cycle is:

Answer 19

Progesterone

Question 20

Day 1 of the menstrual cycle corresponds to:

Answer 20

the first day of menstrual bleeding.

Question 21

Progesterone is secreted by what primary organ?

Answer 21

Ovarian corpus luteum

Question 22

Estrogen is secreted by what primary organ?

Answer 22

Ovarian Follicles

Question 23

Gonadotrophin releasing hormone (GnRH) is secreted by what primary organ?

Answer 23

Hypothalamus

Question 24

Lutenizing hormone (LH) is secreted by what primary organ?

Answer 24

Anterior Pituitary

Question 25

Follicle stimulating hormone is secreted by what primary organ?

Answer 25

Anterior Pituitary

Question 26

Prolactin is secreted by what primary organ?

Answer 26

Anterior Pituitary

Question 27

During the last half of the menstrual cycle

a) progesterone predominates.
b) follicle stimulating hormone predominates.
c) estrogen predominates

Answer 27

a) progesterone predominates.

Question 28

When progesterone is the dominant hormone

a) the endometrium thickens in preparation for implantation.
b) the endometrium begins to proliferate.
c) sloughs off and menses occurs.

Answer 28

a) the endometrium thickens in preparation for implantation.

Question 29

High estrogen levels after a dominant follicle has been established:

a) Increase follicle-stimulating hormone (FSH) and luteinizing hormone (LH) secretion
b) Decrease follicle-stimulating hormone (FSH) and luteinizing hormone (LH) secretion
c) Increase LH secretion, but inhibit FSH secretion.
d) Increase FSH secretion, but decrease LH secretion.

Answer 29

c) Increase LH secretion, but inhibit FSH secretion.

Question 30

When considering sexual dysfunction and its effects on quality of life, the clinician understands that most women who have sexual problems:

A) do not feel that the problems significantly impact their quality of life.
b) have shared this information with their primary care provider.
c) will not report the problem to the clinician unless specifically asked about it.

Answer 30

c) will not report the problem to the clinician unless specifically asked about it.

Question 31

T/F: Lesbian women are not at risk of contracting a sexually transmitted infection.

Answer 31

False

Question 32

A sexual history should be obtained:
A) While the clinician is performing the physical examination
B) Only when a woman presents with a sexual concern
C) After explaining the purpose of the questions

Answer 32

C) After explaining the purpose of the questions

Question 33

SATA: Appropriate questions to ask all women entering your practice:
A) What type of contraceptive do you currently use?
B) Are you married?
C) Do you have sex with men only, women only, or women and men both?
D) How do you protect yourself from sexually transmitted infection?

Answer 33

C) Do you have sex with men only, women only, or women and men both?
D) How do you protect yourself from sexually transmitted infection?

Question 34

T/F: Women who have sex with women may avoid health care because they fear disapproval from providers or staff.

Answer 34

True

Question 35

T/F: Lesbian women never have sex with men.

Answer 35

False

Question 36

T/F: Lesbian women do not need to have Pap smears.

Answer 36

False

Question 37

SATA: Which of the following may COMMONLY cause secondary amenorrhea?

A) prolonged anovulation with normal or high estrogen
B) outflow tract obstruction
C) regular ovulation
D) prolonged anovulation with low or no estrogen

Answer 37

A) prolonged anovulation with normal or high estrogen
D) prolonged anovulation with low or no estrogen

Question 38

A 25-year-old woman has not menstruated in nine months. She had regular menstrual cycles prior to that time. She is in good health with no other symptoms. Physical examination is normal, and pregnancy test is negative. The most appropriate diagnostic tests to order next are:

A) follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels
B) prolactin and thyroid stimulating hormone (TSH) levels
C) uterine ultrasound and endometrial biopsy

Answer 38

B) prolactin and thyroid stimulating hormone (TSH) levels

Question 39

Progestogen challenge test results: match the expected result with the condition causing amenorrhea.

Galactorrhea

Answer 39

No withdrawal bleed

Question 40

Progestogen challenge test results: match the expected result with the condition causing amenorrhea.

Prolactinoma

Answer 40

No withdrawal bleed

Question 41

Progestogen challenge test results: match the expected result with the condition causing amenorrhea.
Group of answer choices

PCOS

Answer 41

Withdrawal bleed

Question 42

Progestogen challenge test results: match the expected result with the condition causing amenorrhea.

excess adipose tissue

Answer 42

Withdrawal bleed

Question 43

Progestogen challenge test results: match the expected result with the condition causing amenorrhea.

ovarian insufficiency

Answer 43

No withdrawal bleed

Question 44

Match the cause of secondary amenorrhea with its hormonal state.

High FSH/LH but low estrogen
Low estrogen
Normal to high estrogen

PCOS

Answer 44

normal to high estrogen

Question 45

Match the cause of secondary amenorrhea with its hormonal state.

High FSH/LH but low estrogen
Low estrogen
Normal to high estrogen

Anorexia

Answer 45

low estrogen

Question 46

Match the cause of secondary amenorrhea with its hormonal state.

High FSH/LH but low estrogen
Low estrogen
Normal to high estrogen

Chronic disease

Answer 46

low estrogen

Question 47

Match the cause of secondary amenorrhea with its hormonal state.

High FSH/LH but low estrogen
Low estrogen
Normal to high estrogen

Excess adipose tissue

Answer 47

normal to high estrogen

Question 48

Match the cause of secondary amenorrhea with its hormonal state.

High FSH/LH but low estrogen
Low estrogen
Normal to high estrogen

Prolactinoma

Answer 48

low estrogen

Question 49

Match the cause of secondary amenorrhea with its hormonal state.

High FSH/LH but low estrogen
Low estrogen
Normal to high estrogen

Menopause

Answer 49

High FSH/LH but low estrogen

Question 50

Match the cause of secondary amenorrhea with its hormonal state.

High FSH/LH but low estrogen
Low estrogen
Normal to high estrogen

Ovarian insufficiency

Answer 50

High FSH/LH but low estrogen

Question 51

In one pathway to secondary amenorrhea, a pituitary tumor causes
____________
to rise, which suppresses
________________
, resulting in very low levels of ____________.

Answer 51

Prolactin
GnRH
Estrogen

Question 52

SATA: Prolactin may increase because of:

a) frequent breast stimulation
b) adrenal overactivity
c) a benign pituitary tumor called a prolactinoma.
d) breastfeeding.
e) low estrogen
f) high androgens
g) medications

Answer 52

a) frequent breast stimulation
c) a benign pituitary tumor called a prolactinoma.
d) breastfeeding.
g) medications

Question 53

Z is a 36-year-old woman whom the clinician has determined has PMS. Z would like to know what her options are to treat her condition. Her symptoms include bloating and fluid retention, moodiness beginning about 5 days before her period begins, feelings of anxiety, breast pain, and craving carbohydrates like chocolate and potato chips. The clinician responds, considering that:

A) alprazolam may be an effective and safe choice to help Z manage her anxiety.
B) lifestyle changes are unlikely to be effective considering how many symptoms Z has.
C) Z should be heavily involved in establishing treatment goals and priorities for herself.
D) a thiazide diuretic may be a helpful option to reduce Z’s fluid retention.

Answer 53

C) Z should be heavily involved in establishing treatment goals and priorities for herself.

Question 54

B, aged 33, presents to the office saying “I just can’t stand myself anymore.” She reports sadness, irritability, crying, and states that she yells at her children too much. To best determine how to help B, the clinician should FIRST inquire about:

A) how old B’s children are.
B) how long B has been feeling this way.
C) how regular B’s menstrual cycles are.
D) how much help B has to care for her children.

Answer 54

B) how long B has been feeling this way.

It’s very important to determine whether or not B has major depression. If she has had these symptoms for 2 weeks, combined with a lack of enjoyment or pleasure and feeling hopeless, B may be depressed.

Question 55

What is the difference between dysmenorrhea and physical symptoms of PMS?

Answer 55

Dysmenorrhea refers specifically to pain or cramping during menstruation itself. PMS physical symptoms usually start before the first day of bleeding and resolve within a day or two after menses begins. Women with PMS may also have dysmenorrhea as part of their symptom clusters, but many women have dysmenorrhea on its own (without any PMS). We mention this because we find this is commonly confused, based on how your textbook presents these two topics.

Question 56

Dysmenorrhea is caused by:

A) excess prostaglandins associated with ovulatory cycles.
B) excess prostaglandins associated with anovulatory cycles.
C) excess progesterone associated with ovulatory cycles
D) excess estrogen associated with ovulatory cycles.

Answer 56

A) excess prostaglandins associated with ovulatory cycles.

Question 57

A 24 year old woman reports dysmenorrhea. Which element is most important in this problem focused gynecologic office visit?

A) Complete review of systems
B) The woman’s description of the problem
C) Physical examination

Answer 57

B) The woman’s description of the problem

Question 58

Dysmenorrhea is:

A) pain during menses.
B) heavy menstrual bleeding.
C) menorrhagia.
D) lack of menstrual periods.

Answer 58

A) pain during menses.

Question 59

What is the clinician’s next step when a Pap result is Atypical Squamous Cells: Cannot Exclude High-grade SIL (ASC-H)?

A) Add HPV DNA testing to determine the next step.
B) Consult with a gynecologist to determine the next step.
C) Refer for colposcopy.
D) Repeat the Pap with HPV testing in 6 months.

Answer 59

C) Refer for colposcopy.

Question 60

To determine management for a low grade squamous intraepithelial lesion (LSIL) Pap using ASCCP guidelines, the clinician must consider the patient’s

A) age
B) age at first intercourse
C) history of genital warts

Answer 60

A) age

Question 61

Which statement is TRUE regarding adolescents and cervical cancer?

A) Cervical cytology testing should begin 3 years after the first sexual intercourse.
B) Cervical cancer is rare in adolescents but cervical dysplasia is fairly common.
C) Cervical cytology testing is not recommended in adolescents because HPV infection is very rare in adolescents.

Answer 61

B) Cervical cancer is rare in adolescents but cervical dysplasia is fairly common.

Question 62

Liquid-based cytology

A) is less expensive than conventional slide-based cytology.
B) is far more sensitive in detecting cervical cancer than conventional slide-based cytology.
C) permits HPV DNA testing but conventional slide-based cytology does not.

Answer 62

C) permits HPV DNA testing but conventional slide-based cytology does not.

Question 63

A 27-year-old woman’s cervical cytology screening result is atypical squamous cells of undetermined significance (ASC-US). The screening was performed using a liquid-based method. What is the PREFERRED management plan?

A) Advise her that she needs to have a colposcopy.
B) Notify her of the need for repeat screening in 4-6 months.
C) Manage based on results of HPV DNA testing.
D) Send her a letter advising repeat screening in 1-2 years.

Answer 63

C) Manage based on results of HPV DNA testing.

Question 64

Which of these statements is TRUE about squamous metaplasia of the cervix?

A) Squamous metaplasia is a normal physiological process that is more prevalent at menopause.
B) Squamous metaplasia is more prevalent among adolescent women under 18 years of age and should be evaluated with a colposcopy.
C) Squamous metaplasia is a normal physiological process that occurs when there is eversion of columnar epithelial cells onto the ectocervix.

Answer 64

C) Squamous metaplasia is a normal physiological process that occurs when there is eversion of columnar epithelial cells onto the ectocervix.

Question 65

A 34 year old woman’s cytology report is: negative with positive high risk HPV. The clinician immediately orders a follow up test to more specifically identify the high risk HPV strains and finds that HPV types 16 and 18 are negative. What is the appropriate management plan?

A) Reassure her and recommend cytology in three years.
B) Recommend repeat cytology and HPV testing in 12 months.
C) Refer for colposcopy.
D) Recommend repeat cytology in 6 months.

Answer 65

B) Recommend repeat cytology and HPV testing in 12 months.

Question 66

A 33 year-old woman has a negative Pap with positive type 18 HPV. The clinician should

A) Consult with a physician to determine management.
B) Verify the HPV status with another sample.
C) Repeat the cytology but not the HPV test in 1 year.
D) Refer for- or perform a colposcopy.

Answer 66

D) Refer for- or perform a colposcopy.

Question 67

The Pap result for a 24 year-old woman is: negative for intraepithelial lesion or malignancy (NILM) with an insufficient sampling of the transformation zone. The clinician should

A) Order HPV DNA testing.
B) Consult with the physician to determine management.
C) Advise screening at the usual interval.
D) Repeat the Pap in 2-4 months.

Answer 67

D) Repeat the Pap in 2-4 months.

Question 68

The clinician collects a Pap on a 34 year-old woman. The result is unsatisfactory cytology with negative HPV. The clinician repeats the Pap 3 months later and the Pap is, again, unsatisfactory. What is the next management step?

A) Repeat cytology again in 2-4 months.
B) Refer for- or perform colposcopy.
C) The clinician must know the HPV result to determine management.
D) Prescribe estrogen cream then repeat cytology in 1 month.

Answer 68

B) Refer for- or perform colposcopy.

Question 69

The clinician collects a Pap from a 45 year-old woman. The Pap result is: Atypical Glandular Cells (AGC) with atypical endometrial cells present. What is the appropriate next step?

A) Repeat the Pap in 6 months.
B) Refer for immediate colposcopy.
C) Refer for- or perform endometrial and endocervical sampling.
D) Order HPV DNA testing.

Answer 69

C) Refer for- or perform endometrial and endocervical sampling.

Question 70

A 22 year-old woman’s Pap result is: low-grade squamous intraepithelial lesion (LSIL). The clinician should

A) Repeat cytology in 12 months.
B) Order HPV DNA testing.
C) Refer for immediate colposcopy.
D) Refer for immediate loop electrosurgical excision (LEEP).

Answer 70

A) Repeat cytology in 12 months.

Question 71

The clinician collects a Pap and HPV from a 32 year-old woman and the results are: cytology negative, HPV positive. The clinician then reviews last year’s results which were: cytology negative, HPV positive. What is the next step now?

A) Refer for colposcopy.
B) Consult with a gynecologist to determine the next step.
C) Repeat both tests in 1 year.
D) Repeat the HPV test now.

Answer 71

A) Refer for colposcopy.

Question 72

A 42-year-old woman’s cervical cytology screening result is high-grade squamous intraepithelial lesions (HSIL). The screening was performed using a liquid-based method. What is the management plan?

A) Contact the laboratory to order HPV DNA testing.
B) Notify her of the need for repeat screening in 4-6 months.
C) Send her a letter advising repeat screening in 1-2 years.
D) Refer her to a physician for colposcopy or loop electrosurgical excision (LEEP).

Answer 72

D) Refer her to a physician for colposcopy or loop electrosurgical excision (LEEP).

Question 73

Which woman is more likely to have endometriosis rather than adenomyosis?

A) 32 year old with dysmenorrhea, painful defecation, and infertility
B) 42 year old with heavy menses and mild dyspareunia

Answer 73

A) 32 year old with dysmenorrhea, painful defecation, and infertility

Question 74

Which woman is more likely to have adenomyosis rather than endometriosis:

A) 23 year old with increasing pelvic pain with menses
B) 45 year old with previously normal menses and no pelvic pain until recently

Answer 74

B) 45 year old with previously normal menses and no pelvic pain until recently

Question 75

A woman who has endometriosis and is symptomatic would be most likely to have

A) menorrhagia.
B) amenorrhea or oligomenorrhea.
C) pain with deep vaginal penetration.

Answer 75

C) pain with deep vaginal penetration.

Question 76

Match the symptoms with the condition: Enlarged uterus on bimanual exam

A) Endometriosis
B) Adenomyosis
C) Both
D) Neither

Answer 76

B) Adenomyosis

Question 77

Match the symptoms with the condition: Tender uterus on bimanual exam

A) Endometriosis
B) Adenomyosis
C) Both
D) Neither

Answer 77

C) Both

Question 78

Match the symptoms with the condition: Uterus maybe fixed to the pelvis or other structures

A) Endometriosis
B) Adenomyosis
C) Both
D) Neither

Answer 78

A) Endometriosis

Question 79

Match the symptoms with the condition: May occur in younger reproductive age women

A) Endometriosis
B) Adenomyosis
C) Both
D) Neither

Answer 79

A) Endometriosis

Question 80

Match the symptoms with the condition: Usually occurs in older reproductive age women

A) Endometriosis
B) Adenomyosis
C) Both
D) Neither

Answer 80

B) Adenomyosis

Question 81

Match the symptoms with the condition: Caused by endometrial tissue implanted outside the uterus

A) Endometriosis
B) Adenomyosis
C) Both
D) Neither

Answer 81

A) Endometriosis

Question 82

Match the symptoms with the condition: Caused by endometrial tissue implanted in the myometrium

A) Endometriosis
B) Adenomyosis
C) Both
D) Neither

Answer 82

B) Adenomyosis

Question 83

Match the symptoms with the condition: May produce amenorrhea

A) Endometriosis
B) Adenomyosis
C) Both
D) Neither

Answer 83

D) Neither

Question 84

Match the symptoms with the condition: Associated with infertility

A) Endometriosis
B) Adenomyosis
C) Both
D) Neither

Answer 84

A) Endometriosis

Question 85

A 14-year-old girl reports lower abdominal cramping, nausea, and diarrhea that occur approximately 4 hours after the onset of menses and last for 1-2 days. What is the MOST LIKELY cause of her symptoms?

A) Adenomyosis
B) Endometriosis
C) Prostaglandins

Answer 85

C) Prostaglandins

Question 86

Which of the following usually cause/s painless bleeding:

A) Endometriosis
B) Adenomyosis
C) Cervical polyps
D) Nabothian cysts
E) Leiomyomata

Answer 86

C) Cervical polyps

Question 87

What are the signs and symptoms of Uterine leiomyomata?

Answer 87

Enlarged uterus, usually asymptomatic, often painless, may be associated with AUB

Question 88

What are the signs and symptoms of Adenomyosis?

Answer 88

Enlarged uterus, usually symmetric, moderate tenderness on palpation, increased menses

Question 89

What are the signs and symptoms of Endometriosis?

Answer 89

Pelvic pain, dysmenorrhea, dyspareunia, abnormal menstrual bleeding

Question 90

What are the signs and symptoms of Cervical Polyps?

Answer 90

Bright red painless bleeding noted after intercourse

Question 91

What are the signs and symptoms of Nabothian Cysts?

Answer 91

White firm nodules visible on the cervix, painless

Question 92

SATA: Which of the following usually cause/s pain?
A) Endometriosis
B) Adenomyosis
C) Cervical polyps
D) Nabothian cysts
E) Leiomyomata

Answer 92

A) Endometriosis
B) Adenomyosis

Question 93

SATA: Which clinical characteristics typically are found with a malignant breast lump?

A) soft mass
B) tenderness
C) fixed mass
D) gritty mass
E) non-tender
F) rubbery mass

Answer 93

C) fixed mass
D) gritty mass
E) non-tender

Question 94

SATA: Which characteristic/s is/are typically found when a woman has a breast cyst?

A) tenderness
B) soft mass
C) mobile mass
D) fixed mass
E) rubbery mass
F) gritty mass

Answer 94

A) tenderness
C) mobile mass

Question 95

Which statement is TRUE regarding an 18-year-old woman with a breast mass?

A) The mass is likely to be a fibroadenoma.
B) A mammogram should be ordered for diagnosis.
C) The mass will likely need to be removed.

Answer 95

A) The mass is likely to be a fibroadenoma.

Question 96

Bloody nipple discharge is most commonly seen in which of the following?

A) Fibroadenoma
B) Intraductal papilloma
C) Mastodynia
D) Paget’s disease

Answer 96

B) Intraductal papilloma

Question 97

SATA: Which clinical characteristics would lead you to suspect a fibroadenoma of the breast?

A) fixed mass
B) smooth mass
C) soft mass
D) gritty mass
E) tenderness
F) not tender
G) mobile mass

Answer 97

B) smooth mass
F) not tender
G) mobile mass

Question 98

Which of the following anti-infectives interferes with the absorption of oral contraceptives?

A) Metronidazole (Flagyl)
B) Rifampin (Rifadin)
C) Azithromycin (Zithromax)

Answer 98

B) Rifampin (Rifadin)

Rifampin is one agent that does interfere with absorption of oral contraceptives, so a contraceptive back-up method is crucial! Lecture notes.

Question 99

Which statement is TRUE regarding self breast exams (SBE)?

A) BSE has not been shown to improve breast cancer mortality.
B) BSE reduces the number of breast biopsies done each year.
C) BSE should be performed monthly to improve breast cancer survival.

Answer 99

A) BSE has not been shown to improve breast cancer mortality.

Question 100

Women experiencing galactorrhea:

A) may have a pituitary tumor.
B) should receive a mammogram.
C) almost always have a history of breastfeeding.

Answer 100

A) may have a pituitary tumor.

Question 101

A 39-year-old woman has bloody discharge from a single duct opening on her nipple. The most likely diagnosis is:

A) fibrocystic breast changes.
B) intraductal papilloma.
C) mammary duct ectasia.

Answer 101

B) intraductal papilloma.

Question 102

A 44-year-old woman discovers a new breast lump, and presents to her clinician for evaluation. The lump is mostly likely a:

A) cyst.
B) fibroadenoma.
C) hamartoma.

Answer 102

A) cyst.

cysts are quite common in the breasts of women in their late 30s and 40s.

Question 103

A 22-year-old woman has breast pain that is unrelated to her menstrual cycle. After a careful history and examination, no etiology is identified. The most appropriate initial treatment is:

A) danazol.
B) evening primrose oil.
C) reassurance.

Answer 103

C) reassurance.

Question 104

Which breast mass characteristic is most suspicious for malignancy?

A) Discrete
B) Immobile
C) Tender

Answer 104

B) Immobile

Question 104

A 32 year-old woman has a mass in her right breast, The mass is 1.5 cm, firm, nontender, fixed, and has a rough texture. A mammogram indicates calcifications. What is the next step in your management plan?

A) Repeat the mammogram in 4-6 months.
B) Repeat the breast exam in 6 months.
C) Refer to breast specialist for a biopsy.

Answer 104

C) Refer to breast specialist for a biopsy.

Question 105

SATA: Which clinical characteristic/s is/are typically found with a lipoma of the breast?

A) soft mass
B) discrete mass
C) tenderness
D) nontender

Answer 105

A) soft mass
B) discrete mass
D) nontender

Question 106

While taking a sexual history the clinician asks the patient, “What do you use for protection?” The patient will understand that the clinician is asking about:

A) both STI prevention and contraception.
B) STI prevention.
C) contraception.
D) Who knows? It would be better to ask “Do you use condoms with intercourse?”

Answer 106

D) Who knows? It would be better to ask “Do you use condoms with intercourse?”

Question 107

A 30-year-old woman is unable to get pregnant and the clinician suspects that it’s related to a sexually transmitted infection that went untreated for a period of time a number of years ago. The test that would be most appropriate to diagnose the patient’s condition is:

A) Serum progesterone levels.
B) Hysterosalpingogram.
C) Colposcopy.

Answer 107

B) Hysterosalpingogram.

Question 108

What is the method of diagnosis for chlamydia?

A) Visual observation, confirmed by biopsy is necessary
B) Western blot
C) NAAT
D) NAAT or wet mount
E) NAAT or culture on Thayer Martin media
F) Viral culture/PCR or serum type specific
G) FTA-ABS

Answer 108

C) NAAT

Question 109

What is the method of diagnosis for trichomoniasis?

A) Visual observation, confirmed by biopsy is necessary
B) Western blot
C) NAAT
D) NAAT or wet mount
E) NAAT or culture on Thayer Martin media
F) Viral culture/PCR or serum type specific
G) FTA-ABS

Answer 109

D) NAAT or wet mount

Question 110

What is the method of diagnosis for syphillis?

A) Visual observation, confirmed by biopsy is necessary
B) Western blot
C) NAAT
D) NAAT or wet mount
E) NAAT or culture on Thayer Martin media
F) Viral culture/PCR or serum type specific
G) FTA-ABS

Answer 110

G) FTA-ABS

Question 111

What is the method of diagnosis for gonorrhea?

A) Visual observation, confirmed by biopsy is necessary
B) Western blot
C) NAAT
D) NAAT or wet mount
E) NAAT or culture on Thayer Martin media
F) Viral culture/PCR or serum type specific
G) FTA-ABS

Answer 111

E) NAAT or culture on Thayer Martin media

Question 112

What is the method of diagnosis for HSV?

A) Visual observation, confirmed by biopsy is necessary
B) Western blot
C) NAAT
D) NAAT or wet mount
E) NAAT or culture on Thayer Martin media
F) Viral culture/PCR or serum type specific
G) FTA-ABS

Answer 112

F) Viral culture/PCR or serum type specific

Question 113

What is the method of diagnosis for HPV-condylomata acuminata?

A) Visual observation, confirmed by biopsy is necessary
B) Western blot
C) NAAT
D) NAAT or wet mount
E) NAAT or culture on Thayer Martin media
F) Viral culture/PCR or serum type specific
G) FTA-ABS

Answer 113

A) Visual observation, confirmed by biopsy is necessary

Question 114

What is the method of diagnosis for HIV?

A) Visual observation, confirmed by biopsy is necessary
B) Western blot
C) NAAT
D) NAAT or wet mount
E) NAAT or culture on Thayer Martin media
F) Viral culture/PCR or serum type specific
G) FTA-ABS

Answer 114

B) Western blot

Question 115

Which of the following statements is true concerning herpes simplex I? Herpes simplex I

A) remains latent in ganglia between outbreaks.
B) is painless.
C) causes post herpetic neuralgia.
D) causes all genital herpes infections.

Answer 115

A) remains latent in ganglia between outbreaks.

Question 116

A 24 year-old man presents to an STI clinic reporting a 3-month history of a discolored rash on the soles of his feet that does not itch.
He had sexual contact with a female sex worker in another country 9 months ago and did not use a condom. He has no other symptoms at this time, but is worried that he may have contracted an illness and requests testing. The clinician considers this history and concludes that the man may require treatment with:

A) penicillin G.
B) valacyclovir.
C) metronidazole.

Answer 116

A) penicillin G.

Question 117

What is the appropriate treatment for chlamydia in a non-pregnant patient?

Answer 117

doxycycline 100 mg orally BID x 7 days

Question 118

What is the appropriate treatment for gonorrhea in a non-pregnant patient?

Answer 118

ceftriaxone (Rocephin) 500 mg IM once

Question 119

What is the appropriate treatment for BV in a non-pregnant patient?

Answer 119

metronidazole (Flagyl) 500 mg po bid x 7 days

Question 120

What is the appropriate treatment for vulvovaginal candidiasis in a non-pregnant patient?

Answer 120

miconazole 2% vaginal cream 5gm intravaginally x3days

Question 121

What is the appropriate treatment for syphillis-primary in a non-pregnant patient?

Answer 121

benzathine penicillin G 2.4 mu IM once

Question 122

What is the appropriate treatment for trichomoniasis in a non-pregnant patient?

Answer 122

metronidazole (Flagyl) 500 mg po bid x 7 days

Question 123

What is the appropriate treatment for HSV in a non-pregnant patient?

Answer 123

Acyclovir 400mg po tid 7-10d

Question 124

What is the appropriate treatment for HPV-condylomata acuminata in a non-pregnant patient?

Answer 124

imiquimod 5% cream

Question 125

What is the appropriate treatment for HIV prophylaxis in a non-pregnant patient?

Answer 125

Truvada 200/300mg 1 tab PO daily

Question 126

An 18-year-old client has multiple blister-like lesions, some crusted with yellow on her labia and inner thighs. She also has enlarged painful inguinal lymph nodes. Her history includes malaise, low grade fever, and a new sexual partner. What is the recommended pharmacological treatment for this condition?

A) penicillin (Pen V K)
B) azithromycin (Zithromax)
C) viscous xylocaine (Lidocaine)
D) acyclovir (Zovirax)

Answer 126

D) acyclovir (Zovirax)

Treat all patients who are experiencing initial genital herpes infections, regardless of severity, treatment of choice acyclovir (Zovirax). Obj:Plan / Management

Question 127

A sign/symptom of secondary syphilis is:

A) Condylomata lata
B) Dementia
C) Neuropathy of distal extremities
D) Purulent vaginal discharge

Answer 127

A) Condylomata lata

Question 128

A 19-year-old woman was recently diagnosed with genital herpes. Which statement by this woman indicates that she needs further education about this infection? (Which statement is wrong?)

A) I can only give someone the virus when I am having an outbreak.
B) Usually later outbreaks are not as severe as the first outbreak.
C) I can take medication to cut down on the number of outbreaks I have.

Answer 128

A) I can only give someone the virus when I am having an outbreak.

Question 129

Which of the following findings is most typical of acute pelvic inflammatory disease?

A) Decreased erythrocyte sedimentation rate
B) Cervical motion tenderness
C) Unilateral pelvic tenderness
D) Missed menstrual period

Answer 129

B) Cervical motion tenderness

Question 130

How many different types of Emergency Contraception are available?

A) 1
B) 2
C) 3
D) 4

Answer 130

D) 4

Yes, the options are: progestogen only pill (Levonorgestrel – Plan B, Next Step and generics), combined oral contraceptives in large doses (see Managing Contraception for details), ulipristal acetate ( brand name is ella – a progestogen antagonist), and insertion of a copper IUD.

Question 131

The contraceptive ring (Nuvaring) is:

A) less effective than combined oral contraceptives or the Evra contraceptive patch.
B) placed in the vagina so that the cervix is within the center opening of the ring.
C) worn continuously for 21 days then removed for 7 days.

Answer 131

C) worn continuously for 21 days then removed for 7 days

Question 132

What is the route of administration of Depo Provera?

Answer 132

IM injection

Question 133

What is the route of administration of Evra?

Answer 133

Transdermal patch

Question 134

What is the route of administration of Skyla?

Answer 134

IUD

Question 135

What is the route of administration of Nexplanon?

Answer 135

Subdermal implant

Question 136

SATA: Which of the following contraceptive methods contain estrogen:

A) Combined oral contraceptives
B) Progestin only oral contraceptive pills (POPs)
C) Evra contraceptive patch
D) Depo Provera (depomedroxyprogesterone acetate)
E) Implanon/Nexplanon
F) NuvaRing contraceptive ring
G) Mirena (levonorgestrel intrauterine system)
H) Paragard (Cu 380A intrauterine device)

Answer 136

A) Combined oral contraceptives
C) Evra contraceptive patch
F) NuvaRing contraceptive ring

Question 137

For which woman are combined oral contraceptives contraindicated?

A) 19-year-old who smokes a pack of cigarettes per day.
B) 25-year-old who has migraine headaches with aura.
C) 42-year-old who is in good health and does not smoke.

Answer 137

B) 25-year-old who has migraine headaches with aura.

Question 138

A woman is going to begin taking combined oral contraceptive pills using the Quick Start method. Her last menstrual period was normal and it began 9 days ago. Regarding the need for a backup method:

A) She does not need to use a backup method. She is protected immediately.
B) She must use a backup method for one complete cycle.
C) She should use a backup method for 7 days.

Answer 138

C) She should use a backup method for 7 days.

Question 139

A 32-year-old woman would like to begin using a diaphragm. Which statement by the patient indicates that the clinician needs to educate the woman further?

A) “A diaphragm might increase my chances of getting a yeast infection.”
B) “I can soak my diaphragm in mouthwash if it develops an odor.”
C) “I can safely leave a diaphragm in my vagina for 48 hours.”

Answer 139

C) “I can safely leave a diaphragm in my vagina for 48 hours.”

Question 140

What pregnancy termination option(s) exist(s) for a woman with an anencephalic fetus at 19 weeks gestation?

A) Surgical abortion
B) Medical abortion
C) Levonorgestrel 1500 mg (Plan B)
D) Insertion of a copper IUD

Answer 140

A) Surgical abortion

Question 141

What compounds can cause an abortion after implantation?

A) mifepristone and misoprostol
B) levonorgestrel
C) ulipristal acetate
D) combined oral contraceptive pills
E) progestogen only oral contraceptive pills

Answer 141

A) mifepristone and misoprostol

Question 142

A 45-year-old woman with significant heavy menstrual bleeding is diagnosed with fibroids by ultrasound. Regarding the levonorgestrel intrauterine system (LNG-IUS) (Mirena) as a treatment option:

A) The LNG-IUS is not a treatment option because it’s contraindicated.
B) The LNG-IUS is a possible therapy if the fibroids don’t distort the uterine cavity.
C) The copper IUD (Paragard) would be a better option to treat her fibroids.

Answer 142

B) The LNG-IUS is a possible therapy if the fibroids don’t distort the uterine cavity.

Question 143

T/F: Users of progestin only pills can expect to bleed during the hormone free week a the end of the pill package.

Answer 143

False

Question 144

A woman who is 6 weeks pregnant has a Paragard IUD in place and wishes to continue the pregnancy. She should be advised of which of the following?

A) Normal pregnancy is unlikely and she should have a therapeutic abortion.
B) The IUD should be left in place to reduce the risk of spontaneous abortion.
C) The IUD should be removed today to reduce the risk of spontaneous abortion.

There is an increased risk of congenital anomalies from the copper in the IUD.

Answer 144

B) The IUD should be left in place to reduce the risk of spontaneous abortion.

Question 145

Which contraceptive method is SAFE for the smoker over age 35?

A) NuvaRing
B) LNG-IUS (Mirena)
C) Combined oral contraceptives

Answer 145

B) LNG-IUS (Mirena)

This is the only progestin only option provided.

Question 146

SATA: Which of the following contraceptive methods are usually associated with irregular bleeding after the first three months of use:

A) Paragard (C8 380A intrauterine device)
B) Combined oral contraceptives
C) Progestin only oral contraceptive pills (POPs)
D) Evra contraceptive patch
E) NuvaRing
F) Mirena (levonorgestrel intrauterine system)
G) Male condom
H) Female condom
I) Diaphragm
J) Implanon/Nexplanon
K) DepoProvera (depot medroxyprogesterone acetate)

Answer 146

C) Progestin only oral contraceptive pills (POPs)
F) Mirena (levonorgestrel intrauterine system)
J) Implanon/Nexplanon
K) DepoProvera (depot medroxyprogesterone acetate)

Question 147

Which woman is most likely to benefit from cancer protection offered by combined oral contraceptives?

A) 38-year-old whose sister and maternal aunt have had breast cancer
B) 40-year-old who has human papillomavirus and is at high-risk for cervical cancer
C) 42-year-old whose mother died of ovarian cancer

Answer 147

C) 42-year-old whose mother died of ovarian cancer

Question 148

Which option is best for exclusively breastfeeding mothers who desire hormonal contraception?

A) Combined oral contraceptives
B) NuvaRing
C) Levonorgestrel-releasing intrauterine system (Mirena)
D) Ortho Evra patch

Answer 148

C) Levonorgestrel-releasing intrauterine system (Mirena)

Question 149

The most common side effect of Depo-Provera in the first months of use is:

A) Acne.
B) Hair loss.
C) Irregular bleeding.
D) Weight gain.

Answer 149

C) Irregular bleeding.

Question 150

Identify the correct description of a method from the following choices. Only one answer is correct. Recall that “top-tier” means the method is among the most effective group of contraceptives.

A) NuvaRing is a combined hormonal method that is considered top-tier in effectiveness.
B) Paragard contains progestins and is considered top-tier in effectiveness.
C) DepoProvera, the injectable method, contains no estrogen and is considered top-tier in effectiveness.
D) Nexplanon, the implant, contains no estrogen and is considered top tier in effectiveness.

Answer 150

D) Nexplanon, the implant, contains no estrogen and is considered top tier in effectiveness.

Question 151

What are the active ingredients in DMPA?

Answer 151

Progestin

Question 152

What are the active ingredients in Evra?

Answer 152

Estrogen and Progestin

Question 153

What are the active ingredients in Nuvaring?

Answer 153

Estrogen and Progestin

Question 154

What are the active ingredients in Nexplanon?

Answer 154

Progestin

Question 155

What are the active ingredients in Combined Pills?

Answer 155

Estrogen and Progestin

Question 156

What are the active ingredients in Paraguard?

Answer 156

Copper

Question 157

What are the active ingredients in mini-pills?

Answer 157

Progestin

Question 158

What are the active ingredients in mirena?

Answer 158

Progestin

Question 159

SATA: Which of the following can be used for Emergency Contraception?

A) Mirena (levonorgestrel IUD)
B) Paragard (copper IUD)
C) monophasic combined oral contraceptive pills
D) ella (ulepristol acetate)
E) Levonorgestrel pills such as Plan B, Next Step, or generic LNG
F) Micronor (progestin only oral contraceptive pills)
G) Any of the pills in a triphasic combined oral contraceptive pill pack

Answer 159

B) Paragard (copper IUD)
C) monophasic combined oral contraceptive pills
D) ella (ulepristol acetate)
E) Levonorgestrel pills such as Plan B, Next Step, or generic LNG

Question 160

A 40-year-old woman requests an effective method of contraception. She is single, non-monogamous, takes nitrofurantoin (Macrobid) daily for UTI suppression, and smokes 10 cigarettes a day. The clinician considers safe and effective options for this client and rules out:

A) Nexplanon, because this method should not be used in women with multiple partners.
B) NuvaRing, because the patient smokes.
C) progestin-only pills, because they are less effective when combined with nitrofurantoin.

Answer 160

B) NuvaRing, because the patient smokes.

Combined hormonal contraception is contraindicated in smokers >35 years old. This is the only choice that is combined.

Question 161

If the clinician asks a patient, “Do you use protection?,” the patient will understand that s/he is asking about:

A) Contraception.
B) STI prevention.
C) both STI prevention and contraception.
D) Who knows? Better to ask specifically about condom use.

Answer 161

D) Who knows? Better to ask specifically about condom use.

Question 162

T/F: Users of progestin only pills should be given the same instructions as users of combined oral contraceptives.

Answer 162

False

Question 163

A woman is going to begin taking combined oral contraceptive pills using the Quick Start method. Her last menstrual period was normal and it began 9 days ago. Regarding the need for a backup method:

A) She does not need to use a backup method. She is protected immediately.
B) She must use a backup method for one complete cycle.
C) She should use a backup method for 7 days.

Answer 163

C) She should use a backup method for 7 days.

Question 164

A woman has a LNG-IUS (Mirena) and has recurrent ovarian cysts. The most certain way for this woman to prevent recurrent ovarian cysts is

A) switch her contraceptive method to depot medroxyprogesterone acetate (DMPA).
B) replace her LNG-IUS with a copper IUD.
C) remove the LNG-IUS and begin a combined hormonal contraceptive.

Answer 164

C) remove the LNG-IUS and begin a combined hormonal contraceptive.

Question 165

A 26 year old woman has just been diagnosed with asymptomatic trichomoniasis. She asks, “Does this mean he’s been cheating on me?” The best response would be:

A) “Well, we cannot really say, since you may have had this infection for years. It often causes no symptoms.”
B) “No, trichomoniasis is not a sexually transmitted disease, so he did not give it to you.”
C) “I’m sorry to have to tell you that trichomoniasis is a sexually transmitted disease, so you did get it from your sexual partner.”

Answer 165

A) “Well, we cannot really say, since you may have had this infection for years. It often causes no symptoms.”

Question 166

A contraceptive patch user forgot to apply her new patch after her last patch-free week. She should have applied a new patch on Monday and now it’s Thursday. Which is appropriate advice?

A) Wait until you have your next period and then put your next patch on.
B) Put your new patch on today and use a backup method for 7 days.
C) Do a pregnancy test today. If it’s negative, put your new patch on. There’s no need to use a backup method.

Answer 166

B) Put your new patch on today and use a backup method for 7 days.

Question 167

A 42-year-old woman wants a highly effective form of contraception and asks how effective a copper IUD is. The most appropriate response from the clinician would be:

A) “Fewer than 1 in 100 women get pregnant each year using this method, which is similar to the effectiveness of female sterilization.”
B) “For every 10,000 women who use the copper IUD, 80 get pregnant each year.”
C) “The copper IUD is extremely effective and its perfect use rate is very close to typical use, with 0.8 pregnancies per 100 women per year.”

Answer 167

A) “Fewer than 1 in 100 women get pregnant each year using this method, which is similar to the effectiveness of female sterilization.”

While B is factually correct, it’s hard for women to understand numbers like 80 in 10,000, and she has nothing to compare this with (i.e. how well this works compared to other methods.)

Question 168

A diaphragm must be left in place for at least _____ hours after intercourse?

A) 1
B) 4
C) 6
D) 8

Answer 168

C) 6

Question 169

T/F: Women over 35 who smoke should not be prescribed hormone therapy for vasomotor symptoms.

Answer 169

False

Question 170

SATA: Which of these estrogen treatments require the addition of a progestogen to protect a woman’s endometrium from hyperplasia?

A) Conjugated estrogens like Premarin
B) Vaginal estrogen cream (Estrace)
C) EstRing
D) FemRing

Answer 170

A) Conjugated estrogens like Premarin
D) FemRing

Question 171

SATA: L.L. is 48 years old and in a long term relationship with a man. She is experiencing vasomotor symptoms that are disrupting her life. What else do you need to know to safely prescribe hormone therapy for her? (Check all that apply.)

A) When was her last menstrual period?
B) Has she had a hysterectomy?
C) How many times has she been pregnant?
D) Is she using contraception?
E) Does she have a family history of DVT?

Answer 171

A) When was her last menstrual period?
B) Has she had a hysterectomy?
D) Is she using contraception?

Question 172

T/F: Combined hormonal contraception is contraindicated for women over 35 who smoke.

Answer 172

True

Question 173

T/F: Perimenopausal/menopausal estrogen therapy to control vasomotor symptoms is contraindicated in women over 35 who smoke.

Answer 173

False

Question 174

T/F: Combined hormonal contraceptives can help to control vasomotor symptoms.

Answer 174

True

Question 175

T/F: Hormone therapy like Premarin (conjugated estrogens) prescribed for vasomotor symptoms can also provide contraception.

Answer 175

False

Question 176

SATA: S.N. smoked for 20 years, but gave it up 5 years ago. She is now 47 years old and experiencing severe vasomotor symptoms. Lifestyle adjustments have not helped. Her LMP was 14 months ago.

A) Mirena IUD (an LNG-IUD) could provide endometrial protection, but will not control her hot flashes.
B) A contraceptive method will treat both her vasomotor symptoms and provide contraception.
C) It is safe to prescribe estrogen to this person.

Answer 176

A) Mirena IUD (an LNG-IUD) could provide endometrial protection, but will not control her hot flashes.
C) It is safe to prescribe estrogen to this person.

Although she does not need contraception, an LNG-IUD could deliver the small dose of progestogen that she needs to protect her endometrium from hyperplasia while taking estrogen.

Yes, as a former smoker she needs to know that resuming smoking while taking estrogen could put her at high risk for stroke and blood clots, as long as she does not smoke estrogen treatment is not contraindicated.

Question 177

What medication matches this description?

Vaginal ring containing estrogen in high dose to treat systemic symptoms of menopause

Answer 177

Femring

Question 178

What medication matches this description?

Vaginal ring containing low dose estrogen to treat vaginal atrophy

Answer 178

EstRing

Question 179

What medication matches this description?

Vaginal cream for local treatment of vaginal dryness of menopause

Answer 179

Estrace

Question 180

What medication matches this description?

Vaginal ring containing estrogen and progesterone in appropriate doses for contraception

Answer 180

Nuvaring

Question 181

What medication matches this description?

Oral estrogen for systemic treatment of both vaginal and vasomotor symptoms of menopause

Answer 181

Premarin

Question 182

SATA: A.C. is 40 years old. She has never had surgery. She is sexually active. Her LMP was last week. She and her male partner have been using condoms irregularly for contraception. She smokes 1/2 a pack of cigarettes a day. Which treatments would be appropriate to provide contraception and treat her vasomotor symptoms?

A) Skyla IUD (an LNG-IUD) and EstRing
B) Depo Provera (DMPA) and FemRing
C) Depo Provera (DMPA)
D) NuvaRing
E) Combined oral contraceptives
F) FemRing
G) EstRing
H) Mirena IUD (an LNG-IUD) and Premarin (conjugated estrogens)

Answer 182

B) Depo Provera (DMPA) and FemRing
H) Mirena IUD (an LNG-IUD) and Premarin (conjugated estrogens)

Question 183

A 51-year-old woman wants to know if she is “done going through the change?” Which would be most accurate for making a menopause diagnosis?

A) Date of her last menstrual period
B) Date she began having hot flashes and how frequently they occur
C) Serum follicle-stimulating hormone (FSH) level

Answer 183

A) Date of her last menstrual period

Question 184

The long term effects of cortisol dysregulation include

A) osteoporosis and increased abdominal fat.
B) dry skin and decreased libido.
C) diaphoresis and anxiety.
D) increased platelet activity and serum lipid levels.

Answer 184

A) osteoporosis and increased abdominal fat.

Question 185

A 49-year-old woman has menstrual cycles that have become increasingly irregular over the past year and now she hasn’t had a period for three months. She is having hot flashes two to three times per week. Physical examination is normal, and a urine pregnancy test is negative. What is the most likely diagnosis?

Answer 185

Perimenopause

Question 186

Considering the pathophysiology of osteoporosis, which hormone influences osteoblast activity and production of cytokines that modulate bone resorption and formation?

A) Parathyroid hormone
B) Glucocorticoid
C) Growth hormone
D) Estrogen

Answer 186

D) Estrogen

Question 187

B. is a 62-year-old woman who was menopausal at age 50. She had a difficult time with hot flashes for the first year or two after menopause but has not had a problem with them for about 10 years now. B.’s MAIN concerns NOW are vaginal dryness, daily vaginal discomfort, and external vaginal and vulvar pain with intercourse. B. recently had a DEXA scan and her T-score was -2.6. B.’s medical history is significant for tension headaches, GERD, and hemorrhoids. Her surgical history includes a tonsillectomy at age 14, a hysterectomy (uterus removed but not ovaries) at age 44 for the treatment of heavy bleeding, and a breast mass biopsy (benign) last year.

B. tells the clinician that her friend takes an oral form of hormone therapy (HT) and she would like to start that now. An appropriate response is:

A) A product with a different ROUTE would be better tailored to the symptoms she is most concerned about.
B) HT is medically contraindicated to be used for more than 5 years.
C) Traditional HT has health risks but personalized therapy with custom compounded HT is proven to be safer.

Answer 187

A) A product with a different ROUTE would be better tailored to the symptoms she is most concerned about.

Yes, although an oral HT formulation could help with her symptoms, clinicians should first look to a vaginal preparation that would target this woman’s particular symptoms of vaginal discomfort. This has the benefit of avoiding exposing her to the risks of systemic HT when her only concerns are vaginal. See SL p. 312 for a listing of vaginal preparations. See also the 2012 NAMS position statement on HT, p. 266: local ET is preferred when treating solely vaginal symptoms.

Question 188

J. declines “regular hormone therapy” because she’s concerned about breast cancer risk she’s read about in the newspaper. Considering alternatives, which is true?

A) Fluoxetine 20 mg (Prozac) orally daily could help decrease hot flashes but could exacerbate other symptoms she reports.
B) Compounded bioidentical hormones are safer than commercially available, traditional hormone therapy options and compounded bioidentical hormones do not increase breast cancer risk.
C) Evening primrose oil 3 gm total orally daily has been shown to be helpful in decreasing vasomotor symptoms.
D) Raloxifene 60 mg (Evista) orally once daily could help decrease hot flashes and also provide bone density benefits.

Answer 188

A) Fluoxetine 20 mg (Prozac) orally daily could help decrease hot flashes but could exacerbate other symptoms she reports.

Yes, SSRIs have been shown to help decrease vasomotor symptoms but they also can have the negative effect of decreased libido. This woman already has decreased libido. See the table on p. 311 of SL 2nd edition.

Question 189

B. is a 62-year-old woman who was menopausal at age 50. She had a difficult time with hot flashes for the first year or two after menopause but has not had a problem with them for about 10 years now. B.’s MAIN concerns NOW are vaginal dryness, daily vaginal discomfort, and external vaginal and vulvar pain with intercourse. B. recently had a DEXA scan and her T-score was -2.6. B.’s medical history is significant for tension headaches, GERD, and hemorrhoids. Her surgical history includes a tonsillectomy at age 14, a hysterectomy (uterus removed but not ovaries) at age 44 for the treatment of heavy bleeding, and a breast mass biopsy (benign) last year.
When B. asks about over-the-counter treatments for her vulvovaginal concerns, the clinician’s best advice is:

A) A mild vinegar and water vaginal rinse will increase her comfort.
B) A vaginal moisturizer may work better than a vaginal lubricant in promoting overall vaginal health.
C) Apply a thin layer of petroleum jelly to the vulva and vaginal introitus twice weekly.
D) Avoid using vitamin E oil because it is damaging to vaginal tissue.

Answer 189

B) A vaginal moisturizer may work better than a vaginal lubricant in promoting overall vaginal health.

Yes, according to SL 2nd edition p. 305, vaginal moisturizers, unlike vaginal lubricants, replenish and maintain fluids in vaginal epithelial cells, can give long-lasting relief, and can help support a normal vaginal pH. Lubricants are best used at the time of sex for more comfortable intercourse.

Question 190

To make a menopause diagnosis, the clinician MUST:

A) order FSH and estrogen levels.
B) ask the age of J.’s mother’s and sisters’ menopause.
C) ask how long J. has smoked.
D) ask the date of J.’s last period.

Answer 190

D) ask the date of J.’s last period.

Question 191

B. is a 62-year-old woman who was menopausal at age 50. She had a difficult time with hot flashes for the first year or two after menopause but has not had a problem with them for about 10 years now. B.’s MAIN concerns NOW are vaginal dryness, daily vaginal discomfort, and external vaginal and vulvar pain with intercourse. B. recently had a DEXA scan and her T-score was -2.6. B.’s medical history is significant for tension headaches, GERD, and hemorrhoids. Her surgical history includes a tonsillectomy at age 14, a hysterectomy (uterus removed but not ovaries) at age 44 for the treatment of heavy bleeding, and a breast mass biopsy (benign) last year.

Expected and normal physical exam findings for B. are:

A) Wet prep: lower pH of vaginal secretions.
B) Speculum exam: decreased vaginal rugae.
C) Wet prep: increased lactobacilli.

Answer 191

B) Speculum exam: decreased vaginal rugae.

Yes, as a result of decreased estrogen levels, menopausal women usually have decreased vaginal rugae making vaginal tissue smooth. See SL 2nd edition p. 296. This also can contribute to discomfort with intercourse because the smooth, unrugated vaginal tissue has difficulty stretching to accommodate vaginal penetration.

Question 192

J. is a 52-year-old woman who comes to the office for a problem visit because she hasn’t had a period recently. She is having 8 -10 hot flashes during the day and wakes 3-4 times each night with sweats that require changing the sheets. She does not sleep at night even though she has to get up at 5 am to go to work. She is not interested in having sex with her husband. She feels as though she is forgetful, and just wants to cry because she does not know what is wrong with her. J.’s mother had osteoporosis and had a stroke at age 82. J.’s sister had endometrial cancer, and J.’s maternal grandmother had dementia. J.’s medical history is significant for fibrocystic breast changes. She is a smoker. She has never had surgery.

J.’s mother had told her that she should only have menopausal symptoms for the first few months after her periods stop or something is wrong. The clinician responds, understanding that:
A) The timing and severity of symptomatic perimenopause varies from woman to woman.
B) These symptoms LIKELY represent depression or pituitary dysfunction.
C) J. should first try hormone therapy to find out if it would relieve her symptoms.
D) Monitoring J.’s hormone levels will be helpful in managing her symptoms.

Answer 192

A) The timing and severity of symptomatic perimenopause varies from woman to woman.

Yes, it is not possible to predict how long a woman will have symptoms or how severe the symptoms will be in the perimenopause. There is a wide range of normal. See SL 2nd edition p. 295 about the presentation and variation of the menopause experience.

Question 193

J. is a 52-year-old woman who comes to the office for a problem visit because she hasn’t had a period recently. She is having 8 -10 hot flashes during the day and wakes 3-4 times each night with sweats that require changing the sheets. She does not sleep at night even though she has to get up at 5 am to go to work. She is not interested in having sex with her husband. She feels as though she is forgetful, and just wants to cry because she does not know what is wrong with her. J.’s mother had osteoporosis and had a stroke at age 82. J.’s sister had endometrial cancer, and J.’s maternal grandmother had dementia. J.’s medical history is significant for fibrocystic breast changes. She is a smoker. She has never had surgery.

Regarding J.’s family, medical, and surgical histories, which is true as J. considers hormone therapy (HT)?

A) J. should use HT to decrease her risk for developing dementia.
B) J. could reduce her risk for osteoporosis by using estrogen.
C) J.’s sister’s endometrial cancer makes HT medically contraindicated for J.
D) J.’s fibrocystic breast changes make HT medically contraindicated.

Answer 193

B) J. could reduce her risk for osteoporosis by using estrogen.

Yes, while clinicians should not prescribe estrogen for the sole reason of osteoporosis prevention, estrogen therapy can help increase bone density. See the NAMS 2012 HT Position Statement p. 258: Osteoporosis.

Question 194

The mechanism responsible for the eventual cessation of ovulation and menses at menopause is that the:

A) Circulating serum estrogen levels are elevated.
B) Circulating serum FSH levels are low.
C) Ratio of progesterone to estrogen increases.
D) The number of ovarian follicles is dramatically decreased.

Answer 194

D) The number of ovarian follicles is dramatically decreased.

Question 195

B. is a 62-year-old woman who was menopausal at age 50. She had a difficult time with hot flashes for the first year or two after menopause but has not had a problem with them for about 10 years now. B.’s MAIN concerns NOW are vaginal dryness, daily vaginal discomfort, and external vaginal and vulvar pain with intercourse. B. recently had a DEXA scan and her T-score was -2.6. B.’s medical history is significant for tension headaches, GERD, and hemorrhoids. Her surgical history includes a tonsillectomy at age 14, a hysterectomy (uterus removed but not ovaries) at age 44 for the treatment of heavy bleeding, and a breast mass biopsy (benign) last year.

The clinician should:

A) Recommend a repeat DEXA in 6 months to determine whether B.’s BMD is trending up or down.
B) Evaluate B.’s DEXA Z-score to make a determination about osteoporosis treatment.
C) Recognize that a bisphosphonate (e.g. alendronate) is a reasonable option for treatment except that adverse effects of bisphosphonates might be problematic for this woman.

Answer 195

C) Recognize that a bisphosphonate (e.g. alendronate) is a reasonable option for treatment except that adverse effects of bisphosphonates might be problematic for this woman.

Yes, bisphosphonates are first line therapy for treatment of osteoporosis. However bisphosphonates can exacerbate reflux, esophagitis, and ulceration of the esophagus. A woman with a diagnosis of GERD would be particularly at risk for esophageal problems with bisphosphonate therapy. See SL p. 303 for “Considerations” for using alendronate, risendronate, and ibandronate. Also see the NAMS 2010 position statement, p. 40 for adverse events with bisphosphonate therapy.

Question 196

J. is a 52-year-old woman who comes to the office for a problem visit because she hasn’t had a period recently. She is having 8 -10 hot flashes during the day and wakes 3-4 times each night with sweats that require changing the sheets. She does not sleep at night even though she has to get up at 5 am to go to work. She is not interested in having sex with her husband. She feels as though she is forgetful, and just wants to cry because she does not know what is wrong with her. J.’s mother had osteoporosis and had a stroke at age 82. J.’s sister had endometrial cancer, and J.’s maternal grandmother had dementia. J.’s medical history is significant for fibrocystic breast changes. She is a smoker. She has never had surgery.

If J. wants to proceed with pharmacologic therapy for vasomotor symptom relief, the clinician could appropriately write which prescription?

A) Conjugated equine estrogen (Premarin) orally once daily.
B) Ethinyl estradiol + norethindrone acetate (Femhrt) orally once daily.
C) Norethindrone acetate (Aygestin) orally once daily.
D) Estradiol hemihydrate (Vagifem) once daily per vagina for two weeks then twice weekly.

Answer 196

B) Ethinyl estradiol + norethindrone acetate (Femhrt) orally once daily.

Yes, this therapy contains estrogen to help her vasomotor symptoms and a progestogen to protect her endometrium from the increased risk of endometrial cancer that would come with unopposed estrogen. Femhrt is listed as a combination EPT product on p. 310 of SL 2nd edition.

Question 197

B. is a 62-year-old woman who was menopausal at age 50. She had a difficult time with hot flashes for the first year or two after menopause but has not had a problem with them for about 10 years now. B.’s MAIN concerns NOW are vaginal dryness, daily vaginal discomfort, and external vaginal and vulvar pain with intercourse. B. recently had a DEXA scan and her T-score was -2.6. B.’s medical history is significant for tension headaches, GERD, and hemorrhoids. Her surgical history includes a tonsillectomy at age 14, a hysterectomy (uterus removed but not ovaries) at age 44 for the treatment of heavy bleeding, and a breast mass biopsy (benign) last year.

The clinician considers prescribing a progestogen for B. Which statement reflects an appropriate prescribing decision WITH an appropriate rationale?

A) The clinician decides NOT to prescribe a progestogen because her medical history makes progestogen medically contraindicated.
B) The clinician decides NOT to prescribe a progestogen because it is not needed based on her surgical history.
C) The clinician decides to prescribe a progestogen because unopposed estrogen is dangerous for B.

Answer 197

B) The clinician decides NOT to prescribe a progestogen because it is not needed based on her surgical history.

Yes, the only usual reason to prescribe a progestogen for hormone therapy is for endometrial protection for women taking systemic-dosed estrogen. This woman has had a hysterectomy and thus does not need a progestogen. See SL 2nd edition p. 313 under HT Protocols and Formulations. Unopposed estrogen increases the risk for endometrial hyperplasia and cancer for women who have a uterus. This patient does not.

Question 198

Which T-score indicates the most bone loss?

A) -3
B) -2
C) -1

Answer 198

A) -3

Question 199

What is the dietary calcium requirement for a premenopausal under the age of 50?

Answer 199

1000 mg/day

Question 200

What is the dietary calcium requirement for a postmenopausal on estrogen and under the age of 65?

Answer 200

1000mg/day

Question 201

What is the dietary calcium requirement for a postmenopausal, not on estrogen?

Answer 201

1500 mg/day

Question 202

What is the dietary calcium requirement for a premenopausal over the age of 50?

Answer 202

1200 mg/day

Question 203

You diagnose your patient with osteoporosis after reviewing her DEXA scan result. You start her on a biphosphonate. How frequently should you monitor the effect of this drug by repeating a DEXA scan?

A) After three years
B) After one year
C) After 6 months
D) After two years

Answer 203

D) After two years

Question 204

A 54 year-old woman has painful intercourse due to vaginal atrophy. She would like to try a local estrogen preparation, such as Vagifem tablets or Estrace cream, to help decrease her vaginal symptoms. Which is TRUE concerning this therapy choice?

A) There’s no need for a progestogen for this woman.
B) This therapy is also likely to help decrease her hot flashes.
C) Transient vaginal bleeding is common after beginning this therapy.

Answer 204

A) There’s no need for a progestogen for this woman.

Question 205

Signs that ovulation may occur TODAY include all EXCEPT:

A) increased basal body temperature.
B) slippery cervical mucus.
C) soft cervix with everted os.

Answer 205

A) increased basal body temperature.

Question 206

A menopausal woman with hot flashes might choose to take a drug from which class of medications if she wants to avoid hormones?

A) A selective serotonin reuptake inhibitor
B) A bisphosphonate
C) An antiviral

Answer 206

A) A selective serotonin reuptake inhibitor

Question 207

A woman recently had a complete hysterectomy. She has nausea and breast tenderness since she started oral estrogen therapy. Which of the following strategies is a reasonable approach to decrease these side effects:

A) Change to a transdermal estrogen.
B) Change to an equivalent dose of bioidentical estrogen
C) Add a low dose progestogen.

Answer 207

A) Change to a transdermal estrogen.

Question 208

Each of these women has dysuria, urinary urgency, and urinary frequency. The clinician is going to treat for a UTI. Which of them does NOT need a urine culture as part of the management process?

A) 22-year-old with a fever, chills, and flank pain
B) 31-year-old whose first urinary tract infection occurred nine months ago
C) 34-year-old who has these symptoms after a course of antibiotics for a UTI

Answer 208

B) 31-year-old whose first urinary tract infection occurred nine months ago

Question 209

T/F: Basal body temperature can tell a woman when she is going to ovulate

Answer 209

False

Question 210

A 16-year-old girl has not yet had a period. She has breast development and pubic hair. The NEXT step in the evaluation is:

A) Check TSH and prolactin levels.
B) Order a pelvic ultrasound.
C) Check FSH and LH levels.

Answer 210

B) Order a pelvic ultrasound.

Question 211

Which woman is experiencing a danger warning sign related to combined hormonal contraceptives?

A) 22-year-old with blurred vision.
B) 34-year-old with abnormal bleeding.
C) 40-year-old with sudden nausea and vomiting.

Answer 211

A) 22-year-old with blurred vision.

Question 212

Which woman is an appropriate candidate to evaluate for testosterone therapy?

A) 47-year-old perimenopausal woman with anorgasmia since she began antidepressant therapy
B) 52-year-old postmenopausal woman whose hot flashes have not responded to estrogen and progestogen therapy
C) 55-year-old postmenopausal woman with decreased sexual desire that is causing her personal distress

Answer 212

C) 55-year-old postmenopausal woman with decreased sexual desire that is causing her personal distress

Question 213

Risk factors for urinary incontinence include all EXCEPT:

A) Inadequate beverage intake
B) obesity
C) diabetes

Answer 213

A) Inadequate beverage intake

Question 214

A 52-year-old woman reports a gradual onset of painful insertional sex. To determine a cause, the most important question to ask her is:

A) “When was your last menstrual period?”
B) “Do you have sex with men, women, or both?”
C) “Do you generally have orgasms?”

Answer 214

A) “When was your last menstrual period?”

Yes! If a woman is menopausal, she may develop problems with lubrication and dyspareunia. Understanding whether she had a period a few weeks ago or a few years ago will help you figure out whether this may be a contributing factor.

Question 215

A 26-year-old woman plans to begin trying to become pregnant in about one year. Which method would be the LEAST appropriate for this woman?

A) Contraceptive patch
B) Progestin-only injection (Depo-Provera)
C) Progestin-only pills

Answer 215

B) Progestin-only injection (Depo-Provera)

Question 216

To determine whether a patient should be offered osteoporosis drug therapy, the clinician should consider all of the following EXCEPT:

A) Z-score.
B) BMI.
C) family history of hip fracture.

Answer 216

A) Z-score.

Question 217

A 30-year-old woman presents with slowly progressive hirsutism. She has regular menstrual cycles and has been pregnant and given birth twice. She is 5’1” tall and weighs 110 pounds. Her physical examination is normal except for the hirsutism. Her testosterone and 17-hydroxyprogesterone (17-OHP) levels are normal. The most likely diagnosis is:

A) congenital adrenal hyperplasia
B) idiopathic hirsutism
C) virilizing ovarian tumor

Answer 217

B) idiopathic hirsutism

Question 218

Which DXA result indicates a need for osteoporosis therapy?

A) Femoral neck -2.5
B) Wrist -2.6
C) Posterior-anterior lumbar spine -2.1

Answer 218

A) Femoral neck -2.5

Question 219

A woman with urge incontinence (overactive bladder) will benefit most from

A) A pessary
B) Anticholinergics
C) Bladder re-training
D) Kegel exercises

Answer 219

C) Bladder re-training

Question 220

The clinician providing preconception care should be aware that which of the following medications is generally considered safe during pregnancy (NOT potentially teratogenic)?

A) metronidazole (Flagyl), an antibiotic
B) isotretinoin (Accutane), a retinoid
C) lisinopril (Zestril), an ACE inhibitor

Answer 220

A) metronidazole (Flagyl), an antibiotic

Question 221

A 47-year-old woman presents with vaginal dryness that is causing discomfort during intercourse. She is not experiencing any other menopause-related symptoms. Physical examination is consistent with atrophic vaginitis. The most appropriate INITIAL management plan is to recommend the use of:

A) petroleum jelly (Vaseline) with intercourse.
B) vaginal estrogen cream twice per week.
C) water-based vaginal lubricants with intercourse.

Answer 221

C) water-based vaginal lubricants with intercourse.

Question 222

A woman and her male partner would like to become pregnant. The woman has a regular menstrual cycle that is 31 - 33 days in length. Appropriate advice for when to have unprotected intercourse is every other day:

A) starting on day 12 through day 16.
B) starting on day 1 through day 10.
C) starting on day 16 through day 21.

Answer 222

C) starting on day 16 through day 21.

Question 223

A 46-year-old woman is a healthy smoker and has been diagnosed with AUB-E (endocrine) because of her heavy periods. What is the most appropriate treatment for her?

A) Combined oral contraceptives
B) Nuvaring
C) Levonorgestrel-releasing intrauterine system (brand name: Mirena)

Answer 223

C) Levonorgestrel-releasing intrauterine system (brand name: Mirena)

Question 224

A 47-year-old woman reports irregular periods of varying amounts, occurring 22 - 60 days apart, starting 4 months ago. She reports no intermenstrual bleeding, hot flashes or mood changes. The most likely diagnosis is:

A) physiologic anovulation.
B) endometrial hyperplasia.
C) cervical polyps.

Answer 224

A) physiologic anovulation.

This woman is likely perimenopausal, and thus not consistently ovulating for physiologic reasons.

Question 225

Which woman is NOT a candidate for combined oral contraceptive pills?

A) A 25-year-old who who smokes 1.5 packs per day.
B) A 38-year-old woman with migraine with aura
C) A 15-year-old with menorrhagia.
D) A 28-year-old woman with bilateral varicose veins.

Answer 225

B) A 38-year-old woman with migraine with aura

Question 226

Which of the following is NOT known to cause decreased sperm count or motility?

A) Marijuana
B) Zinc exposure
C) Type 2 Diabetes

Answer 226

B) Zinc exposure

Question 227

Which statement about perimenopausal women is correct?

A) Combined oral contraceptives may be used for pregnancy prevention and to reduce hot flashes.
B) Women taking estrogen/progestogen therapy (EPT) do not need additional contraception because EPT also prevents pregnancy.
C) Women who are having menses every two to three months are no longer ovulating and do not need contraception.

Answer 227

A) Combined oral contraceptives may be used for pregnancy prevention and to reduce hot flashes.

Question 228

A 42-year-old woman reports that her cycles have become irregular, though they are not heavy. In considering causes for this change in menstrual pattern, the clinician is aware that:

A) an anatomic cause for these irregular menstrual periods should be ruled out.
B) hormonal changes are likely responsible for this menstrual pattern.
C) the irregularity of this patient’s cycle is due to perimenopause.

Answer 228

B) hormonal changes are likely responsible for this menstrual pattern.

Question 229

Appropriate care after single-dose chlamydia treatment of a non-pregnant woman includes:

A) Instructing her to abstain from sex for 7 days.
B) Recommending that all of her sexual partners in the last 2 years be tested and treated.
C) Advising abstinence until the day that her partner takes his single-dose therapy.

Answer 229

A) Instructing her to abstain from sex for 7 days.

Question 230

A 33-year-old woman reports irregular vaginal bleeding, from spotting to heavy amounts, for the past 15 days. The clinician rules out pregnancy with an office urine hCG test and suspects a thyroid abnormality based on history and symptoms. To resolve this woman’s bleeding, assuming no contraindications are present, an appropriate therapy would be:

A) COC 30 mcg PO bid for 5 days, then qd x 21 days
B) levonorgestrel intrauterine system, inserted at this visit.
C) medroxyprogesterone acetate (MPA), 10 mg PO qd x 10 days.

Answer 230

A) COC 30 mcg PO bid for 5 days, then qd x 21 days

While progestins can be helpful in keeping a uterine lining thin, they may not be able to seal off a fragmenting, unevenly sloughing one. For that situation, estrogen is most helpful (see S&L 3rd edition p.591)

Question 231

Non-contraceptive benefits of hormonal contraceptives include decreased risk of:

A) Breast cancer
B) Depression
C) Ovarian cancer
D) Thyroid disease

Answer 231

C) Ovarian cancer

Question 232

A 55-year old post-menopausal woman requests testosterone therapy for low sexual interest. She reports vaginal dryness but not vasomotor symptoms. An appropriate response from the clinician would be:

A) “I can prescribe you flibanserin, but not testosterone.”
B) “Using a vaginal lubricant with each intercourse should help you achieve orgasm.”
C) “Currently, there are no FDA-approved testosterone formulations for women. Low-dose estrogen could help with your vaginal dryness

Answer 232

C) “Currently, there are no FDA-approved testosterone formulations for women. Low-dose estrogen could help with your vaginal dryness

Question 233

A 32-year-old woman has had heavier menses for the past several months. On bimanual examination, her uterus is tender and diffusely enlarged. Which diagnosis is most likely?

A) Adenomyosis
B) Endometrial cancer
C) Uterine fibroids

Answer 233

A) Adenomyosis

Question 234

Which statement is TRUE regarding cervical cancer?

A) African American women are more likely to die from cervical cancer than are white American women.
B) Human papillomavirus (HPV) is the causative agent in approximately 75% of cervical cancers.
C) Cervical cancer is the most common female genital malignancy.

Answer 234

A) African American women are more likely to die from cervical cancer than are white American women.

Question 235

Which of these therapies is NOT appropriate to provide endometrial protection during menopausal estrogen therapy for vasomotor symptoms?

A) Depo-Provera (150 mg medroxyprogesterone acetate, IM or SQ).
B) Skyla (levonorgestrel IUD).
C) oral Prometrium (micronized progesterone).

Answer 235

A) Depo-Provera (150 mg medroxyprogesterone acetate, IM or SQ).

Question 236

Which is most commonly seen with polycystic ovary syndrome (PCOS)?

A) Low estrogen levels
B) Low insulin levels
C) Infertility

Answer 236

C) Infertility

Question 237

Which bone mineral density (BMD) T-score indicates osteoporosis?

A) -1.5
B) -2.3
C) -2.7

Answer 237

C) -2.7

Question 238

A 45-year-old woman presents with heavy menstrual bleeding for six months. Prior to this time, she had light, regular menstrual cycles every 26-28 days. What is the most appropriate next step in the evaluation of this woman’s heavy menstrual bleeding?

A) Colposcopy
B) Dilation and curettage
C) Endometrial biopsy

Answer 238

C) Endometrial biopsy

Question 239

A 49-year-old woman has many hot flashes and decreased vaginal lubrication. These are her only menopause-related symptoms. She had a hysterectomy. The MOST APPROPRIATE regimen for her is:

A) estrogen and progestogen therapy
B) estrogen and testosterone therapy
C) estrogen therapy alone

Answer 239

C) estrogen therapy alone

Question 240

When considering the differences between combined hormonal contraceptive methods and progestin-only methods, the clinician is aware that:

A) combined hormonal methods usually have fewer contraindications than progestin-only methods.
B) combined hormonal methods are less likely to cause irregular bleeding than progestin-only methods.
C) progestin-only methods are often less effective than combined hormonal methods.

Answer 240

B) combined hormonal methods are less likely to cause irregular bleeding than progestin-only methods.

Question 241

A 15-year-old is receiving her first dose of the human papillomavirus (HPV) vaccine. Which statement by the woman is correct concerning the vaccine?

A) “I won’t need to have regular Pap smears after I get all three shots.”
B) “I should get my second shot in six months and my third shot in nine months.”
C) “There are lots of types of HPV, and this shot will protect me from a few of them.”

Answer 241

C) “There are lots of types of HPV, and this shot will protect me from a few of them.”

Question 242

Custom-compounded “bioidentical” hormones are:

A) potentially inconsistent in dosage, purity, and quality
B) safer and more effective than traditional hormone therapies
C) supported by extensive scientific and medical evidence

Answer 242

A) potentially inconsistent in dosage, purity, and quality

Question 243

A 22-year-old woman requests a Mirena IUD for contraception. She plans to become pregnant in about 1 year. Appropriate counseling for this woman includes:

A) This method may protect you from pregnancy for as long as 7 years.
B) This method is contraindicated if you have a history of migraine with aura.
C) This method is not a good choice if you want to become pregnant sooner than 3 years from now.

Answer 243

A) This method may protect you from pregnancy for as long as 7 years.

Question 244

The purpose of progestogen therapy for a woman who is using hormone therapy is to:

A) Decrease the risk of endometrial cancer.
B) Increase bone density
C) Increase libido
D) Stabilize symptoms of vasomotor instability.

Answer 244

A) Decrease the risk of endometrial cancer.

Question 245

The following factors can help to prevent urinary incontinence EXCEPT:

A) Increasing the volume of beverage intake
B) Weight loss
C) Decreasing caffeine intake

Answer 245

A) Increasing the volume of beverage intake

Question 246

A 35-year old woman reports pelvic pain that began 18 months ago and occurs daily, at a level of 4/10 on a pain scale. Menstruation does not affect her level of pain. Her GYN history includes 2 cesarean births, regular menses since age 15, and no STIs. She is monogamous with her partner of 10 years. The most likely cause of her chronic pain is:

A) adhesions.
B) endometriosis.
C) adenomyosis.

Answer 246

A) adhesions.

Question 247

A 17-year-old woman presents with clusters of small, painless growths on her labia minora. What is the most likely diagnosis?

A) genital herpes
B) human papillomavirus
C) syphilis

Answer 247

B) human papillomavirus

Question 248

Which is TRUE regarding assessment and management of female sexual dysfunction?

A) Desire disorders are generally best treated with medications.
B) To assess for arousal disorders, the midwife should inquire about whether the woman experiences adequate lubrication.
C) Selective serotonin reuptake inhibitors can treat orgasm disorders.
D) A desire disorder is usually present if a woman and her partner report sexual intercourse less than once per month.

Answer 248

B) To assess for arousal disorders, the midwife should inquire about whether the woman experiences adequate lubrication.

Question 249

A 35-year-old premenopausal woman should strive for which calcium intake per day?

A) 1,000 mg
B) 1,200 mg
C) 1,500 mg

Answer 249

A) 1,000 mg

Question 250

A 27-year-old woman is experiencing pain with sexual activity. She is able to have intercourse with penetration but she has pain at her vaginal introitus. What is the most likely diagnosis?

A) Atrophic vaginitis
B) Vaginismus
C) Vulvar vestibulitis

Answer 250

C) Vulvar vestibulitis

Question 251

Which of the following diseases or disorders are NOT associated with congenital malformations?

A) HIV
B) diabetes
C) seizure disorders

Answer 251

A) HIV

Question 252

A 20 year old college student would like to start contraception. She wants a method that will not be visible to others. She smokes a pack of cigarettes a day, has no significant medical problems, and would also like to be able to predict her menses. Identify the method that would be LEAST likely to meet her needs along with the rationale for that decision.

A) The contraceptive patch because she is a smoker.
B) DMPA (DepoProvera) because she will likely have irregular bleeding.
C) The copper IUD (Paragard) because her bleeding will be unpredictable.

Answer 252

B) DMPA (DepoProvera) because she will likely have irregular bleeding.

Question 253

A 36-year-old woman and her male partner present to the clinic requesting an evaluation for infertility. They report using no contraception for 13 months. Factors that determine what initial lab tests or imaging are needed include all EXCEPT:

A) the woman’s age
B) regularity of the woman’s menstrual cycle
C) physical exam findings

Answer 253

A) the woman’s age

While a woman’s age helps us determine when a workup is indicated, it won’t help us determine what initial steps are needed. A history and focused physical exam for both partners will be more helpful.

Question 254

Which of these complementary and alternative therapies does NOT show evidence of benefit for vasomotor symptoms?

A) evening primrose oil
B) acupuncture
C) black cohosh

Answer 254

A) evening primrose oil

Question 255

A 46-year old woman presents with a 6-month history of progressively more bothersome pelvic pain. She reports urinary urgency, frequency and dysuria. A urine dipstick is negative for nitrates and leukoesterase, but positive for blood. A urine culture is negative. Pelvic exam reveals tenderness with palpation of the anterior vaginal wall, but no other significant findings. The most appropriate intervention at this time is:

A) an empiric course of antibiotics to cover common UTI-associated organisms.
B) a referral for cystoscopy.
C) an order for CBC and ESR.

Answer 255

B) a referral for cystoscopy.

Question 256

Women with polycystic ovary syndrome are at significantly increased risk for:

A) Ovarian cancer
B) Cervical cancer
C) Endometrial cancer

Answer 256

C) Endometrial cancer

Question 257

A 24 year old woman with a BMI of 38 would like to begin combined oral contraceptive pills for contraception. Today is day 10 of her cycle. Appropriate patient counseling for this patient would include:

A) Because of her weight, this woman will need an oral contraceptive pill with 50 mcg of estradiol.
B) She may start her pills today as long as she uses a backup method of contraception for a full week.
C) Combined oral contraceptive pills are protective against cervical cancer.

Answer 257

B) She may start her pills today as long as she uses a backup method of contraception for a full week.

Question 258

An 18-year-old woman presents with a two month history of intermittent, irregular bleeding. Her last normal menstrual period was three months ago. Before that, her cycles were regular at 30-32 days. She is sexually active. Which diagnostic test should be ordered first?

A) prolactin level
B) thyroid stimulating hormone (TSH)
C) urine human chorionic gonadotropin (hCG)

Answer 258

C) urine human chorionic gonadotropin (hCG)

Question 259

A 34-year-old woman is using observation of her cervical secretions to determine when she is fertile so that she can avoid becoming pregnant. Her cervical secretions are currently clear, stretchy, and slippery. She knows that these secretions indicate that she:

A) is currently fertile and should abstain from intercourse.
B) has already ovulated and is not currently fertile.
C) has not yet ovulated and is not currently fertile.

Answer 259

A) is currently fertile and should abstain from intercourse.

Question 260

The selective estrogen receptor modulator Raloxifene (Evista) is associated with increased risk of which condition?

A) Estrogen receptor–positive breast cancer
B) Deep vein thrombosis
C) Cardiovascular disease

Answer 260

B) Deep vein thrombosis

Correct Answer: This hormone increases the risk of Deep vein thrombosis (DVT). Lecture Notes; Woo & Robinson pg. 626-628.

Question 261

Of the different types of urinary incontinence, the most effective pharmacologic treatments are for:

A) Functional urinary incontinence
B) Stress urinary incontinence
C) Urge urinary incontinence

Answer 261

C) Urge urinary incontinence

Question 262

A 52-year-old woman with an intact uterus is considering starting hormone therapy for menopausal symptoms, but is concerned about cancer risks from treatment. Correct information to share with her includes:

A) “Your risk for invasive breast cancer will slightly increase, and your risk for colon cancer will slightly decrease, if you use hormone therapy.”
B) “Risks for endometrial cancer significantly rise with hormone therapy.”
C) “Your risk for breast cancer is the same as it would be if you didn’t take hormone therapy, since you are starting treatment very close to your final menstrual period.”

Answer 262

A) “Your risk for invasive breast cancer will slightly increase, and your risk for colon cancer will slightly decrease, if you use hormone therapy.”

Question 263

Which exam finding meets the minimum criteria for the diagnosis of pelvic inflammatory disease (PID)?

A) Adnexal tenderness
B) Mucopurulent cervical discharge
C) White blood cells in vaginal secretions

Answer 263

A) Adnexal tenderness

Question 264

A 32-year-old woman wishes to avoid pregnancy using a fertility awareness method. She reports that she had a very regular 34-day menstrual cycle. The clinician advises her that since her cycle is regular and predictable, she probably ovulates on day ______.

Answer 264

20

34 days minus the 14 day luteal phase = ovulation on day 20.

Question 265

a 36-year-old woman presents with an 8-month history of pelvic pain. In order to begin to assess this patient, the clinician is aware that pelvic pain:

A) is almost always related to complications of pregnancy and birth.
B) requires opioid analgesia for adequate pain control.
C) is often caused by gastointestinal or urinary system problems.

Answer 265

C) is often caused by gastointestinal or urinary system problems.

Question 266

A 23-year-old woman is considering an IUD for contraception. The clinician should provide the following information in order to help her make a decision:

A) The copper IUD (Paragard) has no hormones, and no changes are to be expected in menstrual bleeding.
B) Levonorgestrel IUD users may have unpredictable bleeding or develop amenorrhea.
C) Women who have never been pregnant are not good candidates to use a Paragard IUD because insertion is too difficult.

Answer 266

B) Levonorgestrel IUD users may have unpredictable bleeding or develop amenorrhea.

Question 267

A 23-year-old woman wants to start contraception right away, and has had no unprotected intercourse since her LMP 1 week ago. She has sickle cell anemia. She also reports headaches twice a year in which she sees flickering lights before the pain starts. A method she could safely begin today would be:

A) the contraceptive ring
B) Skyla IUD
C) the contraceptive patch

Answer 267

B) Skyla IUD

Question 268

Regarding the relationship between intrauterine devices (IUDs) and ectopic pregnancy, which of these statements is TRUE?

A) A woman with a history of an ectopic pregnancy may still choose an IUD for contraception.
B) The copper IUD increases the likelihood of ectopic pregnancy but the LNG-IUS does not.
C) Women who have IUDs are at greater risk for ectopic pregnancy than women without IUDs.

Answer 268

A) A woman with a history of an ectopic pregnancy may still choose an IUD for contraception.

Question 269

A woman had her baby five months ago and she has not had a menses since the baby was born. She breastfeeds her baby at bedtime, during the night, and in the morning. Her baby drinks formula during the day while she is at work. She has sex one to two times per week. Which factor would indicate decreased effectiveness of the lactation amenorrhea method of contraception?

A) Frequency of sexual activity
B) lack of menses
C) Use of supplementation
D) Length of time since birth

Answer 269

C) Use of supplementation

Varney p. 531. Know the criteria for LAM. 1. 6 mo or less, 2. all nutrition from suckling, no more than 5% from supplementation. 3. menses has not resumed since birth.

Question 270

The dominant ovarian hormone during the proliferative phase of the menstrual cycle is:

Answer 270

Estrogen.

Question 271

Which of the following can increase the risk of acquiring an STI?

A) Higher prevalence of a particular STI in the population.
B) Use of an intrauterine device.
C) Use of barrier contraceptives.

Answer 271

A) Higher prevalence of a particular STI in the population.

Question 272

Which statement regarding ovulation is TRUE for a woman with a regular 28 day menstrual cycle?

A) Ovulation usually occurs on day 7 and is followed by the formation of the corpus luteum.
B) Ovulation usually occurs on day 14 and is followed by a rise in the basal body temperature and further increase in progesterone levels.
C) After ovulation the LH surge occurs and is followed by the formation of the corpus luteum.

Answer 272

B) Ovulation usually occurs on day 14 and is followed by a rise in the basal body temperature and further increase in progesterone levels.

Question 273

A 25 year old woman requests the most effective contraceptive method available, since she and her husband plan never to have children and all other considerations are secondary. She is willing to use a shorter-term method or a permanent one. Considering typical use effectiveness data for contraceptives, which method would best meet her desire for effectiveness?

A) NuvaRing (etonogestrel and ethinyl estradiol)
B) Xulane -transdermal patch (norelgestrolmin and ethinyl estradiol))
C) Nexplanon implant (etonogestrel)
D) Depo Provera (depot medroxyprogesterone acetate (DMPA)

Answer 273

C) Nexplanon implant (etonogestrel)

Question 274

Which contraceptive method is SAFE for the smoker over age 35?

A) Combined oral contraceptives
B) NuvaRing
C) LNG-IUS (Mirena)

Answer 274

C) LNG-IUS (Mirena)

Question 275

In a woman with regular, 32-day cycles, ovulation will most likely occur on day _____ of her cycle.

Answer 275

18

Question 276

The preferred timing for a woman to initiate combined oral contraceptives is the

A) last day of her menstrual period.
B) first day of her menstrual period.
C) same day of her exam or counseling visit.

Answer 276

C) same day of her exam or counseling visit.

Question 277

A 36-year-old woman has vaginal itching and white, curdish discharge that adheres to the vaginal walls seen on speculum examination. The slide for the wet mount looks like this:

Hyphae and pseudohyphae

The most appropriate management plan is:

A) A: Bacterial Vaginosis P: clindamycin cream 2% (Cleocin) one 5 gm applicator PV q HS x 7 days
B) A: Pediculosis Pubis P: permethrin 1% cream (Nix) rinse. Apply to affected area, wash after 10 minutes
C) A: Trichomoniasis P: metronidazole (Flagyl) 500 mg PO BID x 7 days
D) A: Vulvovaginal Candidiasis P: miconazole 2% cream (Monistat) 5 gm applicator PV q HS x 7 days

Answer 277

D) A: Vulvovaginal Candidiasis P: miconazole 2% cream (Monistat) 5 gm applicator PV q HS x 7 days

Question 278

The correct order of the phases of the OVARIAN cycle is

A) Luteal, ovulatory, secretory.
B) Proliferative, ovulatory, luteal.
C) Follicular, ovulatory, luteal.

Answer 278

C) Follicular, ovulatory, luteal.

Question 279

With which of the following conditions would you expect to see a positive progestin challenge test?

A) Congenital adrenal hyperplasia
B) Asherman’s syndrome
C) Polycystic Ovarian Syndrome
D) Turner’s syndrome

Answer 279

C) Polycystic Ovarian Syndrome

Kelsey q #25 p. 218. A positive progestin challenge test indicates the women who is not having menses has adequate production of estrogen, is able to develop a proliferative endometrium and has an unobstructed outflow tract. Asherman’s syndrome is an acquired condition that refers to having scar tissue in the uterus or in the cervix. This scar tissue makes the walls of these organs stick together and reduces the size of the uterus. This would inhibit bleeding as it is an outflow tract issue. Turner syndrome, a condition that affects only females, results when one of the X chromosomes (sex chromosomes) is missing or partially missing. Turner syndrome can cause a variety of medical and developmental problems, including short height, failure of the ovaries to develop and heart defects. Varney p. 365

Question 280

To diagnose Pelvic Inflammatory Disease (PID), the clinician must find:

Answer 280

Adnexal, uterine, or cervical motion tenderness.