Module 3 Zoom Practice Questions Flashcards
A 16 y/o female has not yet begin menstruating but does have pubic hair. She is best described as having…
primary amenorrhea
Red Flags:
-age and hasn’t started menstruating
Ellen is a 21-year-old having her first wellness visit with a CNM. She scheduled this visit because she read she was supposed to have a Pap when she turned 21. She has not seen a healthcare provider since she was 15, when her mother last took her to the pediatrician. She considers herself to be in good health, is not sexually active, and does not have any problems or concerns. She works as a legal assistant. She does not do any strengthening exercises but takes her dog on a daily walk. She does not use tobacco or drugs and notes that she drinks a few beers with friends once a week. She reports her periods have always been unpredictable and sometimes goes 3-4 months without one. Her vitals are: 98.2F, 92 bpm, 130/80. She is 64 in tall and 193 lbs with BMI 33. Her physical examination is unremarkable except for dense hair on her forearm, fine black hairs on her upper lip and several black hairs on each nipple. Her body habitus limits the bimanual exam.
In addition to a Pap, which lab tests are most appropriate to order?
A) CBC and LFTs
B) A1C and lipid panel
C) Progesterone and LH
D) GnRH and cortisol
B) A1C and lipid panel
We do not need an answer c to diagnose her PCOS. We care more about how it is impacting her. Her obesity and PCOS increases risk for cardiovascular disease
Ellen is a 21-year-old having her first wellness visit with a CNM. She scheduled this visit because she read she was supposed to have a Pap when she turned 21. She has not seen a healthcare provider since she was 15, when her mother last took her to the pediatrician. She considers herself to be in good health, is not sexually active, and does not have any problems or concerns. She works as a legal assistant. She does not do any strengthening exercises but takes her dog on a daily walk. She does not use tobacco or drugs and notes that she drinks a few beers with friends once a week. She reports her periods have always been unpredictable and sometimes goes 3-4 months without one. Her vitals are: 98.2F, 92 bpm, 130/80. She is 64 in tall and 193 lbs with BMI 33. Her physical examination is unremarkable except for dense hair on her forearm, fine black hairs on her upper lip and several black hairs on each nipple. Her body habitus limits the bimanual exam.
What specialty would be most appropriate to refer her to?
A) Reproductive endocrinology
B) General gynecology
C) Dietician
C) Dietician
A 10lb weight loss can help with some of the symptoms of PCOS
Note: she is not sexually active!
Which statement regarding ovulation is TRUE for a woman with a regular 28 day menstrual cycle?
A) Ovulation usually occurs on day 14 and is followed by the follicular phase
B) Ovulation usually occurs on day 14 as a result of the LH surge and is followed by a rise in the BBT
C) Ovulation usually occurs on day 7 and is followed by the formation of the corpus liteum
D) After ovulation, the LH surge occurs and is followed by the formation of the corpus luteum
B) Ovulation usually occurs on day 14 as a result of the LH surge and is followed by a rise in the BBT
Carol, a 47 y/o patient, reports being worried about a lump in her right breast. She noticed it because she had pain in the area before her period last month. She is upset because her paternal grandmother died of breast cancer in her early 70s, an it was very traumatic for the family. Her mother has type 2 DM, but her family hx is otherwise negative. Carol has two children, each of whom she breastfed for 18 months. She has no other health problems. The midwife performs a breast exam and notes a firm, smooth, spherical, mobile, mildly tender mass 1x1x1cm in size in the upper outer quadrant of Carol’s right breast. Carol says, “That’s it right there. What is that? Are you going to schedule me for a biopsy or scan or something?
What can the CNM tell Carol about this mass without any further evaluation?
A) There is a low likelihood of malignancy. Further evaluation is expected to be benign.
B) This condition often progresses and leads to invasive cancer and should be reexamined frequently
C) This mass is related to overuse of caffeine and will disappear if carol reduces her caffeine intake
D) There is a high suspicion fo breast cancer, and this finding should be followed up aggressively
A) There is a low likelihood of malignancy. Further evaluation is expected to be benign.
Reason: Most likely, fibrocystic breast changes (tenderness is a big sign for this). This mass has characteristics of a breast cyst, which is benign. It is smooth, mobile, tender, related to the menstrual cycle, and has a well-defined shape. Carol has no first-degree relatives with breast CA and no other known risk factors.
Carol, a 47 y/o patient, reports being worried about a lump in her right breast. She noticed it because she had pain in the area before her period last month. She is upset because her paternal grandmother died of breast cancer in her early 70s, an it was very traumatic for the family. Her mother has type 2 DM, but her family hx is otherwise negative. Carol has two children, each of whom she breastfed for 18 months. She has no other health problems. The midwife performs a breast exam and notes a firm, smooth, spherical, mobile, mildly tender mass 1x1x1cm in size in the upper outer quadrant of Carol’s right breast. Carol says, “That’s it right there. What is that? Are you going to schedule me for a biopsy or scan or something?
Which additional evaluation is most appropriate?
A) Excision and biopsy
B) Examination by an oncologist
C) MRI
D) Breast U/S
D) Breast U/S
Reason: There is low suspicion for malignancy so the other options are not necessary
Beth presents for a WWE. She is 51 y/p white non-Hispanic. 5ft 8in and 120lbs with a BMI of 18. She does not drink or smoke. She drinks two cups of coffee daily. She has two grown children. Is sexually active with a female partner, and neither has had other partners for 14 years. Her last normal period was 8-9 months ago but she had some dark spotting last week. She follows a vegan diet and walks 30m per day. She had no significant history, and her Pap is up to date with no abnormal hx. She takes herbs and supplements (multivitamin, probiotic, vit D). She describes herself as very health conscious and says she would like to do whatever is necessary to avoid the negative effects of menopause. She requests to have her hormone levels tested because she wants to know if menopause has occurred so that she can adjust her dietary supplements. She feels well, except for waking up at least once at night and having trouble going back to sleep.
What is the best counseling Beth can be given regarding the benefits of hormone testing?
A) Comparing LH levels to FSH will definitively diagnose menopause in this case
B) Checking estrogen levels can identify the need for HRT
C) Testing hormone levels in a healthy perimenopausal individual is generally not useful
D) Progesterone levels can predict whether ovulation will occur over the next few months
C) Testing hormone levels in a healthy perimenopausal individual is generally not useful
Reason: We know she is perimenopausal and not menopausal at this point because it has not been 12m without a cycle, so testing her hormone levels would not benefit her unless she would like to start HRT. These hormone tests should only been done if a patient is having bothersome symptoms or there is suspicion of pathology
Beth presents for a WWE. She is 51 y/p white non-Hispanic. 5ft 8in and 120lbs with a BMI of 18. She does not drink or smoke. She drinks two cups of coffee daily. She has two grown children. Is sexually active with a female partner, and neither has had other partners for 14 years. Her last normal period was 8-9 months ago but she had some dark spotting last week. She follows a vegan diet and walks 30m per day. She had no significant history, and her Pap is up to date with no abnormal hx. She takes herbs and supplements (multivitamin, probiotic, vit D). She describes herself as very health conscious and says she would like to do whatever is necessary to avoid the negative effects of menopause. She requests to have her hormone levels tested because she wants to know if menopause has occurred so that she can adjust her dietary supplements. She feels well, except for waking up at least once at night and having trouble going back to sleep.
What additional recommendations will be most helpful?
A) A bone density screen
B) Increasing exercise
C) Increasing calcium in beths diet and adding a calcium supplement
D) Serial FSH levles
C) Increasing calcium in beths diet and adding a calcium supplement
Reason: Beth has a lower BMI, is vegan, is in her 50s, is perimenopausal=all risk factors for osteoporosis. It is recommended that women over 50 consume 1200mg of CA per day.
A GYN patient presents to your office stating that she has had a fever, fatigue and mild aching for 2 days. On physical exam, you note a diffuse rash on the patient’s back and soles of their feet with bilateral inguinal lymphadenopathy. The pelvic exam is WNL except for some white flat wart-like lesions near the anus.
The MOST-likely cause of her symptoms is:
A) secondary syphilis
B) HSV
C) TSS
D) Condylomata acuminate
A) secondary syphilis
Reason: Per CDC symptoms are as follows-Rashes, fever, swollen lymph nodes, sore throat, patchy hair loss, HA, weight loss, muscle aches, fatigue
A 24 y/o G1P1 comes to the family planning clinic for a 6w PP visit and initiation of contraception. The patient is BF and plans to continue. She hopes to have another child in 2 years.
You obtain the following information from the chart: Term NSVD 3864g with a midline epis. Treated for endometritis 1w PP.
Exam reveals normal involution of the uterus and 1st-degree rectocele. All other findings WNL.
Which of the following method is MOST appropriate for this patient?
A) Diaphragm
B) IUD
C) COC
D) POC
D) POC
Reason: This gives her the best efficacy with the safest administration with her Hx of BF and recent endometritis treatment.
A 27 y/o woman has been experiencing pain with the onset of menses lasting three days for the past three months. She states it is so unbearable it is disrupting her ability to work. Menarche at age 12. She states no history of painful menses and describes this as a new finding. She usually has minimal cramping with her periods.
What is the preliminary diagnosis or concern?
A) Primary dysmenorrhea
B) Secondary dysmenorrhea
C) Normal cyclic changes
D) Endometrial CA
B) Secondary dysmenorrhea
Reason: She has been having cycles for 15 years, and now has pain. This is a change.
A 27 y/o woman has been experiencing pain with the onset of menses lasting three days for the past three months. She states it is so unbearable it is disrupting her ability to work. Menarche at age 12. She states no history of painful menses and describes this as a new finding. She usually has minimal cramping with her periods.
What are some possible causes of her pain? What are follow up options?
Causes: Fibroids, Endometriosis, Infection
F/U: TVUS, laparoscopy, NSAIDS
