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NR 602 Final Study Guide
Questions and Answers
Latest Update
Which one best describes lesions associated with condyloma
acuminatum?
a.Verruciform
b.Plaque-like
c.Vesicular
d.Bullous
39yo female has completed course of amox for strep throat. LMP was 2wks ago, says it was normal. On exam, there's erythema of extern. genitalia w/small amount of white discharge. Micro wet prep reveals few clue cells, but many budding hyphae. No WBCs. Which one would be the most appropriate treatment? a. Metronidazole 500mg BID x7 days b. OTC hydrocortisone 1% cream TID c. Fluconazole tabs 150mg x1 dose d. Erythromycin 500mg TID x10 days
c
Which one best describes lesions associated with condyloma acuminatum? a. Verruciform
b. Plaque-like
18yo female c/o secondary amenorrhea. On exam, there is normal secondary sex characteristics and normal genitalia. Pregnancy is ruled out. What would necessitate further eval? a. Elevated blood cholesterol levels b. Androgen deficiency c. Galactorrhea d. Hirsutis m c 24yo female is dx'd w/primary dysmenorrhea. Which med would be used as first-line to help control symptoms? a. Antianxiety meds b. Progesterone-only contraception c. Oral steroids d. NSAID s d Primary amenorrhea is best described as: a. Cessation of menstruation x6mo b. Failure of menstruation to occur by 17ho c. Failure of menstruation to occur by 13yo d. Cessation of menstruation x6mo after menarche c
25yo female c/o vaginal irritation and discharge. On exam, cervix is easily friable and erythematous. No adnexal tenderness. Wet prep reveals mobile protozoa on NS slide. This most likely represents: a. Trichomonas b. Mucopurulent cervicitis c. Bacterial vaginosis d. Gonorrh ea a 16yo female has h/o secondary amenorrhea. Menarche at 10yo, regular cycles x2yrs, has not menstruated x4yrs. What is most frequent etiology of this problem? a. Eating disorder b. Pregnancy c. Anovulatory cycles d. Stre ss a Woman is experiencing vaginal discharge. Wet mount with KOH would be used to confirm: a. Herpes simplex b. Gonorrhea c. Candidiasis d. Chlamydia
Which of the following are of a reproductive and pelvic origin? a. Salpingo-oophoritis (fallopian tube/ovary) secondary to PID b. Gynecologic malignancy c. Adhesions d. Myomata uteri a 25yo female c/o tender area near her introitus and to the L of her perineum. Very painful sex was first sign. Initially bump was very small, but now is ping- pong ball size. On exam, abscess is present on L medial side of labia minora and there's edema extending into perineum. What is dx? a. Lipoma b. Dermoid cyst c. Bartholin's cyst d. Skene's duct cyst c 49yo female c/o dark, watery brown vaginal discharge. Which best describes what might be seen on physical exam in pt's with cervical cancer? a. Ulcerated firm cervix b. Vague lower abd pain c. Enlarged tender femoral lymph nodes d. Soft, still shaped cervix
a 22yo female c/o pelvic pain. Exam reveals cervical motion and uterine tenderness. Which supports PID dx? a. Temp <100F b. Absence of WBCs in vag fluid c. Mucopurulent vag discharge d. Lab documentation of cervical infection w/E. coli c When educating pt about rationale for getting mammo, which statement is false? a. Mammo is cost-effective method to screen for breast cancer b. Mammo detects all breast cancers c. Mammo should be accompanied by breast exam d. Negative mammo should not delay biopsy of clinically suspicious mass b When educating women about breast cancer risk factors, which statement is incorrect? a. Pregnancy after 35yo b. Late menopause after 57yo c. Fibrocystic breast dz d. H/o maternal breast cancer c
PMS occurs with greatest frequency and severity in the: a. Late luteal phase b. Midfollicular phase c. Proliferative phase d. Early luteal phase a Which is not a common cause of irregular menstrual bleeding? a. Endocrine disorders b. Stress c. Anovulation d. Anatomical abnormality c What is considered the primary etiology of primary dysmenorrhea? a. Ovarian cysts b. Prostaglandin production c. Endometriosis d. Adenomyo sis b 28yo female c/o breast tenderness, fatigue, abd bloating, fluid retention, irritability 1wk before her menses onset. What is most important info to obtain from this pt to determine if the pt has
PMS?
a. Severity of symptoms b. Occurrence of symptoms in menstrual cycle c. Frequency and number of symptoms over past 4mo b 35yo woman c/o 6mo h/o hypermenorrhea, backache, pelvic pressure. On exam, you discover 12wk size uterus w/irregular contour. What does this represent? a. Uterine cancer b. Dysfunctional uterine bleeding c. Uterine fibroid d. Fecal impaction c Female c/o vaginal itching and white discharge. Denies sexual activity or douching. In good health except for recurrent strep throat. Pelvic reveals tender vulvovag area w/edema and white patches. No odor. What is the most likely cause? a. Bacterial vaginosis b. DM c. Allergy to personal hygiene product d. Candidiasis after abx treatment d
PALM:
Polyps Adenomyo sis Leiomyom a Malignanc y Name 5 non-structural abnormalities that are causes of dysfunctional uterine bleeding. COEIN: Coagulopathy Ovulatory disorders Endometrial Iatrogenic Not classified What is abnormal/dysfunctional uterine bleeding? Acute or chronic bleeding from uterine corpus; abnormal in regularity, volume, frequency, or duration; occurs in pregnancy absence. What is acute DUB? Episode of sufficient quantity to require immediate intervention to prevent further blood loss What is chronic DUB? Present for the majority of the last 6mo What is the most common benign tumor of the genital tract? Leiomyomas? (Hollier CPG p. 772)
Name some risk factors for DUB.
for DUB? Excessive bleeding on exam Hypotension
Tachycar dia Diaphore sis Vag atrophy Mass Trauma Enlarged uterus/adnexa Hirsutism Thyromegaly Bruising Galactorr hea What are some diff dx's for DUB? PALM-COEIN Traumatic injury Pregnancy-related bleeding (ectopic, SAB, placenta previa/abruptio) What are some diagnostic lab studies for DUB? -*Serum hCG: always do first before examining pt of menstruating age w/vag bleeding -CBC -ABO/Rh if preg. suspected/severe bleeding -STD tests/wet prep -Cervical cytology
-If hx indicates: thyroid panel -Endometrial bx What are some diagnostic imaging studies for DUB? -TVUS: first-line if imaging needed -Saline infusion sonohysterography (helpful for leiomyoma) -Hysteroscopy (can be used for guided endometrial bx) -MRI What are some diagnostic studies for polyps in DUB? -TVUS -Saline infusion sonography -Hysteroscopy What are some diagnostic studies for adenomyosis in DUB? TVUS or MRI What are some diagnostic studies for leiomyomas in DUB? TVUS What are some diagnostic studies for malignancy in DUB? Bx/pathology What are some diagnostic studies for coagulopathies in DUB? Labs What are some surgical options for DUB? -Varies depending on dx, age, fertility status/desire -If bleeding severe/pregn. related: D&C or hysterectomy in extreme cases -Hysteroscopic removal of polyps
-Endometrial ablation -Hysterectomy -Traumatic repair What are some pharm options for DUB? -NSAIDs (cyclic DUB) -Antifibrinolytics (cyclic DUB) -Combined OCP, medroxyprogesterone acetate, levonorgestrel-releasing intrauterine systems (effective if agreeable to contraceptive effects) -Danazol/GnRH agonists (reduce DUB if med/surg treatments fail/contraindicated -Abx if infection/STD -Intravag estrogen for vag atrophy Which meds for DUB are contraindicated in pregnancy? -Ethinyl Estradiol (Estinyl): estrogen; risk of VTE; use w/progesterone if pt hasn't had hysterectomy. -Medroxyprogesterone Acetate (Provera): progesterone; risk of VTE; caution w/CVA, CA risk -Levonorgestrel-releasing intrauterine system (Mirena): combined hormone; risk of infection/migration; bleeding/cramping may occur x1-3mo -Danazol (Danocrine): androgen; risk of acne/wt gain/hirsutism; short- term use for refractory DUB Which meds for DUB are pregnancy cat C? -ibuprofen (Motrin), naprosyn (Aleve): NSAID; risk of gastric upset/ulcer; don't use w/other NSAIDs Which med for DUB is preg cat B?
