Ch. 15- Female Genitourinary Problems

The average age of menopause in the united states is ??

50 years

How long can the vaginal contraceptive ring Nuvaring be out of the vagina before an additional form of contraception is necessary??

3 hours

Ursula, age 19, is going to begin taking birth control pills. She asks you if she is "safe" immediately. How do you respond??

A second birth control method needs to be used during intercourse for the first 7 days while taking the pill. However, the pill doesn't protect you from STIs.

Which of the following drugs may diminish the effectiveness of oral contraceptives??

Antibiotics

When premenstrual syndrome symptoms do not respond to dietary and nonmedical therapies, which of the following drugs might you try??

Antidepressants

the majority of breast carcinomas are found in which anatomical site in the breast??

In the upper outer quadrant

Which of the following drugs may have their effects enhanced when used in combination with an oral contraceptive??

Beta blockers

Joy has been breastfeeding and has developed puerperal mastitis. You tell her, ??

Continue breastfeeding the baby to avoid milk stasis.

Which blood tumor marker is highly specific to epithelial ovarian cancer??

CA 125

Julia is nursing her 8-week-old baby and states that he is very irritable and sleeps poorly. What medication or substance do you ask her if she is taking or using??

Caffeine

What is the most common virus to be transmitted in utero??

Cytomegalovirus

Emergency contraception refers to??

taking emergency contraceptive pills

Procidentia is a ??

third-degree uterine prolapse

Judy has severe pain monthly with her fibrocystic breast disease. Which medication do you suggest she try??

Danazol

Marsha, age 40, has been given a diagnosis of rheumatiod arthritis. She asks you whether she should continue taking her birth control pills. You tell her??

to continue

Jennifer, a 25-year old female patient, complains of dysuria. In taking a thorough history to formulate a diagnosis, it is most important to ask??

Do you have an associated vaginal discharge or irritation??

Which form of estrogen is secreted in the greatest amount by the ovaries during the reproductive years and is considered most potent??

E2-estradiol

Sandra says that her previous doctor never discussed why he took her off HRT. You share with her some of the results of the Women's Health Initiative. Which statement is true regarding the study??

Estrogen plus progestin increased the risk of a cardiac event in apparently health women

Beth is breastfeeding her 3 month old infant with no supplementation. She says she has heard that she cannot get pregnant during this time. What do you tell her??

For the first six months, if you breastfeed and have very little supplementation, your changes are less than 2% that you'll get pregnant.

If a woman is using the basal body temperature method of birth control and does not want to become pregnant, when would you tell her to avoid unprotected intercourse??

From the beginning of the menstrual cycle until the BBT has been elevated for 3 days.

Samantha has a diagnosis of chlamydia vaginal infection. You believe that it is questionable whether she will fill the prescription that you write or take it for 7 days as ordered. What would you do??

Give azithromycin 1 g PO now.

Which of the following conditions is a contraindication to using the copper intrauterine device??

Heart disease

There are many causes of amenorrhea. In ballet dancers or marathon runners, which anatomical structure is the probable cause??

Hypothalamus

Mrs. Williams would like to schedule an appointment to bring her 18 year old daughter in to see you for her first gynecological exam and Pap smear. The most appropriate reply would include??

I would be happy to see your daughter and complete her gynecological exam; however, she does not need a Pap smear until the age of 21.

Lynne, age 43, comes to your office in tears, stating that last night she had unprotected sex and forgot to take her birth control pill. she wants to know about the morning after pill. You tell her??

I'll go ahead and order the Yuzpe regimen

A 27 year old female presents to your office for a Mirena insertion. She reports that her menses started 3 days ago and is normal. How soon after insertion will she be able to safely rely on it for contraception??

Immediately

Julia, age 60, asks you about taking Fosamax. What do you tell her about using this medication??

In addition to its efficacy in the treatment of osteoporosis in postmenopausal women, it is also useful for the prevention of osteoporosis.

Sarah, age 29, complains of premenstrual syndrome. She states she was told that changing her diet might help in managing some of the symptoms. What changes in her diet do you recommend??

Increase her intake of complex carbohydrates

Sydney, age 21, is taking an oral contraceptive. She complains of acne. How should you adjust the estrogen in the OC??

Increase the estrogen content

Mrs. Green called the office to make an appointment for her annual Pap smear. She needs to be given the following instructions prior to her appointment??

Insert nothing in the vagina for 24 hours before the examination.

A dancer from an adult club down the street comes in for a renewal of her birth control pill prescription. She says that everything is fine. ON examination, you find grayish white vaginal discharge, and cervical motion tenderness. Which of the following differential diagnosis is most unklikely??

Interstitial cystitis

Minnie, age 52, states that she is going to have a TRAM procedure after her breast surgery. HOwever, she was in shock from the diagnosis when the surgeon explained the procedure. She asks you to explain it. How do you respond??

Its an autogenous procedure that uses skin from the rectus abdominis muscle to fashion a breast

Joanne wants to use some form of birth control, but because she is getting married next year, she wants to be able to stop the birth control method after the wedding and have her fertility restored almost immediately. Which method do you recommend for her??

Lea's Shield

Lori, age 38, states that she has not had a pelvic examination in 5 years because she does not like having the digital rectal examination. How do you respond??

Let's schedule an examination now because women no longer need a rectal exam with routine pelvic examinations.

The Joneses are thinking about going for infertility counseling because they have been married for 5 years and have been unable to conceive. They ask you whether the man or the woman is usually the cause of the infertility. What do you tell them about the etiology of infertility??

Male and female infertility rates are almost the same in the majority of cases

Marsha, age 42, is having dysfunctional uterine bleeding and cannot take oral contraceptives due to a history of a blood clot. Management includes which medication??

Medroxyprogesterone

A 26 year old female comes to your office to discuss birth control options. Her history includes migraine headaches with aura while on combination oral conraceptiees in the past. She does not want to become pregnant. Which of the following birth control options would be the best choice for her??

Mirena IUD

Which of the following drugs may have their effects diminished when used in combination with an oral contraceptive??

Oral anticoagulants

Which of the following drugs given to nursing mothers may cause a reduction in the milk supply??

Oral contraceptives

Which of the following statements do you use when instructing women about their fertile period??

Ovulation occurs on the 14th day, plus or minus 2 days, before the next menses.

Which type of breast cancer involves infiltration of the nipple epithelium and has an initial symptom of itching or burning of the nipple??

Paget's disease

Jennifer, age 27, is complaining of lower abdominal pain. After doing some laboratory studies, you find leukocytosis, an elevated erythrocyte sedimentation rate, and an elevated C-reative protein level. Whcih is the most appropriate diagnosis??

Pelvic inflammatory disease

Judi has a seizure disorder and wants to get pregnant. What is the drug of choice for her during pregnancy??

Phenobarbital (Luminal)

Which of the following ovarian tumors or cysts has the potential for malignancy??

Secondary ovarian tumors

Jenna has been diagnosed with a generalized anxiety disorder. You know that she may experience which of the following??

She may have been excessively anxious and worried on most days for more than 6 months.

On physical exam, Judy has pubic hair that spreads over her mons pubis with a slight lateral spread. In addition, her breast development shows breast enlargement with a secondary mound formation by the developing areola. Which Tanner stage best describes Judy's development??

Stage IV

What is the most common cause of mastitis in breastfeeding women??

Staphylococcus aureus

Toxic shock syndrome may be caused by which of the following??

Tampon contamination with Staphylococcus aureus

Marcia, age 59, presents with depression. According to the diagnostic criteria for a major depressive disorder, which of the following criterion needs to be met??

The symptoms must be severe enough to upset the client's daily routine or to impact his or her work or interfere with relationships.

Susan is 9 months pregnant and asks you about using umbilical cord blood after birth for newborn DNA identification. What do you tell her??

This cord blood sample is identical to the genetic profile of the infant.

Which of the following is a sexually transmitted infection??

Trichomonal vaginitis

Mary, age 50, desires hormone replacement therapy for her hot flashes, which she can't stand. You've discussed the pros and cons and given her some alternative suggetions. Her mother had a history of osteoporosis. You have decided to initiate therapy for 1 year. She asks you if she also needs to take calcium or vitamin D for prevention of osteoporosis. How do you respond??

Yes, calcium intake should be increased to 1200mg/day along with 600mg of vitamin D to decrease bone turnover and increase intestinal absorption.

Janice, age 26, who has genital herpes, asks if her partner has to use a condom during sexual intercourse even if she does not have a visible lesion. How do you respond??

Yes, shedding of the herpes simplex virus from mucocutaneous surfaces in the absence of visible lesions is a primary mode of transmission.

Brianne, age 24, complains of urgency, frequency, and dysuria. Your dipstick test shows no hematuria, and her urine culture shows no growth. What is your next action??

You suspect a sexually transmitted infection, so you obtain a culture of the urethra, do a potassium hydroxide wet prep, and obtain another urine culture.

First-line treatment for polycystic ovary syndrome is??

a combination of diet modification, weight loss, and stress management.

During a pelvic examination, you ask Mrs. Krane to valsalva (strain). While doing this, a pouching is seen on the anterior wall of the vagina. This is indicative of??

a cystocele

A vaginal pH of 4.2 is an expected finding in??

a healthy woman of reproductive age

Which of the following is an indication for a colposcopy??

a pap smear showing dysplasia

Jane is 7 weeks pregnant and experiencing morning sickness. The most common cause for this condition is??

a production of human chorionic gonadotropin

A 17 year old female patient request to start Depo-Provera injections as her method of birth control. She discloses that she has had four sexual partners in the past year. Her last menstrual period was 12 days ago and she had unprotected intercourse 3 days ago. The appropriate managment for this patient would be to??

advise her to use another method for now and return with her next menses??

Mrs. Peterson would like to be fitted for a diaphragm. She has been on numerous hormones in the past and does not like the side effects. It is important to remember that when properly fitting a patient for a diaphragm, it should??

allow a fingertip between it and the public arch

Unilateral galactorrhea may be present with??

an intraductal papilloma

Emotional support is best given to the client with a sexually transmitted infection by??

authentic active listening

The most common reason for surgery for macromastia is??

back and shoulder pain

The mobiluncus species is responsible for which sexually transmitted infection??

bacterial vaginosis

The most common type of vaginal infection is??

bacterial vaginosis

You've just finished a Pap smear on Sadie, age 39. During the wet mount, you see cells with bacteria adherent to the cell wall giving it a stippled, granular appearance. What do you suspect??

bacterial vaginosis

Jennifer, age 42, presents for her well-woman examination and you notice dimpling on her left breast. Your initial reaction is that it may possibly be??

breast cancer

Human papillomavirus may lead to ??

cervical dysplasia

In a patient diagnosed with cervical gonococcal infection, you would also suspect a co-infection with??

chlamydia

Susan has been diagnosed with fibrocystic breast disease. Which of the following may exacerbate the condition??

chocolate

In a premenopausal woman, the biggest heart attack risk factor is??

cigarette smoking

Herpes simplex virus can be potentially acquired through maternal transmission. This is least likely to occur??

during the neonatal period

When a woman complains of dyspareunia in the lower back during orgasm, you should consider??

endometriosis

An occurrence of genital herpes is??

expected to be completely resolved within 21 days for the primary lesion.

Of the symptoms listed below, the most commonly expressed symptom of women with premenstrual syndrome is??

fatigue

Reiter's syndrome is a complication of??

gonorrhea

The simplest and safest method of suppressing lactation after it has started is to??

gradually wean the baby to a bottle or cup over a 3week period.

The best method to diagnose uterine polyps is a??

hysteroscopy

Infertility is best defined as the??

inability to conceive after 1 full year of unprotected intercourse

The most common type of invasive breast carcinoma is??

infiltrating ductal carcinoma

Women who take oral contraceptives are less likely to experience??

iron-deficiency anemia

When a woman has extreme spasticity, which position should she assume for a Pap smear??

knee-chest position while prone

A treatment used to improve the chance of pregnancy in an infertile woman who has minimal or mild endometriosis is??

laparoscopic resection or ablation of the lesions

Lactobacilli in the vagina??

maintains an acid pH range

A sexually active woman should be aware that genital herpes simplex virus??

may be transmitted to a partner or newborn even in the absence of lesions because of viral shedding.

Menses at irregular intervals with excessive flow and duration is defined as??

metrorrhagia

Dana is a 23 year old patient diagnosed with dyspareunia. Which of the following is NOT a cause for this condition??

multiple pregnancies

Endometrial cancer, hirsutism, acne, breast cancer, increased risk of diabetes, infertility, menstrual bleeding problems, and an increased risk of cardiovascular disease are clinical consequences of??

persistent anovulation

Stein-Leventhal syndrome, one of the leading causes of female infertility, is more commonly known as??

polycystic ovary disease

The most likely cause of amenorrhea is??

pregnancy

Characteristics of polycystic ovary syndrome include??

premenarchial onset, obesity, hyperinsulinemia

Mrs. Henderson inquires about why she needs progesterone in addition to her estrogen for hormone replacement. Women who have an intact uterus need to add progesterone to their prescribed estrogen because progestin??

reduces the incidence of endometrial hyperplasia and cancer

Darcy is to undergo a cone-needle biopsy for a suspicious breast mass. This procedure includes??

removal of a large core of tissue from the lesion for histological evaluation utilizing a large gauge cutting needle.

Gerri, a 33 year old female patient, complains of external vaginal irritation after adding new fabric softener to her laundry. You have diagnosed her with recent vaginitis. The treatment of choice for this condition includes??

rewashing undergarments without fabric softener and applying corticosteroids to the affected area.

A 21-year old woman comes to your office and reports a history of genital warts. In reference to the HPV vaccination, she should be educated that??

she should receive the HPV vaccination

Which of the following lifestyle factors is associated with an increased risk for breast cancer??

smoking

Which type of incontinence has associated symptom of recurrent cystitis??

stress incontinence

Leiomyomas are found ??

within the uterine wall

Candidiasis is more common in ??

women with diabetes