quiz 1 study

A 32 year old female presents to the clinic complaining of worsening chronic lower abdominal pain and dyspareunia. Her past medical history is only significant for a suspected chlamydia infection in the last couple of months. She has no current or prior abnormal PAPs. Which of the following physical exams and findings are most consistent with her likely diagnosis?

"Chandelier sign" elicited via bimanual exam

An asymptomatic 17 year old female presents for a well woman exam. She recently became sexually active. Which of the following would you recommend to her given her history?

-STI testing -family planning convo *remember breast exams start at age 20 and pelvic exams at age 21

27 y/o female smoker, with no pertinent PMHx, presents to the office complaining of "pain down there" x 3 days. She states she has not tried to visualize the area of pain, but does note difficulty walking/sitting due to the pain. Physical exam shows a 4cm mass on the inferior portion of the R vulvar vestibule, near the vaginal opening, and is erythematous and tender to palpation. Based on the likely diagnosis, what is the best treatment?

Incision and drainage with a word catheter or marsupialization (it's a bartholin abscess >3cm)

A 24 year-old female presents to the clinic for her routine cervical cancer screening. The cytology results from her last screening were normal. Today's results reveal abnormal histological changes with findings of CIN-1. These findings indicate that the patient will need which of the following managements?

Observation

A 27 year old female presents to your clinic for a non-painful sore on her labia, onset 10 days ago. She has never had this before, and reports that she was sexually active with a new partner 2 weeks ago . She also has a history of HIV, and is currently on therapy for it. On PE you note b/l lymphadenopathy. You decide to run the non-treponemal test, which is reactive, and follow with the Treponemal test, which is also reactive. What is the proper management for this patient?

She most likely has primary syphilis, so give her Benzathine penicillin G single IM dose.

A 24 y/o female presents to her OBGYN for her first visit since becoming pregnant. She has been in a monogamous relationship for the past three years and has no concerns about her husband having multiple partners. Her previous well woman exam was conducted 2 months ago where a Pap smear and STI testing were performed, both of which were negative. A pelvic exam is conducted, which is unremarkable. Which of the following is true concerning chlamydia screening in this patient?

She needs to be tested at the first visit and during the third trimester. **pt is <25

A 19 y/o female presents to your clinic for a well woman exam. She has an older sister who recently had a pap smear done and she would like to know if she needs to get one done as well. She has been sexually active for the last year and has no past medical conditions. What should you tell her in regards to when she should go in for her first pap smear?

She should come back when she is 21 years old to get a pap smear.

An 18 y/o G0P0 female presents to the clinic for her annual exam. On her history, she reports being sexually active with multiple male partners and denies using condoms during intercourse. She is currently taking a combined oral contraceptive pill for birth control. She denies any complaints or problems today. Speculum exam reveals mucopurulent endocervical discharge and a friable cervix. Due to her history, you suspect an STI and order a NAAT. NAAT results return as positive for Chlamydia Trachomatis. Urine pregnancy test is negative. Which of the following is the BEST medication to treat this STI?

doxy 100mg BID x 7 days

when would you perform cerclage

if pt had previous conization & became pregnant afterwards

A 24-year-old female presents with lower abdominal pain bilaterally for 4 days. She has had 3 sexual partners within the past 60 days. Upon physical exam, you note cervical motion tenderness, as well as some purulent cervical discharge.The NAAT test returns positive for chlamydia, and pregnancy test is negative. What is the best treatment for your patient?

Ceftriaxone + Doxycycline + Metronidazole

A 31-year-old pregnant female comes into the clinic to get tested for STIs for the first time in 15 months. The patient denies any past history of sexually transmitted diseases, and states she has had 20 new sexual partners since her last visit. The patient also denies the use of protection such as condoms or dental dams. The patient shows no signs of painful or painless lesions, or abnormal vaginal discharge. Both the nontreponemal and treponemal tests show a reactive result. Which of the following treatments would be best for this patient's condition?

Benzathine penicillin 2.4 million units weekly x 3 weeks

A 11-year-old female is brought to the pediatrician by her parents for a routine health maintenance visit. The patient reports feeling well, and she has been meeting all developmental milestones. She has no chronic medical conditions and is immunocompetent. Her temperature is 98.7°F, pulse is 70/min, and blood pressure is 110/70 mmHg. She is at the 77th percentile for height and 82nd percentile for weight. A vaccine that is protective against genital warts and cervical cancer is recommended by her pediatrician. Given that she has never had this vaccine before, what should be the dosing schedule?

2 doses of HPV vaccine should be given; one at the visit today and in 8 months.

A 22-year-old female is brought to the ED after experiencing sexual assault. She appears anxious and distraught. She is marked as high priority and is immediately taken to a private room for triage. While taking a quick history patient mentions some injuries she sustained. Which injury needs immediate care?

Bruising around neck *basically anything indicating strangulation

A 15 y/o female visits her pediatrician for her annual physical before starting the school year. She has an unremarkable medical history and all findings at the visit are normal. On review of her vaccination record, her pediatrician notices she has not yet received a vaccination for HPV. How many total doses of the vaccine will she need, and on what schedule should this patient receive the HPV vaccinations?

3 doses administered at 0, 2, and 6 months

A 32 y/o female presents to her family medicine PA and reports a recent history of sexual assault that occurred 36 hours ago. Vital signs are normal. Based on her history you decide to treat prophylactically for STIs with ceftriaxone 500mg IM, doxycycline 100mg BID x 7 days, and metronidazole 500mg BID x 7 days. The patient is prescribed the appropriate ART therapy, and after thorough counseling, she declines Plan B. When should the patient get tested for STIs?

3 months, 6 months, and 1 year post-incident

Sally Joe is a young, female patient who is in your primary care office and has many questions regarding her health. Which of the following patient education points in regards to the female exam is correct to provide to Sally?

A clinical breast exam is recommended every 1-3 years for women above the age of 20.

A 26-year-old male patient presents to the clinic complaining of a painless cut on the tip of his penis. Pt states he first noticed a small "bump" about a month ago that has since developed into more of a scab/cut. Physical exam reveals a 0.5 cm ulcer with indurated margins located on the glans of the penis and bilateral inguinal lymphadenopathy. Patient is sexually active and reports unprotected anal sex with multiple male partners for the past 6 months. RPR is 1:4 and TPPA is positive. Based on these findings, what is the most appropriate next step in the management of this patient?

Administer IM benzathine penicillin G 2.4 million units once in office.

Carol, a 67-year-old female, has come to your clinic for her annual well woman's exam. She states that she last received a pap smear 2 years ago along with a HPV test. Her pap smear and HPV test were both negative. However, Carol stated that she keeps track of when to get her tests done because she had a scare 5 years ago when she received an abnormal pap smear result, otherwise she has only ever received negative results for pap smears and HPV testing. After her examination, she asks you if she will have to continue getting pap smears because she read online that after 65 years old they are no longer required. Based on this information, what should you advise Carol to do?

Advise Carol to get a pap smear next year (need 3 negative paps within 10 years)

A 26-year-old, G1P0 female at 20 weeks gestation presents with mucopurulent endocervical discharge and urinary frequency. Her vitals are unremarkable. You decide to order a chlamydia trachomatis/ neisseria gonorrhoeae (CT/NG) NAAT, which comes back positive for chlamydia. Which of the following is the best treatment option?

Azithromycin 1 g orally in a single dose

A 32-year-old female presents to your family medicine clinic with a 1 day history of mild lower abdominal discomfort and dysuria. She reports being sexually active with one male partner 10 days ago and denies any other sexual activity in the past 90 days. On a physical exam you note a friable cervix with mucopurulent endocervical discharge. A NAAT vaginal swab detected chlamydia and did not detect gonorrhea. The patient's urine pregnancy test was positive. What is the best course of management for this patient?

Azithromycin 1 g orally in a single dose

A 30-year-old female patient presents to the clinic complaining of pain while urinating and has felt an increased urge to urinate for the past week. She reports being sexually active with one male partner two weeks ago and denies using any protection or having any other sexual activity in the past 60 days. The patient is currently 20 weeks pregnant and weighs 140 pounds. Upon examination, you note a friable cervix and mucopurulent endocervical discharge. A NAAT swab is ordered and returns positive for chlamydia, but did not detect gonorrhea. The patient's urine pregnancy test was positive. Of the following options, what is the best course of treatment for this patient?

Azithromycin 1g orally x single dose

A 20-year-old female patient presents to your clinic stating that she has been sexually assaulted by her friend at a college party four days ago and is hurting "down there". After bringing her back to a private room, you discover she is very hesitant to talk to you and to get the sexual assault medical forensic exam done because she doesn't want to get her friend in trouble with the police. Which of the following is a true statement you can give her to inform and reassure her about this process?

Because she is over 18 years old, she has the right to not report the assault to the police and decline the forensic exam while still receiving medical treatment for any injuries.

A 26 yo female presents with abnormal vaginal discharge for 8 days. Examination reveals mucopurulent endocervical discharge and a friable cervix. A vaginal swab is obtained for subsequent NAAT testing for chlamydia and gonorrhea. The patient is positive for gonorrhea and negative for chlamydia. The patient weighs 120 lbs and the pregnancy test is negative. Out of the following options, which is the best therapy for this patient?

Ceftriaxone 500mg IM once

A 21 y/o female presents to your clinic complaining of pelvic pain, uterine tenderness, uterine bleeding, and a fever of 102 degrees. She states she is currently sexually active and has been since the age of 12. In addition to these symptoms, you perform a physical exam which reveals cervical motion tenderness and uterine tenderness. Which treatment option would you want to discuss with this patient?

Ceftriaxone 500mg IM x single dose, plus doxycycline 100mg PO twice a day x14 days, plus metronidazole 500mg PO orally twice a day x14 days

A 26 year old Caucasian female with hx of HPV was recently diagnosed with cervical intraepithelial neoplasia. She presents to the clinic to discuss her plan of care moving forward. You review the histology report from her most recent pap smear which reports: Atypical cellular changes within the lower ⅔ of the epithelium with a positive p16 stain. Which of the following is the best treatment option for this patient?

Cold knife conization (CKC)

A 30 y/o female with past diagnosis of HPV presents to the clinic for her routine well woman exam and Pap smear, she also states she has been noticing watery discharge and intermittent spotting unrelated to her menstrual period. Her last pap smear was positive for CIN1 (LSIL). What is the best next step in management if this routine pap also shows presence of CIN1 (LSIL)?

Colposcopy

A 26 year old sexually active caucasian female presents to the clinic with complaints of copious amounts of mucopurulent vaginal discharge that began x2 days ago. Pt reports she had unprotected vaginal sex with a male partner x1 week ago. A NAAT swab was performed and the patient was found to have chlamydia. Which of the following treatment plans is appropriate for this patient?

Doxycycline 100 mg PO BID x7 days

A 37-year-old woman G2P2 presents with a lump in her left breast. Her aunt had breast cancer and her great-grandmother and other ancestors may have died of breast cancer as well. She has regular physicals and is up-to-date on pap smears which have always been normal. Upon examination, the lump is discovered. What additional exam findings would be most concerning of breast cancer?

Edema-peau d'organe

A 30-year-old female reports to the clinic for her biannual routine health maintenance and lab work. She reports feeling well and has a medical history of Human Immunodeficiency Virus infection, diagnosed at age 28. She currently takes bictegravir/tenofovir alafenamide/emtricitabine (Biktarvy) and reports being compliant to taking the medication. Her blood tests come back and report an undetectable viral load. She states she is seeing a new sexual partner and asks you for advice on how to proceed to protect herself and her partner. What is the best patient education you can give to this patient?

Educate patient about their test results and what it means to be undetectable. Explain she cannot transmit HIV to her sexual partners, however, she should continue to take her medication to keep her viral load at a low level. Recommend condom use to protect herself and partners against other STIs, like chlamydia and gonorrhea.

A 25-year-old patient presents to your clinic for her annual well women exam. Upon inspection of the patient's vulva, a mobile, sac-like structure measuring 2 cm is noted on the right side of the vaginal opening. The patient states she has not experienced any pain or treatment related to this finding and is otherwise asymptomatic. There are no abscesses noted. As you suspect she has a bartholin cyst, which of the following is the next best step in the management of this patient?

Educate the patient on the benefits of sitz baths and warm compresses.

The patient is a 24 y/o female presenting to your clinic complaining of vulvar pruritus and burning, dysuria, and abnormal white, clumpy vaginal discharge after recently taking an antibiotic. On wet mount microscopy of the vaginal discharge, you can visualize budding yeast, pseudohyphae, and hyphae. An in-office pregnancy test was performed and was negative. What would be the best treatment plan for this patient?

Fluconazole 150 mg orally in a single dose, and OTC Clotrimazole 1% cream 5g intravaginally daily for 7-14 days

A 28-year-old female presents to her primary care physician with complaints of a foul-smelling vaginal discharge. She reports that the discharge has a strong "fishy" odor and is thin and grayish-white in color. She denies any vaginal itching or irritation. On examination, the vaginal pH is measured to be above 4.5. Microscopic examination of a wet mount preparation shows the presence of clue cells. Which of the following is the most likely causative organism for the most likely diagnosis?

Gardnerella vaginalis

A 20 year old sexually active female presents to the gynecology clinic for her annual well women visit. Last visit on file was a well-women at age 15. Sexual history includes vaginal and oral sex with 2 new male partners within the last 6 months and no previous partners prior. Patient is not on birth control but reports use of condoms. Previous immunizations include all recommended childhood vaccinations including HPV. Family history is unremarkable for gynecological cancers. Based on her age and history, which screening(s) would you recommend?

Gonorrhea/Chlamydia, and HIV.

A 22 year old female comes into the clinic due to concern over HIV exposure. She states she has not had any specific problems or symptoms of any kind and just wants to make sure "everything is normal." While taking her history, she states she is heterosexual and exclusively has sex with men. She has had more than 15 sexual partners in the past 3 months and that this is normal for her. She engages in vaginal and oral sex. She reports inconsistent use of condoms. She states she has never been tested for HIV, but gets regularly checked for STIs, with her last test a week ago. The test came back negative for gonorrhea and chlamydia. She states she has heard of something called PREP, and wants to know more. What should your exam include today?

HIV testing as well as a prescription for Truvada.

A 35 year old sexually active female with a 10 pack-year smoking history comes to your clinic complaining of pelvic pain and foul smelling vaginal discharge. You obtain a pap smear. Pap smear results come back revealing high grade atypical cellular changes and you diagnose her with CIN-3. Which of the following HPV subtypes has this patient most likely been infected with.

HPV 18

Kerrie is a mother to an 11-year-old boy named James. Kerrie was watching television the other night and a commercial mentioned the Gardasil vaccination. She realized that James had not yet received this vaccination and she wants him to get it so he is protected. She knows the HPV vaccination can help prevent both the transmission and acquisition of HPV through both sexual and non-sexual contact. She especially wants to protect him against genital warts through the vaccine. What are the subtypes of HPV that cause genital warts that the vaccine will protect James against?

HPV 6 & 11

A 31-year-old AFAB female named Jessica presents to your office because she has been unsuccessful in trying to get pregnant. She is concerned because she and her AMAB male partner have been engaging in regular unprotected sex for a year and a half and have not been successful in conceiving. Jessica's partner has been evaluated by a fertility specialist and all tests were within normal limits. During your history-taking she mentions that she had an STI at the age of 22 and had to be hospitalized because her "lower belly hurt so bad." She cannot remember the name of the STI. You do a full pelvic exam and there are no abnormal findings. Assuming all labs that you order are also normal, what diagnostic would you order given her history?

Hysterosalpingography

A 28 y/o female presents to your clinic complaining of difficulty with getting pregnant for 2 years and is worried she may be infertile. No significant past medical history. Her partner has been evaluated for fertility with normal results. What gynecologic diagnostic would be the best to evaluate a patient for infertility?

Hysterosalpingography (HSG)

A 30 year-old female presents to the clinic complaining of foul-smelling, watery discharge that has been occurring for the past month. After performing a colposcopic directed biopsy and a histologic assessment, the results indicate a micro-invasive squamous carcinoma stage Ia1. Based on this staging, and choosing the least invasive procedure that would allow the patient to conceive in the future, what important patient education is most appropriate?

If the patient becomes pregnant, will need a cervical cerclage to prevent premature miscarriage.

A 34 y/o female presents to your primary care office complaining of watery vaginal discharge and intermittent back pain not relieved with regular use of NSAIDs for years. She notes onset of post-coital bleeding as well x1 month. A cytologic screening test was performed and the histological report denoted CIN -2 HSIL (p16 positive). What is the most appropriate choice of management as next steps for the patient's condition?

LEEP procedure and f/u in 6 months

A 34 y/o female presents to your primary care office complaining of watery vaginal discharge and intermittent back pain not relieved with regular use of NSAIDs for years. She notes onset of post-coital bleeding as well x1 month. A cytologic screening test was performed and the histological report denoted CIN -2 HSIL (p16 positive). What is the most appropriate choice of management as next steps for the patient's condition?

LEEP w/ f/u in 6 months

A 24 year old sexually active female presents for her annual Well Woman Exam. Screening results show CIN-1. She has no history of abnormal pap smears and all prior STI screenings have been unremarkable. Which of the following is most consistent with the histologic findings of this patient's screening results?

Low grade, mildly atypical cellular changes in the lower 1/3 of the epithelium. CIN 1 = lower 1/3 CIN 2 = lower 2/3 CIN 3 = >2/3

A 35 y/o female with a history of HPV presents to the clinic complaining of watery vaginal discharge, intermittent spotting, and post-coital bleeding. Based on your clinical suspicion, what kind of epithelial cells would you most likely suspect on the histology report?

Metaplastic epithelium within the transformation zone of the cervix

A 25 year old female presents to the clinic complaining of bilateral lower abdominal pain that began 5 days ago. She denies nausea, vomiting, and fever. She reports seeing blood in her underwear even though she is not currently menstruating. The patient reports that she is sexually active and has had four male partners in the past 6 months. Upon physical exam you note lower abdominal tenderness to palpation, positive rebound tenderness in the LLQ and cervical motion tenderness. The in office pregnancy test was negative. What is the most likely etiology for the patient's condition?

Neisseria gonorrhoeae *could also be chlamydia

A 61 year-old patient presents to your office for complaints of hot flashes, night sweats, vaginal dryness, and decreased libido. She has a history of hypertension, well controlled on lisinopril. She has a history of menarche at age 13 and menopause at age 48. The remainder of her history is negative. What is the best option to treat her symptoms?

Oral estrogen and oral progesterone.

Susan is a 28-year-old female who has been trying to conceive for the last year with no success. She has a history of heavy menstruation, but her periods are regular. She reports a previous episode of pelvic inflammatory disease that was treated with a course of antibiotics. Her pap smear and breast exam appear to be normal. Her lab work is normal. Her husband received a semen analysis that also appears to be within normal range. Given Maria's clinical presentation and history, which of the following is the most appropriate next step in her evaluation?

Order a hysterosalpingography (HSG) to evaluate tubal patency

A 65 year-old female presents to the clinic for her well-woman check up. In the past two visits, she had two negative cytology results during her cervical cancer screening (PAP), and a normal mammogram and breast exam as well. Her most recent visit was three years ago. Which of the following screenings should be performed at this visit?

PAP, colon cancer screening, mammogram and breast exam

A 46 yo white female with no pertinent past medical history presents to your clinic for her annual well woman exam. Which of the following answer choices describes a correct screening guideline to discuss with this patient during her well woman visit?

Pap smear every 3 years

A 27-year-old female presents to the Emergency Department and states that she was sexually assaulted last night. She has been crying and you notice that she has suffered minor physical injuries, including what appears to be from strangulation. She is brought back into a room immediately. What is the best answer in what your next step should be to care for this patient?

Perform an assessment of the patient's medical needs to ensure that she is stable before proceeding.

A 25-year-old female presents to the clinic complaining of "feeling a bump on her genitals." The patient reports it has been present for 2.5 weeks. She reports having an IUD (Mirena) placed in July 2022 without complications. She is sexually active with multiple men and reports not using condoms. On physical exam, a non-tender, ulcerated papule with raised indurated margins is present on the right, upper labia minora. Mild bilateral inguinal lymphadenopathy is present. Syphilis is suspected. The non-treponemal test (RPR) is run and comes back positive. What is the next BEST step in the diagnosis and treatment of this patient?

Perform treponemal assay. If positive, administer Benzathine penicillin G 2.4 million units x 1 IM dose.

A 25 year-old female presents to your clinic with complaints of bilateral pelvic pain. She reports being sexually active with 2 new partners in the past 60 days and denies any form of contraception and protection. The pain worsens with sexual intercourse and is rated a 6/10. Physical exam reveals RLQ and LLQ tenderness upon palpation, cervical motion tenderness, uterine and adnexal tenderness and purulent discharge seen at the endocervix. Based on the patient's history and physical, which diagnostic(s) would be the best choice?

Pregnancy test, microscopy of vaginal discharge, and STI testing would also need CBC:)

A 22 y/o female presents to your clinic complaining of a lesion on the labia majora that is painless but ulcerating with raised indurated margins. The lesion has been present for 1 week. Upon physical examination, you also note mild regional bilateral lymphadenopathy. Patient has never had STI testing and denies previous history of STIs. Both a nontreponemal and a treponemal test are performed. What do you expect the results of the tests to be, respectively?

Reactive; reactive

A 34-year-old female presents to your clinic today for her annual well-check. While inquiring about her immunization status, you learn that she has never received the HPV vaccine. She is currently undergoing treatment for CIN 2. Which of the following is correct regarding HPV vaccination of this patient?

Recommend 3 doses of the HPV vaccine at 0, 2, and 6 months *immunocompetent women 27-45 undergoing tx for CIN2+

A 15-year-old female who is accompanied by her mother presents to your gynecology clinic for her first well woman visit. The patient's medical history is unremarkable. She is currently sexually active and takes Yaz (drospirenone/ethinyl estradiol) for contraception but is on no other medications. The patient's mother is aware that her daughter is sexually active, which is one of the reasons why she decided to make an appointment for her. Which of the following would be most appropriate at this visit?

Recommend the patient get a 3-dose series of the HPV vaccine if she has not yet been vaccinated.

A 36-year-old male presents to the clinic complaining of generalized fatigue and muscle aches. He reports being treated for primary syphilis about 12 months ago, with full resolution of previous symptoms. Past test results reveal an initial RPR titer of 1:8 with positive TPPA. However, over the past 2 weeks, he has lost 12 pounds, has an oral temperature of 100.5°F, and feels very lethargic. Upon physical examination, the PA notes diffuse lymphadenopathy and reddish brown spots on the palms of his hands and soles of his feet. What diagnostic test would be the best choice to confirm the suspected diagnosis and what would be its expected finding?

Repeat RPR titer - 1:32

A 21-year-old Caucasian female presents to the clinic to discuss her recent pap smear results. Cytology revealed atypical squamous cells of undetermined significance (ASC-US) and the patient subsequently underwent HPV testing, where she tested positive for HPV. What are your recommendations regarding this patient's follow up based on the 2019 ASCCP Risk-Based Management Consensus Guidelines?

Repeat cytology at 1 year **note: if they tested negative for HPV: then could undergo routine screening

A healthy 28 year old woman presents to your OBGYN clinic for her annual visit. She has had a cytology (pap) (no HPV co test) every 3 years since she was 21 yo, all which have been normal. She has no current pelvic complaints or concerns. She is, however, curious about her cervical cancer screening schedule. What is the most appropriate cervical cancer screening schedule for her?

She is not due for a cytology (pap) today, so she can return when she is 30yo and continue to have a pap smear every 3 years until she is 65 years old.

A 16yo patient presents to your family practice clinic for her annual check up. The patient is accompanied by her mother Ruth. The patient and her mother inform that she would like to receive the HPV vaccine. The mother states that she has never received this vaccination and would like to know what options her daughter has. What would be the best option for the patient's vaccination schedule?

The three does series of Gardasil 9

A patient presents to you with no history of an HPV vaccine. The patient is a 12 year old female who is immunocompetent. You would like to educate the patient on the HPV vaccine and its benefits. Which of the following is true?

Since the patient is younger than 14, she should get 2 doses of the vaccine, one at this visit and then one more in 6-12 months.

A 23-year-old G0P0 female presents to your clinic for her annual complete pelvic examination. Which of the following statements is CORRECT regarding a Pap smear?

Specimens are obtained from the exocervix and endocervix to ensure full evaluation of the transformation zone.

A 29 y/o female presents to the clinic today complaining of yellow, frothy, malodorous discharge. You suspect trichomonas vaginalis. Which of the following findings would support this diagnosis?

Strawberry cervix

A 53 year-old G2P2 female presents to your primary clinic for her annual well women's exam and to discuss some symptoms she has been experiencing. She says that she has recently been sweating and flushing around her face, neck, and upper back that "comes and goes" as well as numerous occasions where she wakes up at night drenched in sweat for the last 4 months. She reports having two vaginal deliveries with no complications and denies any other surgeries. The rest of her exam is within normal limits. Which of the following medications would be most appropriate given the presenting complaint?

Systemic hormone therapy of estrogen plus progestin.

A 44 y/o female pt presents with complaints of pelvic discomfort and variable watery discharge for 2 months. The results of the pap smear are analyzed and determined to be containing HSIL. Which of the following is the most appropriate patient education?

Tell the patient there is up to a 40% chance risk of progressing to cancer and recommend LEEP or CKC procedure.

A 23 y/o female presents to the clinic today for her annual gynecological visit. She also says that she has had 3 male sex partners over the past calendar year. Patient does mention that she has had vaginal discharge with a distinct musty odor over the past 7 days. She denies any pain from the vaginal discharge. No chancres, lesions, or trauma marks were upon physical exam of the anogenital region. Given the clinical picture, what is the most likely diagnosis and subsequent best course of treatment?

The patient has bacterial vaginosis and BV requires Metronidazole 500mg PO BID x7days.

An 11-year-old female presents to the clinic for an annual physical, accompanied by her mother. She is not currently sexually active per her historical summary. Her mother asks a question regarding the appropriate time for her daughter to receive the HPV vaccination. Which of the following is the most appropriate response?

The patient is permitted to receive two doses of the HPV vaccine at 0 and 6-12 months.

A 32 year-old female presents to the clinic complaining of pain with urination, vaginal itching, malodorous discharge, and discomfort during intercourse for the past 3 weeks. Patient reports having unprotected sex with several sexual partners. On PE she is found to have frothy discharge, strawberry cervix, and erythema around the vulva and vaginal mucosa. What do you suspect as her diagnosis and how would you treat it after confirming the diagnosis?

Trichomonas vaginalis, metronidazole 500mg BID x 7 days

An 18 year old female presents to a OBGYN's office for her first well woman exam. She has no medical conditions and takes no medications. She has not noticed any changes in her menstrual cycle or appearance in her breasts since beginning menarche at age 12. She has no specific concerns when asked. Upon examination the OBGYN observes that the breast tissue is bilaterally limited at the base and overdeveloped in the areola. Breast tissue is nontender, there is no nipple discharge, no palpable masses, and no lesions, puckering, or ulcerations to the skin. What is the most likely condition observed in this patient?

Tuberous breasts

A 19 yo female patient presents to the urgent care with complaints of vague abdominal comfort, purulent vaginal discharge, and dysuria x 5 days. She reports she has had 3 new male sexual partners in the past 30 days. She reports engaging in oral and receptive vaginal sex. She denies condom use. She does not take any medications and has no known drug allergies. She has a negative POC pregnancy test. The PA in charge of her care orders a NAAT for Gonorrhea/Chlamydia. The test returns positive for Chlamydia. Which of the following is NOT an associated complication if her infection goes untreated?

Uterine prolapse

A 25-year-old female patient presents to the clinic after noticing a painless "bump" in her genital region. Patient states she is in a monogamous relationship and recent STI testing was negative at her annual last week. Upon physical exam, you note a small mass measuring approximately 4 cm located at the lower vulvar vestibule. You suspect that the patient has a bartholin gland cyst. What is your next step?

Word catheter placement

A 20 y/o female with a history of a kidney transplant presents to the clinic for her first well women's exam. She is currently sexually active with one partner and denies having any history of watery vaginal discharge, intermittent spotting, and post-coital bleeding. A pelvic exam was performed and the cervix appeared normal with no cervical lesions or abnormal tissue noted. Based on the guidelines for cervical cancer screening, should a pap smear be performed during this visit?

Yes, a pap smear should be performed since she is immunocompromised.

A 65 year-old Caucasian female presents to the clinic for her annual well women's exam. She has no gynecologic complaints today. She has a past medical history of hypertension, diagnosed at age 55, and is well controlled with lisinopril 10 mg. Her BP is 124/86, O2 sat is 95% on RA, temp. 98.8 degrees F, HR of 68 bpm, and RR of 12. Over the past 10 years, 2 cytology reports came back negative for dysplastic changes, but the 3rd came back positive for CIN1, which was observed and later regressed on its own. As her PA, what do you recommend?

Your patient needs one more cytology screening, and if that comes back negative, she does not have to be screened again

A 22 year old female comes to your clinic for a routine pap smear. While discussing sexual history, she says she's been sexually active with a male partner for four years and denies any urinary or sexual symptoms, including pain with sex, abdominal pain, diarrhea, constipation, bloating, or painful, bloody, or foul-smelling urination. The PA performs a pap smear which results in cervical intraepithelial lesion type 1 (CIN I). The patient's previous pap smears were normal. What are the next steps in management?

observe and repeat pap smear in 1 year

A 28-year-old sexually active female presents to your clinic complaining of vaginal itching and burning. Her physical exam is remarkable for yellow, frothy discharge and strawberry cervix. You measure the pH of the vaginal discharge and perform wet mount microscopy. Which of the following results would be consistent with the patient's most likely diagnosis?

pH: 5.0, wet mount microscopy: motile trichomonads

A 32 y/o female presents to your clinic for her scheduled pap smear. She is asymptomatic without any complaints. During her history, she tells you she is sexually active with her husband of 4 years, denies any new partners, and is not using condoms or contraceptives. During your inspection of the cervix, you notice vascular congestion and a bluish color of the cervix. Which of the following is the next best step in the management of this patient?

pregnancy test