NR 602 Final
An adolescent female has had normal menses for almost 2 years. She has not had menses in three months. She is diagnosed with PCOS. What else is a common finding
Elevated insulin levels
Women with P ID typically present with all of the following except
Leukopenia
A 23-year-old woman presents to your practice with a chief complaint of postcoital bleeding. Which of the following would not be included in the initial assessment of this patient
Uterine biopsy
35-year-old woman complains of six month history of hypermenorrhea, backache, pelvic pressure. On exam you discover 12 weeks size uterus with a regular contour. What does this represent
Uterine fibroid
During a pelvic exam on a 70-year-old, the nurse practitioner notices the position of the cervix at the introitus. The diagnosis is most likely
Uterine prolapse
What choice below has no precautions for oral contraceptive pill use
Varicose vein's
Which of the following best describes lesions associated with condyloma acuminatum
Verruciform
A 28-year-old happily married woman presents with new onset insertional dyspareunia. The most likely diagnosis is
Vulvar vestibulitus
A 30-year-old woman who is sexually active complains of a large amount of milk like vaginal discharge for several weeks. A micro scopic slide reveals a large number of cells that have blurred margins. Very few white blood cells are seen. The vaginal pH is at six. What is most likely
Bacterial vaginosis
The clinical syndrome resulting from replacement of normal vaginal flora with anaerobic bacteria is
Bacterial vaginosis
Which of the following choices represents a disorder of the reproductive tract that causes pain, erythema, dyspareunia, and a perineal mass
Bartholin cyst
A client at the woman's health clinic complains of swelling of the labia and throbbing pain in the labial area after sexual intercourse. For what condition does the nurse anticipate the client will be treated
Bartholinitis
Approximately what percent of women will suffer a urinary tract infection at some point in their lives
60%
A woman with lobular carcinoma in situ has a relative risk of developing invasive breast cancer of
8.0
What percent of vulvar carcinomas are of the squamous cell type
90%
855-year-old woman presents to the clinic for evaluation of a breast mass. Which of the following is not a typical presenting sign of breast cancer
A 2cm, rubbery, tender lesion
Rectocele is best defined as
Decent or prolapse of the rectum
Cystocele is best defined as
Descent or prolapse of the bladder
A well woman visit for an adolescent should include which of the following
A general health history focusing on reproductive and sexual health concerns (mentors, gynecologic, and pregnancy related) and psychosocial (Family related, peer related, emotional, and physical as well as related to abuse, drug use and alcohol use) concerns Physical exam, screening test, and immunizations as indicated by the health history and gynecologic considerations for an extern only inspection of the genitalia
845-year-old woman has an abnormal screening mammogram. The next step in management should be
Diagnostic mammogram
A nurse is canceling a female client with type one diabetes to request a contraceptive information. What contraceptive method should the nurse recommend
Diaphragm with spermicide
Complications of Gonococcal and chlamydia genitourinary infection and women include all of the following except
A cute pyelonephritis
The appearance of lichen simplex chronicus is best described as
Diffusely red to red brown
A patient has been diagnosed with interstitial cystitis. The nurse practitioner remembers that this is best defined as
A non-infectious disorder of the urinary bladder
Which of the following findings indicate a possible gonococcal infection
Discharge from urethra or skene glands
A patient diagnosed with bacterial vaginosis should be advised that her sexual partner
Does not need treatment
This is defined as cramping pain in the lower abdomen occurring just before or during menstruation in the absence of other diseases
Dysmenorrhea
You explain to this young woman what this "lump" is and let her know you will be referring her to a gynecologist you consult with regularly. You explain to her the likely treatment as follows:
A possible incision might be necessary and a catheter placed for 2 to 4 weeks to allow for drainage and appropriate healing
A nurse practitioner is educating a woman who has a colposcopy. Which of the following most accurately describes a colposcopy
A procedure that visualizes the vagina, vulvar or cervical epithelium with magnification to identify abnormal areas that may need to be biopsied
A 33-year-old woman presents to your clinic complaining of dark brown watery vaginal discharge and postcoital bleeding. There is a strong history of multiple unprotected sexual encounters. Which of the following findings on examination would be suspicious for cervical cancer
A very firm, easily friable cervix
The clinic nurse is planning care for a client found to have chlamydia. Which treatment should the nurse plan to implement
Administration of azithromycin (Zithromax) 1 g orally in a single dose
Changes and hormonal regulation during menopause result in the gradual cessation of menstruation. From which gland is Androstenedione secreted
Adrenals
And collection of a specimen for a Pap smear, how is the endocervical specimen collected
After the ectocervical specimen with a brush
Which of the following statements is accurate regarding the usefulness of mammo in screening and detection of breast cancer
All women >40 years should have a mammo on an annual basis
The blood test results most consistent with supporting the diagnosis of PCOS is
Androstenedione at the Upper limits of normal or increased
Which is not a common cause of irregular menstrual bleeding
Anovulation
Which of the following is the most common cause of dysfunctional uterine bleeding
Anovulation
And women, most urinary track infections occur through
Ascending contamination from the urethra
An important part of patient education for the patient with bacterial vaginosis who is receiving a prescription for oral Flagyl is
Avoid alcohol for 48 hours after completing medication
A 25-year-old woman comes to clinic complaining of increased vaginal discharge, milky gray in color with a fishy odor that both she and her husband have noticed. I wet smear is performed and the presence of clue cells confirmed. Which type of infection does the nurse suspect
Bacterial vaginosis
A woman visit the clinic because she has dysmenorrhea. What goal should the nurse identify for this client
Easing the pain of the clients menstration
A 25-year-old presents with a report of a very tender area just near her introitus and to the left of her perineum. Very painful sex is how she knew something wasn't right. She showered and when washing, she felt a P sized painful lump on the left side of her bottom. She tells you she looked at it with the mirror and it was very small but now it is the size of a ping-pong ball and getting worse. when you Inspect her genitalia you are amazed at the size and appearance of the lump you know what appears to be an abscess on the left medial side of the labia minora and there is some edema extending into the perineum. Your diagnosis for this presentation is
Bartholins cyst
What is the recommended procedure for the evaluation of a chronic vulvar ulcer
Biopsy
A Bethesda System Pap smear report that reads LSIL is most consistent with which classification
CIN 1
A 20-year-old woman visiting the clinic says that she wishes to begin using Depot Medroxyprogesterone acetate (Depo-Provera) as a form of birth control what important information said the nurse include when teaching the client about Depo-Provera
Calcium intake and exercise should be increased because of the possible loss of bone mineral density with increasing duration of use
The cytology Pap smear results for a 21-year-old sexually active student whose partner uses condoms inconsistently shows a large amount of inflammation. Which of the following is the best follow up
Call the patient and tell her that she needs to return to the clinic for chlamydia and gonorrhea testing
A young woman presents to your practice with vaginal itching and white discharge. She denied sexual activity or douching. She has been in good health except for recurrent strep throat. Pelvic examination reveals a tender vulvovaginal area with edema and white patches, no odor is detected. Which of the following is the most likely cause of this problem
Candidiasis after antibiotic treatment
Uterine prolapse is caused by a relaxation of the
Cardinal ligaments
What is the leading cause of death from a gynecologic malignancy in American women
Cervical cancer
Small, pale yellow, raised, and rounded areas or visualized on the surface of the cervix. You should
Chart this as nabothian cysts
A 24-year-old female presents to the office with a complaint of vaginal itching in addition to thick mucoid discharge. She also has some mild urinary discomfort. The wet mount preparation using potassium hydroxide reveals a negative whiff test and few clue cells. There was no trichomonas visualized but the WBCs were too numerous to count. Which of the following would be the most likely diagnosis in the patient
Chlamydia
All of the following are infections that affect mostly the labia and vagina except
Chlamydia
Patients who are diagnosed with gonorrhea should also be treated for which of the following infections
Chlamydia
Her pelvic exam is remarkable for mild vaginal your Athena and a frothy grade discharge. You know a malodorous discharge and suspect trichomonas a wet prep confirms your diagnosis
Chlamydia and gonorrhea
A nurse practitioner is reviewing the signs of PCOS for a differential diagnosis for a female patient which of the following would be a positive finding
Chronic anovulation
A Pap smear results of atypical squamous cells of undetermined significance rule out high-grade squamous intraepithelial lesion will require which procedure
Colposcopy
What is the ASCCP recommended management for an ASCUS (atypical squamous cells of undetermined significance) pap result with a positive high-risk HPV 16 co-test in a 26-year-old woman without a history of abnormal Pap smears?
Colposcopy
A 16-year-old female is diagnosed with primary dysmenorrhea. She has taken over the counter ibuprofen 800 mg increments every eight hours during mentors for the past three months with minimal relief of symptoms. What intervention will provide greatest relief of dysmenorrhea symptoms
Combined oral contraceptives
A 35-year-old smoker is being evaluated for birth control choices. Patient has a history of pelvic inflammatory disease along with an embolic episode after her last pregnancy. Which of the following methods of birth control would you recommend
Condoms and the vaginal sponge
All of the following findings are associated with secondary stage of an infection by the organism Treponema pallidum
Condyloma acuminate
Which condyloma do we see in syphilis
Condyloma lata - flat
A patient has symptoms consistent with chlamydia which laboratory test would aid in the diagnosis
Culture and sensitivity
A nurse practitioner is examining a 29-year-old female with a three day history of dysuria and urinary frequency. On examination the patient is positive for suprapubic tenderness and negative for costovertebral angle tenderness this most likely represents which of the following
Cystitis
The situation where the bladder forces the anterior vaginal wall down and out is termed
Cystocele
Which of the following is an effective estrogen deficiency on paravaginal tissue
Cystocele
While a speculum is retracting the posterior vaginal wall, a 51-year-old patient is asked to strain down. There is a bulge from the anterior vaginal wall. This is most likely
Cystocele
A woman has been diagnosed with PCOS. Management of PCOS includes all of the following except
Daily basal insulin to reduce blood sugar
A 17-year-old female patient presents with amenorrhea for four months she did experience menarche at age 15 but had not had a menstrual cycle since. On physical examination, it is noted that she has normal secondary sexual characteristics. The nurse practitioner will consider progesterone challenge to determine the presence of adequate
Endogenous estrogen
A teenage patient presents with amenorrhea and moral secondary sex characteristics. The progesterone challenge is ordered. the purpose is to determine the presence of
Endogenous estrogen
You are evaluating a 17-year-old Emily who presented with amenorrhea and normal secondary sex characteristics. The purpose of the progesterone challenge is to a certain the presence of
Endogenous estrogen
Which of the following is common treatment for individuals with Turner syndrome
Estrogen therapy. This helps the girls with breast development and their menstrual cycle
A nurse is teaching a group of women about the side effects of different types of contraceptives. What frequent side effect associated with the use of an IUD should the nurse discussed during the teaching session
Excessive menstrual flow
The client asked the nurse about the use of an IUD for contraception. What information should the nurse include in the response
Explosion of the device, occasional dyspareunia, risk for perforation of the uterus
The most common cause of the delay in diagnosing vulva carcinoma is the
Failure to biopsy lesions
Primary amenorrhea is best described as
Failure to menstrate by 13 years old
A woman with the lower urinary track infection is least likely to experience which of the following symptoms
Fever
A nurse practitioner is participating in a woman's health fair. When educating the woman about risk factors for breast cancer which of the following statements is incorrect?
Fibrocystic breast disease
When educating women about breast cancer risk factors which statement is incorrect
Fibrocystic breast disease
A female patient is 35 years old. She has never had an abnormal Pap smear and has had regular screening since age 18. If she has a normal Pap smear with HPV testing today, when should she have the next cervical cancer screening
Five years
The frequency for cervical screening depends on the patient and her age. What is the longest recommended time interval between cervical screens for patients who are 65 years old or younger
Five years
Tina is evaluated and diagnosed with molluscum contagiosum. The nurse practitioner understands that clinical presentation of this disease is characterized by
Flashy, popular skin colored lesions with indented centers that contain white curdlike material
A Pap smear results of atypical squamous cells of undetermined significance require which procedure next
Follow-up Pap smear
A 25-year-old obese female with type two diabetes presents to your office with a complaint of vaginal itching and burning for two weeks. She has tried douching with an over-the-counter cream with no relief. Physical examination the Vulva is deep red with some thick white adherent material. Which of the following conditions would be most likely cause of her symptoms
Fungal infection
18-year-old female complaining of secondary amenorrhea. On exam, there is a normal secondary sex characteristics and normal genitalia. Pregnancy is ruled out what would necessitate further evaluation
Galactorrhea
Which form of birth control presents the highest risk to a female patient if she is exposed to a sexually transmitted disease
IUD
The first line treatment of severe menstrual cramps that having been occurring for four months in a patient with primary dysmenorrhea includes which of the following
Ibuprofen
Treatment options for patients with condyloma acuminatum include
Imiquimod (Aldera)
After treatment for a bladder infection, a client asks whether there is anything she can do to prevent cystitis in the future. What is the best response by the nurse
Increase daily fluid consumption
Which of the following is not a characteristic of turner syndrome
Increased risk for leukemia
The 16-year-old client has a steady boyfriend with whom she is having sexual relations. She asked the nurse how she can protect yourself from contracting HIV. What should the nurse advised her to do
Insist that her partner use a condom when having sex
Hey 17-year-old high school student is considering her birth control options. She wants to know more about Seasonale. which of the following statements is false
It is a progesterone only method of birth control and does not contain estrogen
A client seeking advice about contraception asked the nurse about how an Intrauterine device prevent pregnancy how should the nurse respond
It produces a spermicidal intrauterine environment
When molluscum contagiosum is found on the general area of children which of the following is the best explanation
It should raise the suspicion of child abuse
Urinary track infections are commonly seen in primary care. 25-year-old female presents with a new onset of dysuria and suprapubic pain for the last 24 hours. Examination reveals only mild tenderness without any peritoneal signs on the lower abdomen. Your analysis reveals the presence of WBCs. The urine is sent for a culture and sensitivity. In addition to E. coli one might typically expect to see the presence of which bacteria
Klebsiella
A 23-year-old woman comes to the clinic for a Pap smear. After the examination, the client confides that her mother had died of endometrial cancer one year ago and says that she is afraid that she would die of the same cancer. Which risk factor stated by the client after an education session on wrist factors indicate that brother teaching is needed
Late onset menarche
Hey 65-year-old female presents for a health maintenance examination. She complains of a bulbar itching due to what she recalls recurrent used infections and her symptoms have worsened over the last few months. She is sexually active with her husband and has experienced dyspareunia with Penetration lately. She always uses a water-based lubricant with intercourse. On examination you find complete loss of the borders of the labia minora, constriction of the vaginal outlet, and several thin white plaques on the Vulva. There is no other skin or mucosal involvement
Lichen sclerosus
Hey 65-year-old patient is diagnosed with lichen sclerosus. The woman asked the nurse what this really means. What is the nurses best response
Lichen sclerosus is a benign condition that is easily treated
A nurse practitioner is reviewing the chart of a woman who has findings consistent with PCOS. The diagnostic criteria for PCOS include all of the following except
Male pattern baldness
You are completing a pelvic exam on 32-year-old and Nancy. You detect a left adnexal mass on the bimanual exam. With an adnexal mass, the practitioner much always suspect
Malignancy until proven otherwise
When educating a patient about the rationale for obtaining a mammogram which of the following statements is false
Mammography detects all breast cancer's
Stein-Leventhal syndrome is characterized by Each of the following except
Many corpora lutea present in the ovaries
Sylvia is 44-year-old woman with dysfunctional uterine bleeding and is an able to use oral contraceptives. Which of the following medications can be use for management of DUB
Medroxyprogesterone
A nurse is caring for a client who has contracted a trichomonal infection. Which oral drug should the nurse anticipate that the healthcare provider will most likely prescribe
Metronidazole (Flagyl)
For the patient with chronic bacterial vaginosis, the nurse practitioner will prescribe
Metronidazole gel .75% vaginally 1-2 times a week for 4-6 months
The differential diagnoses for general ulceration include all of the following except
Molluscum contagiosum
22-year-old female complains of pelvic pain. Exam reveals cervical motion and uterine tenderness. Which supports a P ID diagnosis
Mucopurulent Vaginal discharge
A female client who has been sexually active for five years is found to have gonorrhea. The client is upset and asked the nurse what can I do to keep from getting another infection in the future. Which statement by the client indicates that the teaching by the nurse was effective
My partner has to use a condom all the time
A 24-year-old female patient has been diagnosed with primary dysmenorrhea. Which of the following medications would be best used as the first line to help control her symptoms
NSAIDs
A nurse is teaching a female client about the side effects of estrogen in an oral contraceptive. Which common side effect identified by the client indicates to the nurse at the teaching was effective
Nausea
A nurse in the family planning clinic reviews the health history of a sexually active 16-year-old girl whose chief concern is a thick, burning discharge accompanied by a burning sensation and lower abdominal pain. After an examination the girl is informed that she may have a sexually transmitted infection that requires treatment. The adolescent is concerned that her parents will discover that she has been sexually active and asked the nurse whether her parents will be contacted. The nurse explains that her parents will
Not to be contacted, because treatment at the clinic is confidential
My patient has symptoms consistent with chlamydia. Which laboratory test is gold standard In the diagnosis?
Nucleic acid amplification test
A 21-year-old woman comes into your practice seeking birth control. She has only recently become sexually active and has consistently use condoms for say sex. Your history reveals that she does not use tampons during her inventors I has very little knowledge about female reproductive anatomy. Based on this information, which of the following birth control choices would be the least likely to meet her needs for contraceptive management
NuvaRing
A nurse is describing the Skene glands, explaining that these glands would be found at which location
On either side of the urethral opening
A 40-year-old female presents with an abnormal menstrual cycle with menorrhagia and intermenstrual bleeding. The nurse practitioner Suspect the patient may have dysfunctional uterine bleeding and orders tests for follicle-stimulating hormone and luteinizing hormone levels. Both of these lab values are elevated. What is the most likely cause of DUB in this patient
Onset of climacteric
A 25-year-old woman complains of dysuria, severe vaginal up your ride is, and a malodorous vaginal discharge. Pelvic examination reveals a strawberry colored cervix and frothy yellow discharge. Microscopic examination of the discharge reveals multiple organisms that have flagella. The correct pharmacological therapy for the condition is
Oral Flagyl
Contraceptives that contain estrogen like and or progesterone like compounds are prepared in a variety of forms. Which contraceptives should the nurse to clients have a hormonal component
Oral drugs, transdermal agents
My 24-year-old female presents to the practice with a painless 2 cm lobular mass in the right breast that is freely mobile and firm. This has noted on self breast examination, and she reports it has been unchanged for the past three months. The best course of action by the nurse practitioner would be to
Order a diagnostic ultrasound or diagnostic mammogram
Women with a history of P ID have an increased risk for all of the following except
Ovarian cyst
Which of the following is not part of the criteria for an older woman to see if having any future Pap test performed
Over 55 years of age
Elevated triglyceride levels, low HDL levels, and elevated LDL levels are associated with
PCOS
It 34-year-old woman comes to see you in the office complaining of facial and abdominal hair growth and severe acne. She tells you that although her sister also has some facial hair, her worsening changes are dramatic as compared with family members. Which of the following is the most likely explanation of her symptoms
PCOS
The nurse practitioner understands that a complication of gonococcal and chlamydial genitourinary infection in women include which of the following
PID
Ana, 25-year-old, presents with dysmenorrhea. She states that her sister and mother have endometriosis, so she would like to be evaluated for it. Which of the following is consistent with a diagnosis of endometriosis
Pelvic pain and dyspareunia
A 55-year-old female patient presents with pain in the upper outer quadrant of her left breast for over one month now. The best course of action would be to
Perform a breast examination and order a mammogram
A 21-year-old female presents with three 0.5cm HPV lesions on her vulva. An appropriate treatment option for this patient would be
Podophyllin
A nurse practitioner instructor is reviewing the anatomy of the external genitalia. At the opening of the vagina are the Bartolian glands. Which of the following describes the function of these glands
Production of alkaline secretions for sperm viability
Which of the following is a classic symptoms of endometriosis
Progressive dysmenorrhea
A patient to a nurse practitioner is seeing for the first time has a past medical history of primary dysmenorrhea. She recalls that which of the following is considered as the primary etiology
Prostaglandin production
A nurse practitioner is teaching an undergraduate course in women's health. A student asks about the etiology of the pain that occurs with primary dysmenorrhea. Which of the following response is correct
Prostaglandin release and synthesis
Which of the following substances is responsible for the symptoms of dysmenorrhea
Prostaglandins
The nurse practitioner understands that which of the following lab test is appropriate for the patient who presents with symptoms of dysesthetic vulvodynia
RPR
What instruction should a nurse include one teaching about that the correct use of a female condom
Remove the condom before standing up
Lab results on your 26-year-old patient show a negative Pap smear with a positive HPV screen. Which procedure will be required next
Repeat Pap and HPV screen
And 18-year-old waitress is diagnosed with PID. The cervical Gen-Probe result is positive for neisseria gonorrhea and negative for chlamydia trachomatis. All of the following statements are true regarding the management of this patient except
Repeat the Gen-Probe test for chlamydia to ensure that the previous test was not a false negative result
A single Pap smear reading of ASCUS in a patient negative for HPV infection should have what as follow-up?
Routine screening
All of the following medications may be use for neuropathic pain management of vulvodynia except
SSRIs
Women often tend to reschedule a well woman visit but they don't do so often with the problems such as pelvic pain. This symptom can present as an acute or chronic insult. When a woman presents with pelvic pain, the term can encompass many possibilities. Differentiating acute from chronic assists with narrowing down the possibilities but nonetheless can originate from more than one system as the referred pain or discomfort. Which of the following choices are of a reproductive and pelvic origin
Salpingo-oohoritis secondary to PID
What recommendation should be made to a 70-year-old female regarding mammograms
She should have them annually as long as she has a reasonable life expectancy
Paget disease of the vulva may be associated with carcinoma of the
Skin
A nurse practitioner is completing a speculum exam on a female. Which of the following findings would be considered a normal surface characteristic of the cervix
Small, yellow, raised around area on the cervix
This bread is squamous cell carcinoma of the vulva is best characterized by which of the following
Spread of the disease is typically to the regional lymph nodes
A woman is admitted for repair a cystocele and rectocele. She has nine living children. In taking her health history, which of the following with the nurse expect to find
Stress incontinence with feeling low abdominal pressure
A college freshman who is using oral contraceptives called the nurse practitioners office asking for advice. She forgot to take her pills two days in a row during the second week of the bill cycle and wants to know what to do. What is the best advice
Take two pills a day and two pills tomorrow, and have your partner use condoms for the rest of the pill cycle
During a breast exam of a 30-year-old Nulliparis female the nurse practitioner palpates several robbery mobile areas of the breast tissue. They are slightly tender to palpation. Both breast have symmetrical findings. There are no skin changes or any nipple discharge. The patient is expecting her menstrual period in five days. Which of the following would you recommend
Tell her to return one week after her. So her breast can be rechecked
A young sexually active client of the family planning clinic is advised to have a Pap smear. She has never had a Pap smear before. What should the nurse include in the explanation of this procedure
The Pap smear can detect cancer of the cervix
Does the X chromosome more commonly come from the mother or father and girls with Turner syndrome
The X more commonly comes from mom.
A 14-year-old is brought to the clinic by her mother. The mother explained to the nurse that her daughter has just started using tampons but is not yet sexually active. The mother states I am very concerned because my daughter is having a lot of stabbing pain and burning. What might the nurses backed is the problem with the 14-year-old
Vulvodynia
Which of the following is the best method to diagnose a vaginal trichomonas infection
Wet smear with microscopy
A woman visits the clinic for an annual physical exam and herpes genitalis is diagnosed. The client asks how the disease can be diagnosed without any tests. How should the nurse reply
you have blisters on the skin around your vagina
The patient asked why she need a breast ultrasound when she already has had a mammogram. Which of the following would be the best response of the use
To determine if her breast lesion is cystic or solid
Jenna was evaluated and diagnosed with condyloma acuminatum. Treatment options for Jenna will include all of the following except
Topical acyclovir
Treatment options for patients with condyloma acuminatum include all of the following except
Topical acyclovir
Patient education for Condylomata acuminata should include all of the following except
Treatment and elimination of visible words as a sign of a cure, and transmission will not occur
849-year-old female patient presents with a chief complaint of dark, watery brown vaginal discharge. Part of the differential diagnosis includes that a cervical cancer. Which of the following best describes what might be visualized
Ulcerated firm cervix
Which of the following statements is not true about turner syndrome
Unlike down syndrome, it does not increase with an increase in maternal age
A 25-year-old patient presents with urinary frequency and urgency. These symptoms have been occurring for three days without fever. The patient with interstitial cystitis would most likely describe their symptoms as
Urinary urgency and frequency in the morning and at night
It woman questions the nurse about the effectiveness of oral contraceptives. What most important factor about the effectiveness of oral contraceptives should be included in the reply to this question
User motivation
In patients with vulvar carcinoma, what is the most common presenting complaint
vulvar pruritus
