reproductive questions fnp
A 32 year old patient who is 28 weeks pregnant presents with gestational diabetes, class A1. She has been testing her blood glucose levels with a glucometer every morning fasting, and then 2 hours after breakfast, lunch and dinner respectively. When should patients in the class, who are using nutrition alone to manage their diabetes, be counseled to begin medical treatment?
- When fasting glucose levels are consistently >95 - When 2 hour postprandial glucose levels are consistently >120
A 23-year old female presents to your office requesting more information about how the vaccination of women against human papillomavirus (HPV) reduces rates of cervical cancer. Which two types of high-risk HPV are responsible for approximately 70% of worldwide cervical cancers?
16 and 18
A 21 year old female presents to the urgent care with abnormal vaginal discharge. Pelvic exam reveals a moderate amount of malodorous discharge and punctate hemorrhages on the cervix. No cervical motion tenderness is appreciated on bimanual exam. How should this patient be treated.
2 g of metronidazole PO x 1 dose (trichomonas0
A 19 year old female presents to the office for an annual physical examination. Women with normal-risk for cervical cancer should begin screening with pap smears at what age?
21 years old
A 56 year old female arrives at your office with a request for a DEXA scan. In a woman without risk factors, at what age is bone density screening with DEXA recommended.
65 years
An 18 year old female presents with chief complaint of "fishy" vaginal discharge. A medical student asks what the most common cause of vaginal discharge. Which of the following choices is the best response.
Bacterial vaginosis
Colposcopy is appropriate for the following PAP test cytology results except:
A high-grade squamous intraepithelial lesion (HSIL)
A 24 year old nulligravid woman presents with irregular menstrual cycles, sever facial hirsutism, acne, and clitoromegaly which has developed over the past six months. As part of her evaluation, you recommend a dehdroepiandrosterone sulfate (DHEAS) level. A severely elevated DHEAS level should be followed by which of the following test?
Adrenal imaging
A 31 year old female who is G1P0 at 32 weeks EGA presents with a red "bull's eye" on her forearm after she endorses taking a hiking trip in upstate New York last weekend. She reports there was a ick on her husbands shirt that they found at the end of their hike. She presents today with complaints of malaise. The clinician is concerned for early stage Lyme disease. PCR for B. burgdorferi is positive. Which of the following would be the most appropriate course of action?
Amoxicillin for 14-21 days
A 38 year old African American female is referred by her gynecologist for consultation concerning stage 3 chronic kidney disease. She is not pregnant and uses a long-acting reversible contraceptive (LARC) as birth control. At her annual exam , bp 150/85. Her GFR was calculated using the MDRD study equation and was 29. She has not started anti-hypertensive therapy. You plan to prescribe an antihypertensive prior to the evaluation of her CKD and hypertension. Which class of medication is the most appropriate initial therapy for this patient?
Angiotensin converting enzyme inhibitors
A patient presents at 6 weeks gestation with a history of chronic renal disease. She has been married for 4 years and is now 33 years old. How might you revise your strategy for pregnancy follow up?
Assemble multi0disciplinary team of counseling and management of pregnancy complications.
A 35 year old presents with polycystic ovary syndrome. She wants to start trying to become pregnant shortly. She currently has regular cycles off birth control pills, after 15 pounds of weight loss over the past few months. Her current list of medications includes a multivitamin with folic acid, albuterol, clindamycin topical lotion, atorvastatin, and fish oil. Which of these medications should she discontinue before attempting to conceive?
Atorvastatin-
A 23 year old woman comes to your office after having unprotected intercourse the night before. She is requesting emergency contraception. Upon further questioning, you find she is inconsistently using other types of contraception and has no plans to become pregnant for many years. What method of emergency contraception would be best to recommend to this patient?
Copper IUD
A 14 year old female reports for a sick visit/ She says " i have something leaky 'down there'." She describes a thin, noticeably fishy fluid discharge that leaks out of her vagina. She denies sexual intercourse on repeated questioning but reports that the fluid smelled "pretty bad," seems to come at the same point of her cycle, and has done so for the last 4 months. What is the most common cause for discharge in the adolescent population ?
Bacterial vaginosis
A 19 year old female presents with complaint of vaginal discharge. Pelvic examination reveals a copious milky discharge that releases a strong fishlike odor when a drop of potassium hydroxide is added to the slide. Which of the following is the most likely cause of the discharge?
Bacterial vaginosis
A 25 year old female arrives at your office 2 days postpartum. Management of postpartum endometritis is MOST effective if it includes which of the following?
Broad spectrum antibiotics, including coverage for anaerobic bacteria.
A 30 year old female with no significant past medical history presents with vaginal irritation and discharge for 2 days. She says she is 7 weeks pregnant and was recently treated for a UTI with nitrofurantoin for 1 week. She has not dysuria, abdominal pain, or vaginal bleeding. Her vitals are as follows: blood pressure 11/70, heart rate 75, respiratory rate 16, temperature 98.5, and O2 saturation 99% on RA. On exam, a whitish vaginal discharge is noted that is not malodorous. Her abdomen is nontender, she has no cervical motion tenderness, and her os is closed. Ho should this patient be treated?
Check vaginal pH, if normal, treat for candidiasis with miconazole cream applied vaginally for 1 week.
A 33 year old woman with polycystic ovary syndrome arrives at your office for treatment of disease. In women with polycystic ovary syndrome who are not attempting to conceive, what is the best medical maintenance therapy to treat menstrual disorders?
Combination hormonal contraception
A 20 year old woman is in your office prior to entering a sexual relationship with potential long-term partner. She is concerned about HPV and cervical cancer. She has received the HPV vaccination as an adolescent. You advise that:
Consistent use of a condom will reduce HPV transmission rate.
A 43 year old pre-menopausal woman comes to your office complaining about recurrent urinary tract infections (UTI). Over the past three years, she has had up to seven infections per year. Her primary care doctor completed testing and she does not have urinary calculi or urinary tract abnormalities. She has tried different soaps, changing behaviors, and changing contraceptives. She is asking if anything can be done to prevent future infections. What would be the best treatment choice for this woman to significantly reduce the number of UTI's she is experiencing?
Continue antibiotic therapy with trimethoprim-sulfamethoxazole nightly for six months.
A 24 year old pregnant female arrives at the clinic for a wellness check. Which of the following would date a pregnancy most accurately?
Crown rump length 7 week ultrasound
A 14 year old female present to the office with her mother. The mother would like her to start birth control. She found her daughter alone with her boyfriend in the basement last night. Which of the following contraceptives has the lowest failure rate with typical use?
subdermal contraceptive implant
A 25 year old female presents with a significant history of endometriosis. Which of the following factors increases risk of the development of endometriosis?
Delayed childbearing.
A 24 year old woman comes to your clinic in search of contraception. In talking to her you find that she does not want to take a daily pill, would rather avoid any invasive procedures, and is hoping to find an option that will decrease or eliminate her menses. What is the most appropriate treatment option?
Depo medroxyprogesterone injections
A 22 year old female presents to the ER for evaluation of dysuria and vaginal discharge. She has also had a few days of vaginal itching and irritation. On further questioning she admits to having sexual intercourse with a new partner 2 weeks ago. She has had 6 partners in her lifetime and uses condoms occasionally. She tested negative for STDs in her primary care providers office six months ago. She has never been pregnant and her last menstrual period was three weeks ago. On exam she is well appearing and her vital signs are within normal limits. The vaginal exam reveals thick yellow discharge and moderate erythema with the presence of ulcers and vesicles. A urine pregnancy test is negative. What is the best course of treatment while waiting for results of nucleic acid amplification test for C. trachomatis and N. Gonorrhea?
Doxy 100mg, PO, BID for 7 days and Cetriaxone 500 mg IM x1
A 33 year old woman presents to your office presenting with pelvic pain. She states it is a dull crampy pain which typically begins two days before her menses and sometimes continues for a week afterwards. She also frequently experiences pain with intercourse. She mentions her menses are also quite heave in amount of bleeding. She also occasionally experiences pain with urination and defection. Physical exam demonstrates some pelvic discomfort to palpitation and tenderness during vaginal pelvic examination without discharge or cervical motion tenderness. Which of the following is the most likely diagnosis?
Endometriosis
A 23 old nulligravida present to eh ER with vaginal spotting and mild cramping pains. She reports missing her period 2 weeks ago but has a history of irregular menses. . . Which of following is NOT an absolute contraindication of medical management with methotrexate therapy.
Fetal cardiac motion
A 29 year old female is 16 weeks pregnant with her 2nd child. She has a history of hypertension, which has worsened during both pregnancies. She has not symptoms related to her hypertension currently, but her blood pressures have consistently been in the 160s/100s during her last several visits.
Labetalol
A nurse is collecting a urine specimen for urinalysis from a client with suspected urinary tract infection. Whish of the following is measured in a routine urinalysis?
Glucose protein
A sexually active 29 year old G3P3 female present with vulvar pruritic and burning, dysuria, dyspareunia, and copious foul Smalling frothy green vaginal discharge. History of significant for frequent swimming and the use of a hot tub. The physical exam is significant for culture edema, erythema, and petechia of the upper vagina and cervix. A microscopic examination of her vaginal secretion reveals numerous white blood cells and trichomonas. For which additional infection should this patient be tested.
Gonorrhea, chlamydia, syphilis, all of the above
A 16 year previously healthy female presents to the clinic for evaluation of dysuria. She also reports malaise, low-grade fevers and headache. She admits to having unprotested sex with a new male partner a few weeks ago. On exam, she appears uncomfortable. Vital signs reveal a heart rate of 115 beats per minute, respiratory rate of 25 breaths per minute, a blood pressure of 120/80 and T of 100.5. Exam of eye, ears, nose throat, heart, and abdomen are within normal limits. An exam of her external genitalia reveals, multiple shallow ulcers on an erythematous base. What is the most likely cause of her symptoms?
Herpes simplex virus
A 16 year old female presents to your office with her mother for evaluation of amenorrhea. She had her first menstrual period 12 months ago and her last menstrual period was three months ago. She has no significant past medical history, She denies sexual activity. On exam her vital signs reveal a heart rate of 80 beats per minute, respiratory rate of 20 breaths per minutes, blood pressure of 12/80 . Her height and weight are both on the 75%tile for age. She is well appearing with tanner stage V breast and pubic hair. What test should be performed first to diagnose the cause of her secondary amenorrhea?
Human chorionic gonadotropin (hCG) urine test.
Which of the following is not considered a risk factor for a UTI?
IUD
Which of the following is/are safe and effective immediate post-abortion contraception?
IUD subdermal implant placement
A 26 year old G2P1 presents at 16 weeks gestational age for a routine prenatal visit. She is interested in getting the flue vaccine; however, she is concerned about recent media warnings she heard on the news about the vaccination. What is the best recommendation for administration of the influenzas vaccination?
Immediate vaccination
A 29 year old female is presenting for her scheduled OB/GYN and prenatal visit at 33 weeks gestation. She endorses recently feeling like her "heart is beating very rapidly" when at rest. However, examination and EKG are within normal limits. The provider explains that this feeling likely represents which of the following expected physiologic hemodynamic changes during pregnancy?
Increased blood volume, decreased system and peripheral vascular resistance, increased HR, increased CO.
A 38 year old woman presents for pelvic pain. She tells you she has had this pain for at least 4 years, has seen multiple physicians already, and that you are her "last hope." She says she's tried "everything," and she has been on oral contraceptives (both continuous and cyclic), Depo-Provera, NSAIDs, leuprolide acetate, and the NuvaRing, none of which helped. She states that the pain is worst when she has a full bladder, so she tried to keep her bladder from getting too full. She denies any leaking but states that she sometimes has the urge to urinate not too long after having just emptied her bladder. You refer her to urology for hydrodistension cystoscopy to be evaluated for which of the following?
Interstitial cystitis
A 25 year old Caucasian primigravida presents for her initial prenatal visit at 10 weeks gestation. Her dating is confirmed by LMP and 9- week ultrasound. She is in good health with no complaints or concerns today. Her vitals are stable. Prior to presenting at this appointment, she had initial screening blood work, which is unremarkable except for hemoglobin of 10g/dL/. Which of the following is NOT true regarding the management of anemia in pregnancy.
Iron supplementation is recommended in all pregnant women, regardless of H/H levels
A 26 year old pregnant female presents at the clinic for a wellness check. Which of the following is NOT associated with prenatal maternal depression?
Larger infant-head circumference
A 34 year old woman comes to your clinic to discuss IUD's. She has a had a history of heavy menstrual periods due to her endometriosis. She also has episodic dysmenorrhea which can be quite disabling at times. What type of IUD would you recommend, and why?
Levonorgestrel IUD, to reduce her heavy menstrual periods.
According to the National Survey of Family Growth, the rate to contraceptive failure in the US is the lowest with which of the following methods?
Long-acting reversible contraceptives (LARCs)
In the ovarian cycle, what phase begins with ovulation and ends with the onset of menses?
Luteal phase
A couple in their twenties comes to you stating they have been trying to become pregnant for the last six months without success. They are having regular intercourse, and he woman is having regular menstrual cycles without any change or abnormality. The man is a smoker, the woman is a non-smoker, and they both exercise regularly. What is the next best step in evaluation?
No testing, recommend male quit smoking
An otherwise healthy 32 year old G2 P2 calls her primary obstetrician in January, 8 days after an uncomplicated vaginal delivery at 39 weeks. She has had fevers to 101.9, couch and muscle aches. She thinks that one of her friends may have had a similar illness the past week. She received the influenza vaccine during her pregnancy. She has no vaginal bleeding or discharge and no abdominal pain besides the aforementioned myalgias. She is breastfeeding. She has had a slight loss of appetite but otherwise no gastrointestinal upset. Which of the following steps in indicated?
Maternal neonatal separation
A 19-year-old female presents to the clinic for evaluation of vaginal discharge. She describes the discharge a thin and white with a fishy odor. She denies sexual activity and has never been pregnant. On physical exam, her vital signs reveal, a temperature of 98, a heart rate of 75, a RR 20 and BP of 111/60. On exam there is a thin homogenous vaginal discharge, the remainder of her exam is unremarkable. The vaginal pH is 5 and clue cells are visible on the wet mount. When a 10% potassium hydroxide solution is applied to the specimens a fishy odor appears. What is the best treatment for this patient?
Metronidazole 500 mg PO twice daily 7 days
A 22 year old female presents to the office with dysmenorrhea and request treatment options. Which of the following is the most appropriate choice for first line treatment of dysmenorrhea?
NSAIDS
A previously healthy 23 year old female presents to the clinical for a routine exam. She has not had any problems since her last visit three years ago. She has had new sexual partners in the last 6 months and rarely uses condoms. Her last menstrual period was one week ago. Her pregnancy test is negative. On exam, she is well appearing and vital signs are within normal limits. Exam of her heart, lungs, and abdomen are also normal. Exam of her external genitalia reveals a sing indurated, well circumscribed painless ulcer on the left side of her vulva. In addition to screening for gonorrhea and chlamydia which of the following test is most likely to reveal the correct diagnosis?
Non-treponemal test syphilis can present with a single, painless ulcer with sharply demarcated edges. Since co-infection with other STD's is common she should also be screened for G an dC
A 19- year old woman presents with increased vaginal discharge and odor over the past month. She became sexually active for the time 6 months ago. You discuss sending gonorrhea and chlamydia cultures, as well as evaluation for trichomoniasis. Wet mount is negative. Which of the following is considered gold-standard for evaluation for trichomoniasis?
Nucleic acid amplification test
A 33 y/o patient requests a refill of her birth control pills. She heard from a friend that birth control pills protect a woman from cancer and would like additional information. You inform the patient that oral contraceptives can regulate menstrual cycles and reduce dysmenorrhea and you also provide which of the following information
Oral contraceptives' have an increased risk of cervical cancer for a short time.
A 55-year-old female presents to your practice with complaints of lower abdominal pain, bloating with intermittent constipation, and low backache. She reports that she thought she had entered menopause but she has started having 'cycles' again but they are different from before. On bimanual exam you find a palpable ovary. What is your next step?
Order an intravaginal ultrasound and CA-125
The leading cause of death in women with genital cancers, excluding breast cancer is?
Ovarian cancer
A 17 year old female presents to the clinic alone for evaluation of amenorrhea. She developed breast buds at the age of 12 years and her first menstrual cycle started at the age of 13 years. Starting at age 16 her cycles would last for 7 to 10 days and occur every 31 to 45 days. Her last menstrual cycle was 6 months ago. On exam her vital signs reveal HR 90, RR 22, BP 130/82. Her height is 70% for her age and weight is 75% for age. She has multiple open and closed comedones scattered over her forehead, chest and upper back. The remainder of her exam is within normal limits. A urine pregnancy test is negative,. What is the most likely cause of her amenorrhea?
PCOS
A 63 year old woman presents to your office with the complaint of urinary urge incontinence. She feels like this has been worsening for the last several years. You do a physical exam which does not demonstrate any pelvic organ prolapse. She is a healthy weight. What is the first line recommended treatment?
Pelvic floor therapy and exercises.
A 23 year old female arrives at the clinic for a gynecology check-up. Which of the following is NOT true?
Pelvic inflammatory disease should be treated with a single antibiotic to reduce drug-resistant organisms.
A 30 year old female develops menorrhagia and iron deficiency anemia. She also reports an increasing sense of pelvic pressure and worsening dysmenorrhea. On abdominal and pelvic exam, a large, mobile pelvic mass is palpable at the midline, and uterine leiomyoma is suspected. Which of the following is the initial test used to confirm the diagnosis?
Pelvic ultrasound
A mother of advanced-maternal age calls your office complaining of dark red vaginal bleeding. She states that her abdomen is hard and very painful. She is 33 weeks pregnant. What do you suspect?
Placenta abruptio
A 26 year old woman presents to your clinic and states that her periods are very irregular. Upon further questioning she states she typically goes about six weeks between periods. She is using condoms for contraception. Upon physical exam you not that her body mass index (BMI) is 32, she has a brown discoloration to the back of her neck, and she has fairly significant acne and some thick hair abode her upper lip. What is her most likely diagnosis?
Polycystic ovarian syndrome
Which of the following patients should NOT receive HPV immunizations?
Pregnant patient
A 27 year old African American female presents with a complaint of weight gain of 15 lbs over three weeks. On examination, her blood pressure is 180/120, and she displays generalized edema. Urinalysis reveals large amounts of protein with broad waxy casts and hyaline casts. Serum creatinine is 1.2. Serum complement C4/C3, antinuclear/anti-DNA titers, and antineutrophil cytoplasmic antibody titers and serum protein electrophoresis are negative. Serologies for hepatitis B and C are negative. Which is the recommended test to correctly diagnose this patient?
Renal biopsy
A 31 year old presents with new-onset symptoms of lower abnormal pain and abnormal vaginal discharge. Physical exam reveals tenderness over the uterus to palpation and a mucopurulent vaginal discharge. Pap and vaginal cultures are done. She has a history of lovonorgestrel intrauterine system replacement three years ago. Cytology and cultures show actinomyces israelii. What is the most effective treatment for this patient.
Remove IUD and treat with penicillin
A 27 year old client reports the desire to become pregnant. She and her husband have had regular, unprotected intercourse for more than one year. The nurse practitioner completes a thorough history and gynecologic exam and finds no abnormalities. What diagnostic test might he or she order early in the workup?
Semen analysis
A patient presents for her well woman exam. A routine urinalysis is positive for leukocytes and nitrates. She has a history of type II diabetes and three urinary tract infections UTI) over the last 12 months. What is your initial plan for this patient?
Send patient's urine for culture and sensitivity.
A 28 year old female is complaining of severe abdominal pain since she woke up this morning. Her pain began in the periumbilical region and migrated to the lower part of her abdomen. She vomited twice and complains of nausea but no diarrhea. Her LMP began 26 days ago. The patient is afebrile with a heart rate of 110/ minutes and respirations are 18 /minutes. Her blood pressure is 108/68 mm Hg. On examination, she has diffuse abdominal tenderness with mild guarding. Her bowel sounds are hypoactive. Complete blood count reveals a hematocrit of 36% and whit blood cell count is 12,500 mm3. Which of the following is the next step in management of the patient?
Serum beta -hCG
The NP is evaluating results of serum blood studies for a client who is experiencing a slight increase in blood pressure. The client has no history of hypertension and no other chronic diseases.
Serum creatinine level of 5.2
A healthy 18 year old G2 P1 presents to her primary obstetrician in January at 27 week gestation for routine prenatal care. Her pregnancy is uncomplicated. She reports exposure to influenza by a co-worker. Today, she feels well and has good fetal movement. Whish of the following is true for this patient?
She should begin oseltamivir prophylaxis immediately.
A 18 year old pregnant female undergoes prenatal genetic screening. Results indicate a deletion of 1 of the 4 genes controlling the production of alpha chains in hemoglobin. Her CBC is within normal limits. What is the diagnosis?
Silent carrier of alpha thalassemia
A 29- year old female presents for a routine examination and a pap smear, which is positive for cervical neoplasia. Approximately 90% of cervical neoplasia occurs in which epithelial region of the cervix?
Squamocolumnar junction
A woman presents at 10 weeks for her prenatal visit. Her medical history is significant for genital herpes, and her last outbreak was several months ago. Whish of the following is the appropriate recommendation?
Suppressive viral therapy starting at 36 weeks EGA.
Your patient is a 20-year-old college student who takes oral contraceptive pills. She forgot to take her pills two days in a row during the second week of her cycle. What advice should the nurse practitioner give this patient?
Take the most recent missed pill, discard any othe missed pills, continuing taking the remaining pills as indicated, use an alternative method for the remainder of they cycle.
What is the best plan of action for an 21 year old sexually active female whose PAP smear results reveal large amounts of inflammation?
Test for gonorrhea and chlamydia and educate on safe sex practices.
You are counseling a 24 year old female who has been trying to get pregnant for four months. Her mensural cycles are regular and she has regular intercourse with her husband. She askes you to explain the menstrual cycle and the best time to "try for a baby." What should you tell the patient.
The fertile time period begins five days before ovulation.
An 18 year old G1P0 at 8 weeks gestation presents to the ER with vaginal bleeding that started this morning. She also has some mild cramping. She denies any episodes of nausea and vomiting and states that her pregnancy has been uncomplicated thus far. On speculum exam, there is blood in the vaginal vault, and the cervix is closed. There is no presence of tissue. Fetal heart tones are auscultated on US. Which of the following is the correct diagnosis?
Threatened abortion
A 16 year old female presents to the clinic for evaluation of frothy green vaginal discharge. She admits to having unprotected intercourse with a new partner three weeks ago. On exam, her vital signs reveal a heart rate of 100 beats per minute, a respiratory rate of 22 breaths per minutes, a blood pressure of 120/60 mmHg and a temperature of 98. Vaginal exam reveals diffuse, frothy, green malodorous discharge and vulvar irritation. The vaginal pH is 5.2 and the we preparation reveals flagellated moving organisms. What is the best treatment for this patient?
Tinidazole 500mg po bid for seen days.
20 year old female presents to you office for evaluation of a one-week history of vaginal pain. She has been sexually active with 3 partners over the last 6 months and only uses condoms occasionally. She has never been pregnant. She has been using Motrin for the pain and tried sitz baths three times a day for a few days without any improvement. On exam, vital signs reveal a heart rate of 70 beats per minutes, a respiratory rate of 20 breaths per minutes, a blood pressure of 90/60 mmHg and a temperature of 100.23 degrees Fahrenheit. An exam of her heart, lungs and abdomen is within normal limits. Examination of her external genitalia reveals a 3 cm erythematous mass in the posterior labia between the vesicle and labia majora at the 7 o'clock position. there is foul green discharge for the mass. Speculum exam is within normal limits. In addition to screening for STDs what is the best course of action?
Treatment with a course of antibiotics effective against mixed flora
A 22-year old otherwise healthy female presents to the office with symptoms of acute uncomplicated cystitis. Which of the following agents is recommended as first-line treatment for acute uncomplicated cystitis in women.
Trimethoprim-sulfamethoxazole is the most appropriate choice as it has demonstrated efficacy in acute cystitis and current uro-pathogens have minimal resistance to this choice.
A 28 year old woman presents to your office with the complaint of pelvic pain which started suddenly last night. It is severe and is accompanied by nausea. Upon examination, she is tender in the left lower pelvic region to palpation and you think you can palpate a mass in her left adnexa. The best next step in evaluation is what?
Urgent referral to the ER
A 19 year old G1P0 presents at 26 weeks for a new OB visit. She complains of headaches, poor weight gain, and insomnia. English is not her primary language, she is unemployed, and she lives with her boyfriend. Initial prenatal lab work reveals mild normocytic anemia. Which option should NOT be part of her workup?
Use of close family member for translation
A 52 year old female presents with complaints of urinary incontinence that has gotten progressively worse over the last two months. She was abstinent up until six months ago when she got married. She has a history of irregular menses for the last 12 months. The incontinence has now progressed to the point where she leaks urine before she can make it to the bathroom. What is the most likely diagnosis?
Vaginal atrophy This patient present with irregular cylices over the last year, which is most likely secondary to symptoms of perimenopausal with thinning of the vaginal mucosa.
A 50 year old woman has symptoms of urinary incontinence. Which of the following is not part of the neurological screening exam for urinary incontinence?
Valsalva maneuver
A 67 year old woman presents to your office and tells you she has been diagnosed recently with osteoporosis and started on bisphosphonate medication. She is asking if there are any supplements she should consider taking to help with this treatment, you advise which supplementation?
Vitamin D and Calcium
Which of the following should be the first-line treatment for overweight women with polycystic ovary syndrome and infertility to improve ovulation and pregnancy rates?
Weight reduction
Although universally recommended, women with which of the following attributes would be least likely to benefit from a universal glucose challenge screening for gestational diabetes?
age 23
Which of the following represents first-line therapy for severe, acute elevation of blood pressure in pregnant patients with gestational or chronic hypertension.
antihypertensive medications
A 32 year old woman present for a yearly check up and she is due for cervical cancer screening. You perform a pap-smear and the result return as atypical squamous cells cannot exclude high-grade (AC-H) and she is HPV negative. What is the next appropriate step?
colposcopy
A 63 year old woman comes to see you in your office. She has been post-menopausal for the last ten years, but in the last month she has had several episodes of vaginal spotting. This has never happened previously. She is not currently on any hormonal therapies but was earlier in her life. She is a former smoker who quit approximately eight years ago. What is the most appropriate next diagnostic step?
endometrial biopsy
An 18 year old woman presents to the clinic for evaluation of irregular menstrual cycles. Each cycle ranges from 7 o 14 days, and she has a cycle every 35 to 50 days. Over the last few months, she has noticed increased hair growth on her chin. She also complains of acne on her face, back and upper chest that has not responded to over the counter acne treatments. Her BMI is 35. Which of the following conditions does she have the greatest risk of developing?
endometrial cancer
A 20 year old G1P0 at 35 weeks gestation has a headache and elevated blood pressure at her prenatal visit. On follow-up, repeat blood pressure is 140/84. Which of the following physical findings is most likely in this patient?
facial swelling and upper extremity edema
You would expect the fundus of a 34 week multigravida patient to be at which level?
from 33-35cm
A 15 year old African American female presents with her mother for evaluation of abdominal pain. She has been followed in your clinic since birth had has never had any significant medical problems. She developed breast buds at the age of 14 years but has not yet start her mensural cycle. The abdominal pain started about three months ago. It occurs a few days and then resolves spontaneously only to return a month later. On physical exam, her vital signs are within normal limits and she is well appearing. The examination of her abdomen reveals a mass in the center of the lower abdomen. Examination of her external genitalia reveals a bulge in the introitus of the vagina. What is the most likely cause of her amenorrhea?
imperforate hymen
A 25 year old C2P1, currently 30 weeks pregnant, female arrives at your office for a wellness check. She is concerned about her right calf, which has been red, swollen and tender for several days. She has not had any respiratory difficulty or fevers. A lower extremity ultrasound confirms your clinical suspicion of a deep vein thrombosis. Which of the following is likely to increase the risk of venous thromboembolism during pregnancy?
inferior vena cava and pelvic vein compression by enlarging uterus.
A 45 year old obese female presents with hypertension and coronary artery disease. She has a GFR of 60. From the following options, what complication of kidney disease should you advise her of?
neuropathy
A 34 year old female is seen in your clinical to discuss her recent difficulties with conception. She has never been pregnant before, and has been trying for a child with her partner for over a year without any success. She states that she ahs only had 2 or 3 menstrual cycles during this time, and that has made her efforts at timing complicated. On exam, she is obese with a BMI of 35, and exhibits acanthosis nigricans. Following a comprehensive evaluation, she is diagnosed with polycystic ovarian syndrome and appropriate interventions are implemented. Which of the following is a criterion in the diagnosis of polycustic ovarian syndrome?
oligomenorrhea PCOS has 3 different possible diagnostic schemes: they include hyperandrogenism, oligomenorrhea, and or polycystic ovaries by ultrasound
A 22 year old female presents to the office requesting a human immunodeficiency virus (HIV) testing. How often should adult women be screened for HIV?
one time screening only, repeated if engaged in high risk behaviors.
A 40 year old woman presents complaining of dysuria and urinary frequency for three days. She denies fever or hematuria. On exam her temperature is 98.9 F heart rate is 88 beats per minute, and blood pressure is 140/80. Examination is unremarkable except for suprapubic tenderness. Urinalysis reveals cloudy urine with positive leukocyte esterase, nitrates, and protein. Culture is pending. What is the correct medication therapy for this patient?
oral trimethoprim-sulfamethoxazole
A 32 year old G3P2 female at 31 weeks gestation presents with sudden onset bright red vaginal bleeding. She states the amounts are small but this ahs happened on several occasions. She is concerned. Upon examination you note her uterus is soft when palpated. You are concerned about?
placenta previa
In which of the following groups should asymptomatic bacteriuria be treated?
pregnant women
A 30 year old nulliparous woman presents for preconception counseling. She has a medical history significant for heterozygous Factor V Leiden mutation and hypothyroidism. She has no history of prior surgeries and has no known drug allergies. She smokes 1/2 pack of cigarettes per day since age 18. She takes 75 mcg of Synthroid daily and is euthyroid. She has just gotten married and is anxious to have her first child. In counseling, you tell her that her infant will be at risk of being small for gestational age. How can she prevent this condition?
quit using tobacco
A NP performs a PAP smear as part of an annual health maintenance examination. The results of the test are "atypical squamous cells of undetermined significance." The patient is a G0P0 21 year old female.
repeat Pap smear in 12 months.
A 27 year old woman presents to your clinic complaining of intermittent vaginal bleeding, pelvic discomfort, and bloating. On examination her uterus feels slightly enlarged but is otherwise normal. You test her urine and she is not pregnant. You suspect she may have uterine fibroids. What would be your best choice of test to confirm your suspicion?
ultrasound
A 16 year old female presents to her doctors office for evaluation of vulvar discomfort. For the past week, she has had persistent itching, burning with urination and white, chunky discharge without much odor. She is not sexually active, and has no systemic signs of infection. Which of following is the first line evaluation for vulvovaginal candidiasis?
wet-mount
