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A series of multiple-choice questions and answers related to women's health, covering topics such as postmenopausal bleeding, osteoporosis, pelvic exams, dysmenorrhea, athletic amenorrhea, breast lumps, and vaginal discharge. Each question includes a detailed explanation of the correct answer, providing valuable insights into the underlying medical concepts and clinical reasoning.
Typology: Exams
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A 54 - year-old female presents with a small to moderate amount of vaginal bleeding of recent onset. She has been postmenopausal for approximately 2 years. What diagnosis is least likely? Endometrial carcinoma Ovarian cancer Endometrial hyperplasia Uterine polyps B. Ovarian cancer may present as an adnexal mass, pelvic or abdominal symptoms and a variety of others.
Postmenopausal bleeding (PMB) is an uncommon presentation of ovarian cancer, but can present this way. In women with PMB, likely causes of uterine pathology should be evaluated before considering ovarian pathology. In early menopause, the most common etiology is atrophy of the endometrium or vaginal mucosa. This patient has been postmenopausal for approximately 2 years. Other common causes of PMB are polyps, fibroids, and endometrial hyperplasia. Three of the following interventions are appropriately used to prevent osteoporosis after menopause. Which one is NOT? Avoidance of corticosteroids Performance of weight-bearing activities for 40 mins at least 5 days/week Estrogen replacement therapy Adequate calcium &
48 hours 36 hours 1 wee k B.
The general recommendation is to avoid these activities and any vaginal medication for 48 hours prior to the PAP smear. Douching and tampon use can remove superficial cells, which are the ones collected and used as representative samples on PAP smear. Sexual intercourse should be avoided because there can be specimen contamination by the male partner. With vaginal medications or creams, either can serve as a barrier to epithelial cell sampling. When collecting cervical cells for a PAP smear, when are the endocervical cells typically collected? After the ectocervical specimen with a broom After the ectocervical specimen with a brush Before the ectocervical specimen with a broom Before the ectocervical specimen with a brush B.
supplementation 30 minutes of regular exercise daily B. NSAIDs and hormonal contraceptives represent the mainstay of pharmacologic treatment for dysmenorrhea. NSAIDs produce an 80 - 86% response rate when used for dysmenorrhea. The general recommendation is that when one agent (NSAIDs or hormonal contraceptives) does not produce relief of symptoms, the other agent
should be tried. Hence, the best choice is oral contraceptives. Both agents should be considered for women who are symptomatic with one agent only.
She has no associated lymphadenopathy and there is no nipple discharge. How should she be managed? Mammogram Ultrasound and mammogram
Re-examination after her next menses Clinical exam only C. Women who are younger than age 35 years and who have no associated suspicious findings of breast cancer should delay imaging studies until re-examination 3 - 10 days after the last menstrual period to determine whether the lump changes in size or becomes nonpalpable. If there are associated suspicious findings on exam, such as palpable nodes, a large lump (>2.0 cm), or nipple discharge, diagnostic evaluation should not be delayed. If management involved a return visit for re- examination after menses, and the lump is unchanged, ultrasound is certainly advised. Mammogram may not yield good information in a 28 - year-old because of the density of the breast tissue. Baseline mammogram may be advised, and direction from a radiologist or breast surgeon could be sought. A definitive diagnosis of osteoporosis can be made when:
and itching. Besides trichomoniasis and yeast, what else should be included in the differential? Bacterial vaginosis Chlamydia Herpes genitalis Syphilis A.
The most common cause of vaginal discharge in women of child-bearing age is bacterial vaginosis. The most common presentation is a complaint of vaginal discharge with a fishy odor, most noticeable after sexual intercourse. Chlamydia can produce a discharge but it is not reported as pruritic. Herpes can produce a discharge, but it is typically associated with burning, not itching. Syphilis produces a lesion. Clue cells are found in patients who have: leukemia. bacterial vaginosis. epidermal fungal infections. pneumonia. B. The hallmark finding in a patient with bacterial vaginosis
stimulating hormone D. Follicle-stimulating hormone (FSH) begins to rise during menopausal transition. This stage of menopause begins with variation in menstrual cycle length and ends 12 months after the final menses. If the patient is older than 45 years and menstrual cycle dysfunction has been ruled out, menopause should be considered. Possibly the best approach to diagnosing menopause is to ask and observe clinical manifestations. An elevated FSH is not necessary to make a diagnosis of menopause, but it is commonly done in clinical practice. Diagnosis entails a review
of her symptoms. Specifically, changes in bleeding patterns, hot flashes, sleep disturbances, and genitourinary symptoms are characteristic of menopause. By definition, cessation of menses for 12 months constitutes menopause. “Hot flashes” that occur during menopause are thought to be related to: low estrogen levels. low progesterone levels. fluctuating progesterone levels. fluctuating estrogen levels. D. Low estrogen levels alone do not produce hot flashes. Female first graders are known to have low estrogen levels but do not have hot flashes. The fluctuation in estrogen levels produces vasomotor symptoms referred
is no demonstrated increase in efficacy when acetaminophen is added or given alone. The recommended time to initiate screening for cervical cancer in women is: prior to becoming sexually active. at age 18 years. at age 21 years. 3 years after first sexual intercourse.
The cervical screening recommendations were updated in 2012. The current recommendation for initial cervical screening is the age of 21 years according to ACS and The American Congress of Obstetricians and Gynecologists (ACOG). Cervical cancer is rare in patients younger than 21 years. A 51 - year-old female patient presents with a 2 - cm palpable breast mass. How should this be evaluated to determine whether it is solid or cystic in nature? Mammog ram Ultrasou nd MRI Clinical
