Oral contraceptives taken for 6 or more years has been associated with the risk reduction of (Points : 1) Ovarian cancer Breast cancer Cervical cancer Pancreatic cancer/ Menstrual Cycle Disorders. Please match diagnosis with definition. (Points : 8) Potential Matches: 1 : More frequent menstrual bleeding 2 : No menstrual cycle for 6+ months 3 : Pain associated with menstrual flow in the absence of pelvic disease 4 : Excessive or prolonged uterine bleeding > 80 ml or > 7 days 5 : Frequent heavy menstrual bleeding 6 : Midcycle or Ovulatory pain 7 : Pain occurring during menses related to or caused by pathologic pelvic disease such as endometriosis, uterine fibroids, adenomyosis, ovarian cysts, etc 8 : Bleeding occurring less frequently, intervals > 35 days

multi choice questions

1. Oral contraceptives taken for 6 or more years has been associated with the risk reduction of (Points : 1)
Ovarian cancer
Breast cancer
Cervical cancer
Pancreatic cancer
Question 2.2. Menstrual Cycle Disorders. Please match diagnosis with definition.
(Points : 8)
Potential Matches:
1 : More frequent menstrual bleeding
2 : No menstrual cycle for 6+ months
3 : Pain associated with menstrual flow in the absence of pelvic disease
4 : Excessive or prolonged uterine bleeding > 80 ml or > 7 days
5 : Frequent heavy menstrual bleeding
6 : Midcycle or Ovulatory pain
7 : Pain occurring during menses related to or caused by pathologic pelvic disease such as endometriosis, uterine fibroids, adenomyosis, ovarian cysts, etc
8 : Bleeding occurring less frequently, intervals > 35 days
Answer
: Menorrhagia : Oligomenorrhea : Amenorrhea : Metrorragia : Menometrorrhagia : Secondary Dysmenorrhea
: Mittelschmerz : Primary Dysmenorrhea

Question 3.3. Although all of the following are part of the work-up for sexual dysfunction in women, the one thing that will give the most information supporting this diagnosis is (Points : 1)
STD testing
Transvaginal Ultrasound
Laboratory testing of hormones
A detailed psychosocial, physical, sexual, and medical history
Question 4.4. If a harmful BRCA1 or BRCA2 mutation is found, which of the following is not an acceptable option to help decrease her cancer risk (Points : 1)
Mastectomy
Increased screening and surveilance
Prophylactic oophorectomy
Medications to decrease blood levels of BRCA
Question 5.5. You are examining a female during a pelvic exam and assess plaques covered with silvery scales on the vulva. Past medical history for this patient includes rheumatoid arthritis. She states sometimes there is itching and pain involved with the lesions. What would be your primary diagnosis for this patient? (Points : 2)
Lichens planus
Lichens simplex chronicus
psoriasis
vulvar cancer
Question 6.6. You are reviewing a patient’s transvaginal ultrasound report. She asks you to explain what are “nabothian cysts” which have been identified on the report. You provide teaching and reply with the following: (Points : 1)
“nabothian cysts are a common finding with no known exact cause, but they are rarely problematic”
“nabothian cysts may turn into cancer so we will refer you to a oncology gynecologist for further care”
“nabothian cysts are usually related to trauma. Do you recall any recent injuries to the vaginal area?”
“nabothian cysts need to be removed to prevent infection, so we will rupture and drain the cyst while you are here at today’s appointment”
Question 7.7. Which information will the NP include when teaching a 48 year old patient with uterine bleeding caused by uterine fibroids (leiomyomas)? (Points : 1)
Uterine fibroids are likely to create difficulty conceiving in the future
the tumor size is likely to increase throughout the patient’s lifetime
the patient will need frequent monitoring to detect any malignant changes
the symptoms may decrease after the patient undergoes menopause
Question 8.8. A 70 year old female visits the NP for a yearly evaluation. Which physical exam finding should receive the highest priority for immediate diagnosis and treatment? (Points : 1)
a palpable ovary or adnexal mass
atrophy of the vaginal rugae
a cystocele
a pessary is in place
Question 9.9. A 32 year old woman presents at the GYN clinic with complaint of pelvic pain. Which of the following conditions requires immediate diagnosis and management? (Points : 1)
Fibroid Tumor
Primary Dysmenorrhea
Ectopic Pregnancy
Endometriosis
Question 10.10. In a patient with a breast mass suspicious for malignancy, an ultrasound should be ordered if the patient is less than 30 years old, and a mammogram should be ordered if the patient is over 30. (Points : 1)
True
False
Question 11.11. A patient is complaining of tender masses in her breasts that tend to change in size related to her menstrual cycle. You can counsel this patient to try: (Points : 1)
drinking several cups of green tea each day.
reducing her intake of caffeine and other stimulants.
sleeping on her side with pillows supporting the breasts.

using ice packs on the tender area for 20 minutes at a time.

Question 12.12. What is the diagnostic tool used to further evaluate abnormal pap smear findings? (Points : 1)
Cryotherapy
Cystoscope
Colposcopy
Hysteroscopy
Question 13.13. Which has the highest mortality rate of all GYN cancers? (Points : 1)
Cervical Cancer
Endometrial Cancer
Vulvar Cancer
Ovarian Cancer
Question 14.14. Risk factors for Endometrial Cancer are all of the following except (Points : 1)
Chronic Anovulation
Chronic Dysmenorrhea
Family History of Endometrial Cancer
Unopposed Estrogen Use in Menopause
Nulliparity
Question 15.15. Causes of amenorrhea may include (Points : 1)
Pregnancy
Hypothalamic dysfunction
PCOS
All of the above
None of the above
Question 16.16. HPV is a causative agent in which of the following cancers:
(Points : 1)
Cervical and endometrial cancers
Cervical and vulvar cancers
Endometrial and vaginal cancers
Endometrial and bladder cancers
Question 17.17. When educating a woman about guidelines for early detection of breast cancer, it is important to emphasize: (Points : 2)
That breast cancer is very rare, and she will only develop breast cancer if she has a family history
It is not important to do self breast exams (SBE) after they begin mammograms
Clinical breast exam (CBE) every 3 years for women in their 20’s and 30’s and Yearly mammograms starting at age 40 or age 50, depending on the guidelines used

Screening mammograms will diagnose breast cancer in an otherwise healthy woman
Question 18.18. You are performing a vaginal exam and when inserting the speculum, you notice a small round, red, moist lesion appearing from the cervical os. The client does not have any pelvic complaints nor show tenderness when adnexa are palpated or moved. Your likely diagnosis is: (Points : 1)
uterine fibroid
nabothian cyst
cervical polyp
cervical cancer
Question 19.19. The NP examines a 52 year old female and while conducting the pelvic exam notes a lesion on the vaginal vestibule and labia minora. When obtaining a history from the patient, it is noted there has been a long standing history of pruritus. You are suspicious for cancer and obtain a biopsy. What type of cancer is your primary diagnosis? (Points : 1)
endometrial
cervical
vulvar
ovarian
Question 20.20. The NP is evaluating a woman who has complaints of changes in skin around the vaginal area Upon examination, the NP notices a figure-8 appearance of depigmented tissue around the vulvar and perianal area. What is the most likely diagnosis? (Points : 1)
lichen sclerosis
lichen planus
vulvar cancer
allergic contact dermatitis (ICD)
Question 21.21. Primary dysmenorrhea is (Points : 1)
painful periods that start immediately after childbirth
commonly caused by the release of prostaglandins which cause uterine contractions
less likely during the adolescent period
is worse around the time of ovulation
Question 22.22. The NP is assessing a patient with complaints of “heavy periods”, cramping, painful sex, and an urge to urinate frequently. An ultrasound is ordered and uterine fibroids are diagnosed. Treatment options for uterine fibroids may include: (Points : 1)
hysterectomy
uterine artery embolization
hormone therapy
medication therapy
all of the above
Question 23.23. Which of the following are not considered risk factors for cervical cancer (Points : 1)
risky sexual behavior
family history of cervical cancer
cigarette smoking
HPV infection
Question 24.24. A 35 year-old has a screening pap with ASCUS, positive HPV. The next appropriate step is: (Points : 1)
Repeat in 1 year
Colposcopy
LEEP
Repeat in 3 years
Question 25.25. When evaluating abnormal uterine bleeding (AUB), special populations should be considered. The older woman with postmenopausal uterine bleeding should always be considered to have cancer until proven otherwise. In adolescents, which condition should be considered when bleeding is heavy and unexplained and does not respond to medical therapies? (Points : 1)
pregnancy
coagulopathies
cervical cancer
anorexia
Question 26.26. Symptoms of ovarian cancer include all of the following except (Points : 1)
Abdominal bloating
Unexplained weight loss
Vague abdominal pain
Heavy menstrual bleeding
Question 27.27. Match the following benign breast masses with their clinical characteristics:
(Points : 4)
Potential Matches:
1 : Discrete, smooth, round or oval, nontender and mobile
2 : Ill defined, firm, nontender, nonmobile with inflammatory changes on pathology/histology
3 : Discrete firm, sometimes tender, result from duct dilation following lactation
4 : Discrete, soft, nontender, may or may not be mobile and is composed of fatty tissue
Answer
: Galactocele : Lipoma : Fibroadenoma : Fat necrosis

Question 28.28. Which of the following information would be appropriate to share with a woman concerning risk factors for breast cancer? (Points : 2)
Over 50% of women who get breast cancer have a first degree relative who has had breast cancer.
The majority of women who get breast cancer do not have apparent risk factors.
One out of every 20 women in the United States will get breast cancer in her lifetime regardless of family history.
If a women’s mother is BRCA negative, she does not need to continue having mammograms or doing breast exams
Question 29.29. Possible causes of breast pain in adolescents include (Points : 1)
pregnancy
menstrual cycle
fibrocystic breast disease
exercise
all of the above
Question 30.30. According to ASCCP guidelines (Points : 1)
Pap smear should be done annually at the Well Woman exam, starting when a woman becomes sexually actie
HPV testing is not done after administration of the Gardasil vaccine
Pap smears should begin at age 21 years old, regardless of sexual activity
The pap smear is the screeeing test for ovarian cancer
Question 31.31. The goals of Healthy People 2020 include (Points : 1)
Attain high quality, longer lives free of preventable disease
Achieve health equity, eliminate disparities
Create social and physical environments that promote good health
Promote quality of life, healthy development, healthy behaviors across life stages
All of the above goals
Question 32.32. A causative agent highly associated with cervical cancer is (Points : 1)
HSV
HPV
HIV
Gonorrhea
Question 33.33. A 52 year old woman presents to the clinic with complaint of nipple discharge. Which of the following signs would be the most concerning for breast cancer? (Points : 1)
milky bilateral nipple discharge
clear discharge from both nipples after sexual activity or breast stimulation
Spontaneous clear or bloody discharge from one nipple only
Breast pain around the time of her menses
Question 34.34. Factors that could potentially increase a woman’s risk of PID include all of the following except (Points : 1)
Intrauterine device
Sex during menses
Bacterial Vaginosis
Condom use
Previous episode of PID
Question 35.35. The hormone responsible for causing an ovum to mature in the ovary is called (Points : 1)
Estrogen
Follicle Stimulating Hormone (FSH)
Adrenaline
Luteinizing hormone (LH)
Question 36.36. The hormone that determines whether an embryo will develop into a phenotypical male or female is (Points : 1)
Testosterone
Progesterone
TSH
Estrogen
Question 37.37. Persistent or recurrent extreme avoidance of all or almost all genital sexual contact with a sexual partner is (Points : 1)
Orgasmic disorder
Hypoactive sexual desire disorder
Sexual aversion disorder
Sexual arousal disorder
Question 38.38. Your 87 year old patient is brought into the clinic by her part time CNA caregiver. She lives at home with her daughter. You are concerned that there is abuse or neglect going on in the home, but the patient denies this allegation. Upon examination, you see that she is unkempt, dirty, and has some bruises on her upper arms. She is diagnosed with a UTI and bedsore. It is determined that there has been abuse taking place. The most likely abuser in this instance is (Points : 1)
42 year old male nurse
27 year old hispanic CNA who has recently graduated from school
56 year old daughter who lives with the patient
Workers in the home who have been painting the bedroom
Question 39.39. Ovulation is dependent on an increased level of ___________________ .
(Points : 1)
enzyme activity

progesterone

prostaglandins

estrogen and the LH surge

Question 40.40. Risk factors for sexual dysfunction in women can include (Points : 1)
Medication side effect
Lack of privacy for intimacy
Doesn’t like her partner/Conflict in relationship
History of physical or sexual abuse
All of the above
Question 41.41. Although all of the following are part of the work-up for sexual dysfunction in women, the one thing that will give the most information supporting this diagnosis is (Points : 1)
STD testing
Transvaginal Ultrasound
Laboratory testing of hormones
A detailed psychosocial, physical, sexual, and medical history
Question 42.42. Sudden onset pelvic pain that has occurred in the last 7 days, is less than 3 months in duration, and sharp in intensity is (Points : 1)
Always Infectious
Acute pelvic pain
Chronic pelvic pain
Deep pain
Question 43.43. A 32 year old woman presents at the GYN clinic with complaint of pelvic pain. Which of the following conditions requires immediate diagnosis and management? (Points : 1)
Fibroid Tumor
Primary Dysmenorrhea
Ectopic Pregnancy
Endometriosis
Question 44.44. Which of the following are differential diagnoses of acute pelvic pain? (Points : 1)
Ectopic pregnancy
PID
Ovarian Torsion
All of the Above
Question 45.45. Causes of amenorrhea may include (Points : 1)
Pregnancy
Hypothalamic dysfunction
PCOS
All of the above
None of the above
Question 46.46. 20 year old female presents to the office with c/o pelvic pain and vaginal discharge. She is single, with a new sex partner. Takes OCPs for contraception. Periods are regular. Exam findings include BP 102/76, P 72 T 101.2, lower abdomen painful to palpation. Speculum exam reveals mucopurulent discharge with an odor, no vaginal or cervical lesions. Bimanual exam reveals CMT, uterine tenderness, and tenderness in the adnexal area bilaterally. Microscope evaluation reveals abundant WBC. The most likely diagnosis for this patient is (Points : 1)
BV
PID
HSV
Endometriosis
Question 47.47. For the above-described patient, the recommended next step testing includes (Points : 1)
HCG, CBC, Gonorrhea and Chlamydia cultures

TVUS, CBC, Cystoscopy

Chlamydia and Gonorrhea cultures, D&C
UPT, Laparoscopy, CA-125
Question 48.48. Which type of breast cancer involves infiltration of the nipple epithelium and has an initial symptom of itching or burning of the nipple? (Points : 1)
Ductal carcinoma in situ
Paget’s disease
Mammary duct ectasia
Fibroadenoma
Question 49.49. A disorder of androgen excess and ovarian dysfunction presenting with elevated free testosterone levels, hirsuitism, acanthosis nigricans, and irregular or infrequent periods (Points : 1)
Type 2 Diabetes
Menorrhagia
Hypothyroidism
Polycystic Ovarian Syndrome
Question 50.50. Appropriate diagnostic testing for the above patient includes (Points : 1)
Serum prolactin
TSH
FSH/LH
Pelvic Ultrasound
All of the above
Question 51.51. Which has the highest mortality rate of all GYN cancers? (Points : 1)
Cervical Cancer
Endometrial Cancer
Vulvar Cancer
Ovarian Cancer
Question 52.52. All of the following are benign breast conditions except (Points : 1)
Fibroadenoma
DCIS
tuberous breast deformity
Galactocele
Lipoma
Question 53.53. Match the following vulvar dermatoses with their descriptions:
(Points : 6)
Potential Matches:
1 : Immunological, 48-72 hour delayed reaction
2 : Localized variant of atopic dermatitis with epidermal thickening,
“the scratch that itches”
3 : Depigmentation of skin around vulva and perianal area, may result in loss of vulvar architecture including fusing of clitoral hood
4 : Non-immunological, appears quickly after exposure
5 : Inflammatory condition of scalp, skin and nails, often manifests as bright red vulvar patches and/or white lacy patches in oral mucosa
6 : Chronic, immune-mediated disease with may manifest in skin and joints, plaques covered with silvery-white scales
Answer
: Lichen Planus : Lichen Simplex Chronicus : Psoriasis : Lichen Sclerosis : Allergic Contact Dermatitis
: Irritant Contact Dermatitis

Question 54.54. A 52 year old woman presents to the clinic with complaint of nipple discharge. Which of the following signs would be the most concerning for breast cancer? (Points : 1)
milky bilateral nipple discharge
clear discharge from both nipples after sexual activity or breast stimulation
Spontaneous clear or bloody discharge from one nipple only
Breast pain around the time of her menses
Question 55.55. Symptoms of ovarian cancer can include all of the following except (Points : 1)
Abdominal bloating
Unexplained weight loss
Vague abdominal pain
Enlarged uterus
Question 56.56. The NP is assessing a patient with complaints of “heavy periods”, cramping, painful sex, and an urge to urinate frequently. An ultrasound is ordered and uterine fibroids are diagnosed. Treatment options for uterine fibroids may include: (Points : 1)
hysterectomy
uterine artery embolization
hormone therapy
endometrial ablation
All of the Above
Question 57.57. A 32 year old African American female presents to the clinic and complains of feeling like she has “pelvic pressure”. Upon further questioning she states pain with intercourse. Upon pelvic exam, there are no gross abnormal findings noted. She has been trying to get pregnant for the past year but has been unsuccessful. You order an HCG, and perform a PAP test all of which return back negative. You then order a transvaginal ultrasound to confirm your preliminary diagnosis of (Points : 1)
cervical cancer
vulvar dermatoses
uterine fibroids
ovarian cancer
Question 58.58. Breast masses that are painless, well-circumscribed, freely moveable masses with a rounded, lobulated or discoid configuration are most likely (Points : 1)
Malignant
Fibroadenoma
Infection
Gynecomastia
Question 59.59. All of the following are typically benign ovarian masses except (Points : 1)
Dermoid
Follicular cyst
Adenomyosis
Endometrioma
Serous Cystadenoma
Question 60.60. A 37 year old woman presents to the clinic for contraceptive management. Her medical history includes hypothyroidism and eczema. She drinks alcohol socially, and smokes 1/2 ppd cigarettes. Her family history includes her mother has Diabetes Type 2 and her sister has epilepsy. She is not sure if she has completed her family yet or not. What method of contraception should be recommend to her? (Points : 1)
Paragard IUD
ESSURE
Oral Contraceptives
OrthoEvra
Question 61.61. Potential outcomes of unintended pregnancy include (Points : 1)
Low birth weight
Preterm delivery
Foster Care placement
All of the above
Question 62.62. In the state of Georgia and in the state of Florida, a minor (< 18 years old) may consent to contraception, pregnancy testing, prenatal care, STI/HIV testing and treatment if the health care provider feels her health is at risk otherwise. No consent is needed for emergency contracpetion (Points : 1)
True
False
Question 63.63. Match the following types of urinary incontinence with their characteristics:
(Points : 3)
Potential Matches:
1 : involuntary leakage with effort or exertion, sneezing or coughing
2 : a strong desire to urinate that is difficult to postpone with involuntary leakage accompanied or preceded by urgency
3 : a strong desire to urinate that is difficult to postpone with involuntary leakage with effort or exertion that may or may not be related to urge
Answer
: Stress urinary incontinence : Urge urinary incontinence : Mixed urinary incontinence

Question 64.64. In the first two trimesters of a normal pregnancy, patients are typically seen for prenatal visits every two weeks. (Points : 1)
True
False
Question 65.65. Please match the following characteristics with the Tanner Staging definition
(Points : 5)
Potential Matches:
1 : breast mound with projection of the nipple, adult pubic hair but none on the thighs
2 : pre-adolescent (10-14), nipple, no pubic hair
3 : fully mature breasts, adult pubic hair with inverted triangle pattern
4 : breast buds, beginning of fine pubic hair
5 : middle adolescent (12-14), breast and areola enlarged and elevated, coarser, curlier pubic hair
Answer
: Tanner I : Tanner II : Tanner III : Tanner IV : Tanner V

Question 66.66. The Affordable Care Act (ACA) offers preventative services for women. This coverage may include (Points : 1)
Annual Well Woman visit
Domestic Violence screening
Breast-feeding support and supplies
Gestational Diabetes screening
All of the above
Question 67.67.
The above finding on a wet mount would be consistent with a diagnosis of: (Points : 1)
Trichomonas vaginalis
Bacterial vaginosis
Candida glabrata
Mobiluncus mulieris
Question 68.68. Which of the following patients is “Menopausal” by definition? (Points : 1)
47 year-old woman whose mother went through menopause at 47. Her LMP was 7 weeks ago
51 year-old complaining of hot flashes, night sweats, vaginal dryness, and irregular periods
48 year-old whose FSH is 52 and has not had a period in 14 months
All of the above
None of the above
Question 69.69. The use of unopposed estrogen by a menopausal women who has recently stopped having periods increases her risk of (Points : 1)
Endometrial carcinoma
Ovarian cancer
STDs
Cervical cancer
Question 70.70. Mrs K, aged 65, is worried about developing Osteoporosis. Which of the following assessment findings would indicate that she may be at risk for Osteoporosis? (Points : 1)
she exercises at least 3 times per week
she drinks 3-4 glasses of milk per day
she has a body weight of 119 pounds, BMI 18.6
she enjoys an occasional glass of red wine
Question 71.71. You 24 year old patient has been taking Lo-Ovral for six months and has recently begun experiencing breakthrough bleeding and weight gain over the last three months. What would be the best course of action? (Points : 2)
Switch her prescription to Alesse
Switch her prescription to Desogen
Switch her prescription to OrthoCyclen
Have her take only the active pills of her Lo-Ovral continuously for three months.
Question 72.72. The ACOG recommendation for timing of the anatomy ultrasound in pregnancy is: (Points : 1)
20 weeks
16 weeks
18-20 weeks
16-18 weeks
Question 73.73. Your 14 year old patient has just moved to the area and is establishing care with your practice. She has not seen a provider for a year. In reviewing her immunization records, you note that she had two doses of Cervarix three months apart at 12 and 15 months ago. You have Cervarix, Gardasil-4 and Gardasil-9 available and her insurance will pay for any of them. Your recommendation should be: (Points : 1)
Administer the third dose of Cervarix to complete the series
Start the series again since it has been more than a year since her last dose
Give a booster of Cervarix today, and have her return when she becomes sexually active for a single dose of Gardasil-9
Finish the series with Gardasil-9
Question 74.74. What is the best explanation for why don’t we screen for HPV in women under 30? (Points : 1)
We don’t treat them until they are finished having children
Women under 30 don’t usually get cervical cancer
The HPV virus is more likely to clear on it’s own than it is to progress to cancer, and a finding of HPV can be stressful to the patient when it cannot be treated
Women under 30 are very unlikely to have HPV
Question 75.75. A 24 year old female presents with complaint of sharp lower abdominal pain radiating to the lumbar region for 3 hours. Her LMP was 7 weeks ago. A CT of the abdomen/pelvis was ordered, and revealed a perforated fallopian tube. The patient is most likely experiencing: (Points : 1)
pelvic inflammatory disease (PID)
ruptured ectopic pregnancy
endometriosis
advancing ovarian cancer

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