A 30-year-old paralegal analyst comes to your clinic, complaining of a bad-smelling vaginal discharge with some mild itching, present for about 3 weeks. She tried douching but it did not help.
Question 1 A 30-year-old paralegal analyst comes to your clinic, complaining of a bad-smelling vaginal discharge with some mild itching, present for about 3 weeks. She tried douching but it did not help. She has had no pain with urination or with sexual intercourse. She has noticed the smell increased after intercourse and during her period last week. She denies any upper respiratory, gastrointestinal, cardiac, or pulmonary symptoms. Her past medical history consists of one spontaneous vaginal delivery. She is married and has one child. She denies tobacco, alcohol, or drug use. Her mother has high blood pressure and her father died from a heart disease. On examination she appears healthy and has unremarkable vital signs. On examination of the perineum there are no lesions noted. On palpation of the inguinal nodes there is no lymphadenopathy. On speculum examination a thin gray-white discharge is seen in the vault. The pH of the discharge is over 4.5 and there is a fishy odor when potassium hydroxide (KOH) is applied to the vaginal secretions on the slide. Wet prep shows epithelial cells with stippled borders (clue cells).
What type of vaginitis best describes her findings?
Trichomonas vaginitis
Candida vaginitis
Bacterial vaginosis
Atrophic vaginitis
Question 2A 34-year-old married daycare worker comes to your office, complaining of severe pelvic pain for the last 6 hours. She states that the pain was at first cramp-like but is now sharp. Nothing makes the pain better or worse. She has had no vaginal bleeding or discharge. She has had no pain with urination. She has had some nausea for the last few days but denies vomiting, constipation, or diarrhea. She states she feels so bad that when she stands up she has fainted. Her past medical history consists of two prior cesarean sections and an appendectomy. She is married and has two children. She denies any tobacco, alcohol, or drug use. Her parents are both healthy. On examination you find a pale young woman who is obviously in a great deal of pain. She is lying on her right side with her eyes closed. Her blood pressure is 9060 and her pulse is 110. She is afebrile. She has bowel sounds and her abdomen is soft. The speculum examination reveals a bluish cervix but no blood or purulent discharge at the os. There is a mild amount of tenderness with palpation of the cervix. The uterus is nongravid but the right adnexal area is swollen and very tender. Urine analysis is normal and the urine pregnancy test is pending.
What type of adnexal disorder is causing her pain?
Ovarian cysts
Tubal pregnancy
Pelvic inflammatory disease
Question 3A 55-year-old married homemaker comes to your clinic, complaining of 6 months of vaginal itching and discomfort with intercourse. She has not had a discharge and has had no pain with urination. She has not had a period in over years. She has no other symptoms. Her past medical history consists of removal of her gallbladder. She denies use of tobacco, alcohol, and illegal drugs. Her mother has breast cancer and her father has coronary artery disease, high blood pressure, and Alzheimer’s disease. On examination she appears healthy and has unremarkable vital signs. There is no lymphadenopathy with palpation of the inguinal nodes. Visualization of the vulva shows dry skin but no lesions or masses. The labia are somewhat smaller than usual. Speculum examination reveals scant discharge and the vaginal walls are red, dry, and bleed easily. Bimanual examination is unremarkable. The KOH whiff test produces no unusual odor and there are no clue cells on the wet prep.
What form of vaginitis is this patient most likely to have?
Trichomonas vaginitis
Candida vaginitis
Bacterial vaginosis
Atrophic vaginitis
Question 4Which of the following represents metrorrhagia?
Fewer than 1 days between menses
Excessive flow
Infrequent bleeding
Bleeding between periods
Question 5 Posteriorly, the labia minora meet as two ridges that fuse to form the:
fourchette
vulva
clitoris
perineum
Question 6The vaginal discharge of a woman with a typical Trichomonas vaginalis infection is:
moderate, gray, with low pH.
scant, curdy, with high pH.
profuse, frothy, with high pH.
profuse, curdy, with low pH.
Question 7
A 48-year-old high school librarian comes to your clinic, complaining of 1 week of heavy discharge causing severe itching. She is not presently sexually active and has had no burning with urination. The symptoms started several days after her last period. She just finished a course of antibiotics for a sinus infection. Her past medical history consists of type diabetes and high blood pressure. She is widowed and has three children. She denies tobacco, alcohol, or drug use. Her mother has high blood pressure and her father died of diabetes complications. On examination you see a healthy-appearing woman. Her blood pressure is 13080 and her pulse is 70. Her head, eyes, ears, nose, throat, cardiac, lung, and abdominal examinations are unremarkable. Palpation of the inguinal lymph nodes is unremarkable. On visualization of the vulva, a thick, white, curdy discharge is seen at the introitus. On speculum examination there is a copious amount of this discharge. The pH of the discharge is 4.1 and the KOH whiff test is negative, with no unusual smell. Wet prep shows budding hyphae.
What vaginitis does this patient most likely have?
Trichomonas vaginitis
Candida vaginitis
Bacterial vaginosis
Atrophic vaginitis
Question 8Which is the most effective pattern of palpation for breast cancer?
Beginning at the nipple, make an ever-enlarging spiral.
Divide the breast into quadrants and inspect each systematically.
Examine in lines resembling the back and forth pattern of mowing a lawn.
Beginning at the nipple, palpate outward in a stripe pattern.
Question 9What structures are located at the five-o’clock and the seven-o’clock positions of the vaginal orifice?
Skene glands
Bartholin glands
Nabothean glands
Hymenal glands
Question 10For purposes of examination and communication of physical findings, the breast is divided into:
halves (upper and lower).
thirds (left, middle, and right).
four quadrants plus a tail.
circles (six consecutive rings, each 1 inch farther away from nipple).
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