APEA Women’s Health Questions and Answers

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1. Question: When palpating the cervix during the bimanual exam, cervical motion tenderness (chandelier sign) is noted. This tenderness could be suggestive of: pelvic inflammatory disease Explanat... ion: Cervical motion tenderness, also known as Chandelier's sign, and/or adnexal tenderness, suggest pelvic inflammatory disease, ectopic pregnancy, or appendicitis. 2. Question: In a female diagnosed with a first-degree uterine prolapse, the cervix: has slipped but is well within the vagina Explanation: Uterine prolapse occurs in progressive stages. The uterus becomes retroverted and descends down the vaginal canal to the exterior. In first-degree prolapse, the cervix is still well within the vagina. In seconddegree prolapse, it is at the introitus. In third-degree prolapse (procidentia), the cervix and vagina are outside the introitus. 3. Question: Daughters of women who took Diethylstilbestrol (DES) during pregnancy are at a high risk for developing all of the following abnormalities except: a slit- like cervical os. Correct Explanation: Daughters of women who took Diethylstilbestrol (DES) during pregnancy are at greatly increased risk for several abnormalities: columnar epithelium that covers most or all of the cervix vaginal adenosis, and a circular collar or ridge of tissue, of varying shapes, between the cervix and vagina. The slit-like cervical os is a normal variation. 4. Question: A female patient presents with a profuse, yellowish, green vaginal discharge that is malodorous. This vaginal discharge is most consistent with: Trichomonal vaginitis Explanation: Trichomonas vaginalis causes trichomonal vaginitis. Presenting symptoms include a profuse, yellowish, green vaginal discharge that is malodorous. Candidal vaginitis produces a white and curd-like thin discharge that is rarely malodorous. With bacterial vaginosis, the discharge can be gray or white, thin, malodorous (fishy), and not usually profuse. The discharge associated with gonorrhea is usually thick and bloody. 5. Question: The most common causes of sexual problems in females are related to: psychosocial factors Explanation: The most common problems that occur during sexual activity are related to situational or psychosocial factors. Although lack of desire, inadequate vaginal lubrication, and pelvic disorders may all contribute to sexual problems, the most common causes are situational and psychosocial in origin. Therefore, obtaining a comprehensive sexual history is of utmost importance. 6. Question: Chronic pelvic pain refers to pain that does not respond to therapy and: lasts more than 6 months Explanation: According to the International Pelvic Pain Society, chronic pelvic pain refers to pain that lasts more than 6 months without response to treatment. 7. Question: In female patients with dyspareunia, superficial pain is most likely related to all of the following except: pressure on a normal ovary Explanation: In females, dyspareunia, or painful intercourse, can occur at the vaginal opening, occurring at the start of intercourse, or when the partner is pushing deeper. It is important to differentiate the pain to determine the etiology. Superficial pain suggests local inflammation, atrophic vaginitis, or inadequate lubrication. Deeper pain may be from pelvic disorders or pressure on a normal ovary. 8. Question: If urethritis or inflammation of the paraurethral glands is suspected in a female patient, the index finger should be inserted into the vagina and: milk the urethra gently from the inside outward Explanation: If urethritis or inflammation of the paraurethral glands is suspected, the examiner should insert the index finger into the vagina and milk the urethra gently from inside outward. Note any discharge from or about the urethral meatus. If present, it should be cultured. 9. Question: Upon examination of the vagina, a swollen red ring is noted around the urethral opening. This finding is most consistent with a: prolapse of the urethral mucosa Explanation: A prolapsed urethral mucosa forms a swollen red ring around the urethral meatus. A urethral caruncle is a small, red, benign tumor visible at the posterior part of the urethral meatus. It usually occurs in postmenopausal women. A cystocele is a bulge of the upper two-thirds of the anterior vaginal wall and the bladder above it. It results from weakened supporting tissues. When the entire anterior vaginal wall, together with the bladder and urethra, is involved in the bulge, a cystourethrocele is present. 10. Question: When performing a bimanual vaginal exam, a solid, nodular-like lesion is palpated over the right ovary. This finding is most consistent with: an ovarian tumor Explanation: Ovarian tumors appear solid and often nodular upon palpation. Ovarian cancer is relatively rare and usually presents at an advanced stage with symptoms of pelvic pain, increased abdominal size, and urinary tract symptoms. An ovarian cyst tends to be smooth and compressible and if uncomplicated, nontender. A right tubal pregnancy does not typically present with an ovarian lesion. A tubo-ovarian abscess is difficult to palpate and typically presents with severe pain and purulent vaginal discharge. 11. Question: Indications for performing a rectovaginal exam include all of the following except to: assess an inguinal hernia Explanation: The rectovaginal examination has three primary purposes: to palpate a retroverted uterus, the uterosacral ligaments, cul-de-sac, and adnexa; to screen for colorectal cancer in women 50 years or older; and to assess for pelvic pathology. It is not indicated for assessing or palpating inguinal hernias. 12. Question: Examination of a female patient's right breast reveals a retraction of the nipple and areola. This finding is consistent with: breast cancer Explanation: Retraction of the nipple and areola are suggestive of an underlying tumor. Mastitis is an inflammation of the breast tissue. Paget's disease is an uncommon form of breast cancer that starts with a scaly, eczemalike lesion that may weep, crust, or erode. Fibrocystic breast disease findings include lumps, thickening and swelling in the breast tissue, and becomes prominent immediately before onset of menses. 13. Question: To assess pelvic floor muscle strength during the bimanual vaginal exam, have the patient squeeze around the inserted fingers for as long as possible. To consider full strength, snug compression should last for: 3 seconds Explanation: To assess pelvic floor muscle strength during the bimanual vaginal exam, have the patient squeeze around the inserted fingers for as long as possible. To consider full strength, snug compression should last for 3 or more seconds. 14. Question: Upon examination of the vagina, a tense, hot, very tender abscess with labial swelling is noted. This finding is most consistent with a: bartholin gland infection Explanation: A bartholin gland infection appears as a tense, hot, very tender abscess with labial swelling over the area of the bartholin gland. A cystocele is a bulge of the upper two-thirds of the anterior vaginal wall and the bladder above it. It results from weakened supporting tissues. A urethral caruncle is a small, red, benign tumor visible at the posterior part of the urethral meatus. A rectocele is a herniation of the rectum in [Show More]

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