Question 1

The rectovaginal examination is an important component of the total pelvic examination because it

Accepted Answer

The rectovaginal examination allows you to reach almost 2.5 cm higher into the pelvis to examine structures not reached with the bimanual examination. It is more uncomfortable for the patient and is not the source for cytology specimens or more complete evaluation of the bladder.

Question 2

The assessment of which structure is not part of the bimanual examination?

Accepted Answer

The bimanual examination consists of assessing the cervix, uterus, adnexa, and ovaries.

Question 3

An examiner rotated a brush several times into the cervical os. The brush was withdrawn and stroked lightly on a glass slide. The slide was sprayed with fixative. Which type of specimen requires this technique for collection?

Accepted Answer

This describes the technique for obtaining a cytology Pap smear.

Question 4

During digital examination of the vagina, the cervix is noted to be positioned posteriorly. Upon bimanual examination of this woman, you would expect to palpate a(n) _____ uterus.

Accepted Answer

The position of the cervix correlates with the position of the uterus. A cervix that is pointing posteriorly indicates an anteverted uterus.

Question 5

The most common cause of a foul vaginal discharge in children is a(n)

Accepted Answer

Foul vaginal discharge in a preschool child is most likely indicative of the presence of a foreign body.

Question 6

The presence of cervical motion tenderness may indicate

Accepted Answer

Painful cervical motion tenderness suggests a pelvic inflammatory disease or a ruptured tubal pregnancy. The cervix is expected to move 1 to 2 cm without discomfort under normal conditions.

Question 7

When collecting specimens, which sample should be obtained first?

Accepted Answer

A Pap smear is performed first; then other tests for gonorrhea, Chlamydia, Trichomonas, bacterial vaginosis, or candidiasis are done. Pap smear results are affected by the presence of blood, and vaginal infections result in more friable tissues; therefore, the Pap smear should be done first.

Question 8

A mother brings her 8-year-old daughter to the clinic because the child says it hurts to urinate after she fell while riding her bicycle. Upon inspection, you find posterior vulvar and gross perineum bruising. These findings are consistent with

Accepted Answer

A straddle injury from a bicycle seat is usually evident over the symphysis pubis; injuries resulting from sexual molestation are generally more posterior and may involve the perineum grossly.

Question 9

Swollen and bruised genitalia in a newborn are most likely related to

Accepted Answer

Although the genitalia of a newborn girl can be swollen because of maternal hormones, swelling and bruising are more likely from a breech delivery.

Question 10

The presence of a fishy odor after dropping potassium hydroxide on a wet mount slide containing vaginal mucus suggests

Accepted Answer

A positive "whiff test" suggests bacterial vaginosis.

Question 11

When a woman is not sexually active, cervical cancer screening should begin

Accepted Answer

Women who are not sexually active should have their first examination by the age of 21 years. Women under age 21 should not be tested.

Question 12

A 3-year-old girl is being seen because of a foul vaginal odor. To inspect the vagina vault, you should first

Accepted Answer

Applying anterior labial traction allows the hymenal opening to become visible as well as the interior of the vagina, almost to the cervix. The presence of a foreign body will be visible with this maneuver.

Question 13

A fixed uterus may indicate

Accepted Answer

The uterus should be mobile in the anteroposterior plane. A fixed uterus indicates adhesions.

Question 14

Which one of the following is a proper technique for use of a speculum during a vaginal examination?

Accepted Answer

Gently insert a finger of one hand to push the introitus down to relax the pubococcygeal muscle. Then hold the closed speculum with the other hand and insert the speculum past your finger obliquely.

Question 15

When performing a gynecologic exam, the examiner should change gloves after touching the patient's

Accepted Answer

Whenever the anal surface is touched, the examiner should change gloves to prevent bacterial cross-contamination to other genital areas.

Question 16

Dacron swabs are necessary when testing for which condition?

Accepted Answer

DNA probe for gonorrhea and Chlamydia uses a Dacron swab because a wooden cotton-tipped applicator may interfere with the test results.

Question 17

Prominent labia minora are a normal finding in

Accepted Answer

Newborn genitalia findings are the result of maternal hormones. Both the labia majora and minora are swollen, with the minora often being more prominent.

Question 18

The visualization of a large proportion of "clue cells" on your wet mount slide examination suggests

Accepted Answer

Clue cells are present in bacterial vaginosis. Hyphae are present in candidiasis, and flagella are present in trichomonal infection. Gonorrhea and cervical cancer cannot be identified on a wet mount.

Question 19

Small, pale yellow, raised, and rounded areas are visualized on the surface of the cervix. You should

Accepted Answer

This describes nabothian cysts, which are retention cysts of the endocervical glands and are considered a normal variant. No further testing is warranted.

Question 20

During a routine vaginal examination, you insert the speculum and visualize the cervix. The cervix projection into the vaginal vault is approximately 5 cm. Upon bimanual examination, you would expect to find the uterus

Accepted Answer

Normally, the cervix protrudes into the vagina 1 to 3 cm. Longer projections suggest a pelvic or uterine mass. A pelvic mass would cause the uterus to be deviated to the right or left, but an anteverted, retroverted, or retroflexed uterus would still be in the midline regardless of its position.

Quiz 18: Female Genitalia