Question 1

When collecting specimens, which sample should be obtained first?

Accepted Answer

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

Question 2

The presence of a fishy odor after adding potassium hydroxide to a wet mount slide containing vaginal mucus suggests:

Accepted Answer

A positive whiff test suggests bacterial vaginosis.

Question 3

What accommodations should be used for the position of a hearing-impaired woman for a pelvic examination?

Accepted Answer

The woman with a hearing impairment will need to see the clinician and/or an interpreter during the examination; therefore, her head should be elevated.

Question 4

Young women who are not sexually active should have their first pelvic examination:

Accepted Answer

Young women who are not sexually active should have their first examination by the age of 21.

Question 5

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. On 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 6

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 7

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

Accepted Answer

Use two fingers 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 fingers obliquely.

Question 8

An examiner has 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 The brush was withdrawn and stroked lightly on a glass slide.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 Pap smear for cytologic examination.

Question 9

During a digital examination of the vagina, the cervix is noted to be positioned posteriorly. On 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 10

During a pelvic examination for a postmenopausal woman, you would expect to assess:

Accepted Answer

Expected findings in the pelvic examination of an older woman include a narrower and shorter vagina, the absence of rugation, a less mobile cervix, and a palpable cervical os.

Question 11

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

Accepted Answer

Although the genitalia of the newborn girl can be swollen due to maternal hormones, swelling and bruising are more likely caused by a breech delivery.

Question 12

Bimanual examination of the uterus includes:

Accepted Answer

The bimanual examination includes testing for cervical motion tenderness by grasping the cervix between the examining fingers and moving from side to side.

Question 13

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 14

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

Accepted Answer

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

Question 15

Mrs. Reilly brings her 6-year-old daughter in with complaints of a foul vaginal discharge noted in her underpants. The most common cause of a foul vaginal discharge in children is a(n):

Accepted Answer

A foul vaginal discharge in the preschool-age girl is most likely indicative of the presence of a foreign body.

Question 16

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.

Question 17

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 flagellae are present in trichomonal infection. Gonorrhea cannot be identified on a wet mount.

Question 18

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 19

Dacron swabs are necessary when testing for which condition?

Accepted Answer

Dacron swabs are necessary when testing for chlamydia.

Question 20

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 that are considered a normal variant. No further testing is warranted. A friable cervix describes one that is red and bleeds easily. You would not obtain a viral culture or test the pH of the cervical os.

Quiz 18: Female Genitalia