Question 1

What are the criteria used to make a diagnosis of bacterial vaginosis?

Accepted Answer

Clue cells on microscopic examination of wet mount, the presence of an amine odor when vaginal discharge is mixed with KOH 10%, an increased amount of white, homogeneous vaginal discharge, and a vaginal pH of >4.5 describe the Amsel criteria used to diagnose bacterial vaginosis.
Any three of the four findings must be present in order to make the diagnosis of bacterial vaginosis. The presence of hyphae on microscopic examination of wet mount indicates candida. Likewise, the finding of white, clumpy vaginal discharge is characteristic of candida. A vaginal pH of >4.5 is pathologic.

Question 2

Maternal emotional lability at five days postpartum, without other psychological symptoms, is most indicative of:

Accepted Answer

Maternal emotional lability at five days postpartum, without other psychological symptoms, is most indicative of postpartum blues.
Postpartum blues (mood swings, episodes of tearfulness, irritability) are experienced by 40-80% of women and typically resolve within the first two weeks postpartum. A smaller percentage of women (10-20%) experience postpartum depression, which is characterized by feelings of hopelessness or despair that occur on most days within a two week period. Postpartum depression most often has an onset within the first month postpartum, but may occur anytime during the first year after giving birth. Postpartum psychosis occurs in 0.1% of women and is characterized by symptoms similar to bipolar disorder.

Question 3

What is the ASCCP recommended management for an ASCUS (atypical squamous cells of undetermined significance) pap result with a positive high risk HPV 16 cotest in a 26 year old woman without a history of abnormal pap smears?

Accepted Answer

The ASCCP guidelines recommend colposcopy for the management of an ASCUS (atypical squamous cells of undetermined significance) pap result with a positive high risk HPV 16 cotest in a 26 year old woman without a history of abnormal pap smears.
This result carries a 7.1% 5-year risk of CIN 3. A LEEP or other excisional procedure is reserved for biopsy-confirmed CIN 2-3 or greater. Repeating the pap and HPV cotest at any later date may delay diagnosis and treatment.

Question 4

On clinical exam, you detect a 2cm x 1cm non-tender, smooth, round, rubbery, mobile mass in the upper outer quadrant of your 32 year-old nulligravid patient's right breast. This mass is most likely:

Accepted Answer

A 2cm x 1cm non-tender, smooth, round, rubbery, mobile mass in the upper outer quadrant of the right breast of a 32 year-old nulligravid woman, detected on clinical exam, is most likely a fibroadenoma.
Fibroadenomas are the most common breast pathology found in reproductive-aged women, with an estimated prevalence of 9%. Breast cancer is less common in this age group, and on exam is usually firm and non-mobile. A clogged duct is uncommon in women who are not breastfeeding. Lesions with smooth, round, rubbery, mobile characteristics are typically benign, however, the finding of any breast mass warrants imaging and possible needle biopsy. Clinical exam is not adequate to distinguish benign lesions from those that are malignant.

Question 5

Which of the following HPV protocols is correct?

Accepted Answer

According to CDC guidelines, boys and girls age 9-14 should receive two doses of 9-valent HPV vaccine (Gardasil 9) six to twelve months apart.
One dose of 9-valent HPV vaccine is not sufficient to confer immunity. Three doses of 9-valent HPV vaccine are no longer required to confer immunity for children in this age group. Children do not have to wait until age 15 to be vaccinated.

Question 6

The most significant risk factor for postpartum depression is:

Accepted Answer

A history of depression or anxiety is the most significant risk factor for postpartum depression. There is no evidence to support that a cesarean delivery or an unplanned pregnancy increases the risk of postpartum depression.

Question 7

According to the WHO Medical Eligibility Criteria for Contraceptive Use, which of the following contraceptive methods should not be used by a patient with an acute DVT?

Accepted Answer

Combined oral contraceptives, should not be used by a patient with an acute DVT. A Paragard IUD can be used by a patient with an acute DVT without restrictions. An implant (Nexplanon) is generally not recommended for use by a patient with an acute DVT, but clinical judgment and access to care may override this recommendation.

Question 8

Which class of anti-hypertensive medications is least likely to be effective for a 53 year old African American woman with chronic hypertension?

Accepted Answer

ACE inhibitors are least likely to be effective for a 53 year old African American woman with chronic hypertension. ACE inhibitors work less well for people of African American descent than for people of other ethnicities. Other classes of anti-hypertensives are more effective for treating chronic hypertension in people of African-American descent.

Question 9

Which of the following is not a risk factor for gestational diabetes (GDM)?

Accepted Answer

Age < 25 years is not a risk factor for gestational diabetes (GDM). A family history of diabetes, and American Indian race are both risk factors for gestational diabetes.

Question 10

A pregnant patient with sickle cell trait is at increased risk for:

Accepted Answer

A pregnant patient with sickle cell trait is at increased risk for asymptomatic bacteria. Screening for asymptomatic bacteria in pregnant women with sickle cell trait should be done every trimester.
A pregnant patient with sickle cell trait may be at increased risk for asymptomatic bacteriuria, or bacteria in the urine without any symptoms, due to several factors.
First, the physiological changes that occur during pregnancy, such as an increase in the volume of urine produced and a decrease in bladder capacity, can make it easier for bacteria to grow and thrive in the urinary tract. This can increase the risk of urinary tract infections (UTIs), leading to asymptomatic bacteriuria.
Also, sickle cell trait, an inherited condition resulting in the production of abnormal red blood cells, can cause inflammation and damage to the blood vessels and organs, including the urinary tract. This can increase the risk of UTIs and asymptomatic bacteriuria.
It is essential for pregnant patients with sickle cell trait to be screened for asymptomatic bacteriuria and to receive treatment if it is detected, as it can lead to more severe complications such as pyelonephritis (kidney infection) if left untreated.

Question 11

When hormone therapy is prescribed for menopausal symptoms:

Accepted Answer

When prescribing hormone therapy for menopausal symptoms, it should be prescribed at the lowest effective dose for the shortest period of time necessary. Some women will require less than five years of hormone therapy, while other women will require more than five years of hormone therapy in order to treat menopausal symptoms. Effectiveness of hormone therapy can be determined before three months of use.

Question 12

Poor dental hygiene in pregnancy is correlated with:

Accepted Answer

Poor dental hygiene in pregnancy is correlated with an increased risk for pre-term delivery.

Question 13

The HPV vaccine (Gardasil 9) is indicated for:

Accepted Answer

The HPV vaccine is indicated for all children and adults aged 9-26. Though HPV vaccine was initially approved only for use in girls and women, its use was eventually expanded to include an indication for boys and men as well.
Gardasil is a vaccine that protects against certain types of human papillomavirus (HPV). HPV is a virus that can cause certain types of cancer and other diseases. Gardasil is given in a series of three injections over a six-month period. It is recommended for both males and females, and is most effective when given before an individual becomes sexually active.

Question 14

The risks of dilantin use in pregnancy include:

Accepted Answer

Fetal hydantoin syndrome (which includes craniofacial anomalies, fetal growth deficiency, developmental delay, fingernail hypoplasia, cardiac anomalies and facial clefts) is an established risk of dilantin use in pregnancy. Fetal neural tube defects are associated with the use of the anti-seizure medication valproate; fetal skeletal defects are theoretically associated with the use of the anti-seizure medication keppra.

Question 15

Which ethnic groups have an increased risk for Tay-Sach's disease?

Accepted Answer

Tay-Sach's disease is more common among people of Ashkenazi Jewish, French Canadian and Cajun descent. Sephardic Jewish heritage does not carry an increased risk of Tay-Sach's disease.

Question 16

Which procedure is initially indicated for a woman over age 35 with intermenstrual bleeding?

Accepted Answer

An endometrial biopsy is initially indicated for women over age 35 with intermenstrual bleeding in order to identify potential endometrial hyperplasia and cancer. An MRI is not useful for the initial evaluation of intermenstrual bleeding. A dilation and curettage (D&C) is not initially indicated for the evaluation of intermenstrual bleeding due to surgical risks, expense, pain and the need for anesthesia.

Question 17

What is the recommended daily calcium intake for a postmenopausal woman?

Accepted Answer

The US RDA for calcium for postmenopausal women is 1200mg. The US RDA for adolescent females is 1300mg. The US RDA for non-pregnant women of reproductive age is 1000mg.

Question 18

Which sexually transmitted infection is most likely with the finding of a single, painless, indurated lesion on the labia?

Accepted Answer

A single, painless, indurated labial lesion is most likely indicative of primary syphilis. HSV typically presents with multiple, tender, blister-like lesions. HPV typically presents with single or multiple, non-tender, fleshy lesions.

Question 19

At what point can a woman discontinue routine cervical cancer screening?

Accepted Answer

ASCCP guidelines support exiting women from cervical cancer screening at age 65 with adequate negative screening and no CIN2+ within the past 20 years. Adequate negative screening is defined as three consecutive negative paps or two consecutive negative HPV tests within the past 10 years, with the most recent being within the past five years. Sexual history has no impact on the decision to exit a patient from cervical cancer screening.

Question 20

Routine preconception care and counseling include all of the following except:

Accepted Answer

Routine preconception care and counseling does not include recommendation and testing for diabetes. Preconception testing for diabetes would be indicated for patients who are symptomatic for diabetes or at increased risk for diabetes. All patients requesting preconception care and counseling should receive recommendations for taking prenatal vitamins with folic acid and DHA and for testing for immunity to rubella and varicella.

Quiz 1: Womens Health and Reproductive Medicine