hypomenorrhea
unusually light menstrual flow
menometrorrhagia
bleeding that occurs at irregular intervals with irregular duration and amounts
oligomenorrhea
menstrual periods that occur more than 35 days apart
contact bleeding
occurs frequently after intercourse, but must be considered a sign of cervical cancer
menorrhagia
heavy or prolonged menstrual flow
metrorrhagia
bleeding that occurs any time between menstrual periods
postmenopausal bleeding
bleeding that occurs after 12 months of amenorrhea in a middle-aged woman
polymenorrhea
periods that occur too frequently
50 y/o female who experiences regular uterine bleeding for nine consecutive days each month
20 y/o female who experiences uterine bleeding unexpectedly throughout the month
41 y/o female who experiences regular uterine bleeding every two and a half weeks
initial work up for uterine bleeding
CBC, pregnancy test and endocrine studies
an adult client's last menstrual period was 2 months ago. She has had a Mirena IUD in place for the past 4 months. She is c/o nausea, fatigue, breast tenderness, and abdominal bloating. Physical exam reveals the following: abdomen: WNL, Pelvic: positive Chadwick's sign, string protruding from cervical os; uterus enlarged and nontender. What is most likely the diagnosis?
pregnancy
65 y/o reports to office w intermittent vaginal bleeding over the last 2 months. LMP was more than 10 years ago. Last pap was WNL. She is not taking HRT. What is the most appropriate response of the nurse practitioner at this time?
schedule endometrial biopsy
A middle-aged female presents with abnormal uterine bleeding, as well as elevated FSH adn LH levels. What is the most likely cause for these findings?
Onset of climacteric
A young client comes to the office complaining of vaginal bleeding. The client states that she has used 5 tampons in the last hours. She admits to sexual activity and takes OCs. On further questioning, she states that she was started her last pack of pills a few weeks late. The nurse practitioner should:
Perform a stat urine pregnancy test
Evaluation of abnormal uterine bleeding initially involves a detailed history, PE, and labs. Which of the following are examples of the most inclusive list of nongynecological problems that may cause abnormal uterine bleeding?
hypothyroidism, liver disease, bleeding disorders, and eating disorders
A 24 y/o woman presents for amenorrhea for 2 monthly cycles. She has been training for a marathon at the gym daily. After ruling out pregnancy, the next most important test would be:
TSH
An endometrial biopsy should be seriously considered in the assessment of abnormal bleeding in all of the following except:
adolescents with irregular menstrual cycles
What is not a risk factor for breast cancer?
fibrocystic breast disease
Which would be considered clearly an abnormal finding on a 75 y/o client?
palpable ovaries
A 21 y/o virgin female presents for her first well-woman exam. Her family and personal history are negative for any significant disease. Her menses are regular with only mild dysmenorrhea. Her visit today should include:
Pap smear
On a speculum exam, describe the presentation of cervical polyps:
moist, red, and glandular
Women who have HPV and smoke cigarettes have a higher risk of vulvar cancer, true or false?
true
The endometrial cycle is often described in 3 phases which are?
proliferative, secretory and menstrual
Which of the following infections would be reported with the initial Pap smear results?
Candida
Standard guidelines in the preventive care of women include:
Routine pap smears beginning by 3 years post-coitarche or by age 21
Which of the following HPV serotypes is most strongly associated with cervical cancer?
HPV 16
Normal menstrual bleeding occurs from a decrease in:
Progesterone
The Bethesda system equivalent for a Class III, moderate dysplasia pap smear is:
high-grade squamous intrepithelial lesion
To promote client comfort before performing a pelvic examination a pelvic examination, the nurse practitioner first:
has the client empty her bladder
The current American Cancer Society guidelines recommend mammogram screening begin at age:
40 years
In collecting specimens for chlamydia and gonorrhea testing, where is the most appropriate place to collect the swab?
inside the cervical os
The nurse practitioner is reviewing the lab results of an 18 y/o recently screened for her annual pap smear. Her classification is HGSIL (high grade squamous intraepithilial lesion); endocervical cells; adequate screen, HPV 16 positive. You ask the client to come in to review her results and tell her which of the following:
your pap smear shows abnormal tissue that needs further evaluation. Please schedule an appointment for a colposcopy as soon as possible.
Which of the following is NOT a risk factor for the development of cervical cancer?
virginal status
A 21 y/o female client is seen for her annual gyn exam. She is sexually active, rarely uses condoms for STD prevention and has multiple sex partners. She smokes one ppd., admits to sedentary lifestyle, eats 2 meals per day, most often at fast food restaurants.. Her exam is negative for any abnormality. Her family and person history are negative for major disease. There are no menstrual abnormalities, her LMP was 1 week ago. The nurse practitioner has done her Pap smear. Which intervention is the least appropriate for this client at this time?
Lab testing: glucose, cardiac risk profile, and TSH
The NP knows the majority of breast cancers occur in which area of the breast?
upper outer quadrant
A patient is dx with HPV. He cannot understand how he got it. Both he and his partner claim monogamy. Which of the following is most important to elicit from his history?
Number of previous partners
A 69 y/o woman presented w/abnormal vaginal bleeding and has now been dx with endometrial cancer. She returns to you because she doesn't understand how this could happen when her pap smear was normal 6 months ago. What is your best response?
Pap smears are not useful in determining uterine cancer in most cases
what finding is considered a normal surface characteristic of the cervix?
small, yellow, raised area on cervix
which of the following is not considered a treatment approach for PMS?
oral contraception
All of the following are true regarding the proliferative phase of the endometrial cycle except?
during this phase, prostaglandins intitiate contractions of the uterine smooth muscle and sloughing of the degraded endometrial tissue
If a female has abnormal uterine bleeding, what tests must be obtained?
Pregnancy (HCG), CBC, TSH, Gonorrhea and chalmydia
what condition is a benign, chronic, progressive disease of the skin characterized by inflammation, epithelial thinning and distinctivew dermal changes that may occur on the trunk, neck, forearms, axillae and under the breasts as well as on the vulva?
lichen sclerosus
A 40 y/o woman presents in clinic with complaint of dull aching pelvic pain that has been ongoing for the past 2 years. You know that potential gyn causes of pelvic pain include all of the following except?
mulitple pregnancies
Which of the following is characteristic of a normal cervix?
cervix is round and should move 2-4 cm without discomfort
A 18 y/o female comes to you complaining of dysmenorrhea. All of the following are important initial questions to ask except:
Do you have first degree relatives with breast cancer?
When a patient presents with symptoms of ovulatory dysfunctional uterine bleeding the clinician should:
Check quantitative HCG, iron, and TSH levels, perform a pelvic, speculum and bimanual exam, obtain detailed menarche and menstrual hx
When trying to narrow down the etiology of secondary amenorrhea in your 28 y/o pt, which of the following would most likely NOT be the cause?
a body fat % 30
All of the following management techniques can be used for polycystic ovary syndrome except:
estrogen
The first consideration in women of childbearing age who presents with abnormal uterine bleeding is:
The proliferative phase of the endometrial cycle coincides with what phase of the ovarian cycle?
follicular phase
In the first weeks of viable uterine pregnancy, serum quantitative HCG levels double every?
48 hours
Risk factors associated with endometrial cancer include all of the following except:
early menopause (before age 50)
What is the initial medical tx for a client who presents with severe bleeding from a raw and denuded endometrium?
High dose estrogen
All are considered diff dx for abnormal uterine bleeding except:
excessive weight gain
A 21 y/o female is dx with trich. You prescribe metronidazole 2 grams in single dose. What further education should be provided?
Do not drink ETOH for 48 hours after treatment, trich may cause labia minora edema and tenderness; your partner needs to be treated and avoid sex until tx is completed
Which of the following factors place women at increased risk for breast cancer?
hx of previous bx that revealed atypical hyperplasia
What are the phases of the ovarian cycle?
follicular, ovulatory and luteal
What are the phases of the endometrial cycle?
proliferative, secretory and menstruation
What is not considered a non-gynecological cause of abnormal uterine bleeding?
cholecystitis
What is most freq symptom of uterine fibroids?
increased bleeding at menses
All of the following are nongyn causes of abnormal uterine bleeding except:
dysmenorrhea
A pt comes to clinic c/o mood swings, depression, anxiety, bloating, and breast tenderness that occurs in the second half of her menstrual cycle. The most likely dx is?
PMS
A middle-aged woman, in the climateric stage of her life, presents with pelvic pain. What is the least likely cause of her pain?
Uterine fibroids
Wet prep is used to test for?
Trichomoniasis
The following are signs and symptoms of cervical cancer except?
GI upset
Progestin therapy is preferred tx for all of the following except:
acute uterine bleeding
Management goals for treating abnormal uterine bleeding include all of the following except:
episodes of acute hemorrhage should be managed by a NP
Which of the following is not a biochemical feature of PCOS?
markedly elevated serum total testosterone levels
A 60 y/o woman whose LMP was more than 5 years ago presents with intermittent uterine bleeding over the past few months. You know that:
she is experiencing post menopausal bleeding which is strongly suggestive of endometrial cancer
Cyclic mastalgia typically begins in the ___ phase and subsides with ____?
luteal, menses
When considering the physiology of the menstrual cycle, we know that all are true excpet?
the follicular cycle consists of 3 phases: maturation, expulsion and endometrial phases
When cervical mucus is applied to a clean, dry slide, a non frond like appearance indicates?
ovulation has occurred
65 y/o presents with uterine bleeding. She is post menopausal and has been taking HRT for 2 years. The appropriate tx is?
Offer D & C
Your fellow practitioner explains that she has ordered a CBC and hematology consult for an adolescent pt who presented today with severe menstrual bleeding and frequent bruising. The practitioner is most likely trying to identify or rule out?
inherited coagulopathy
The most common psychological illness accompanying PMS and PMDD is
depression
30 y/o presents as a new patient for routine screening check up and to discuss OC use. Se confides that her mother died this year of breast cancer and maternal gm died at age 58 from ovarian cancer. She is worried that she may develop cancer. You acknowlege her concerns and review the known risk factors for breast cancer. All of the following except:
smoking
A contraindication for HRT would be:
hx of nontraumatic DVT
13 y/o female in clinic c/o heavy menstrual bleeding this month. The NP learns from the hx that pt's first menses was four months ago. The practitoner realizes that:
it is not unusual for her periods to be irregular and it would be wise to perform pelvic exam and get an ultrasound
28 y/o presents to clinic c/o bleeding. She is concerned because it is not time for her period. In what order would the NP work up this pt to determine a presumed dx of dysfunctional uterine bleeding?
rule out pregnancy, rule out iatrogenic causes, rule out systemic disorders, rule out pathology of genital tract, presumed dysfunctional bleeding
Current USPSTF guidelines assigns an "A" recommendation to screening for cervical cancer for all of the following except:
65 y/o with hx of previous cytologically normal screens who is not at increased risk for cervical cancer
When evaluating dysfunctional uterine bleeding in women of childbearing age, it is important to understand the risk factors for endometrial cancer. These risk factors include all of the following except:
multiparity
What factor is considered high risk for breast cancer?
genetic mutation in BRCA-1 and BRCA-2 genes
65 y/o comes to gyn for her annual exam. Her friend was recently dx with ovarian cancer and she wants to be tested. Which of the following would be the most appropriate screening for ovarian cancer?
No screening at all
You are performing an exam on a 45 y/o female. Which of the following screening recommendation does not apply to this pt?
osteoporosis
15 y/o female presents to the clinic worried because other girls her age have started their menstration, and she has not. She has no physical complaints, no past medical history adn is not sexually active. Her most likely diagnosis would be:
primary amenorrhea
26 y/o woman presents to the clinic with concerns of trying to become pregnant for several months. During history and physical she indicates that she has been extremely stressed and has a long history of bulimia. What is the most likely cause of anovulation?
Hypothalamic suppression
Based on symptoms, including homogenous white discharge with "fishy" odor, pH > 4.5, clue cells on microscopic exam and positive "whiff" test...First line recommended treatment would more than likely include:
Metronidazole 500 mg bid x 7 days
In which of the following patients would the HPV vaccine be contraindicated?
27 year old female
Which of these women does not need to receive mammogram screening?
34 y/o dx with fibrocystic breast disease
34 y/o AA woman presents to your clinic with a history of heavy menstrual bleeding occurring every 30-32 days. She states that she has to wear both a super absorbency tampon and a pad. She is most likely experiencing:
Polycystic ovarian syndrome should be considered in the patient who is:
40 y/o obese, never been pregnant, and has been dx with type 2 diabetes
Characterized by depressed or labile mood, anxiety, irritability, anger and other symptoms that are severe enough to interfere with occupational and social functioning. It occurs exclusively during the two weeks preceding menses.
PMDD
Upon a pelvic examination, the NP attempts to place the speculum in the vaginal vault. She notes the patient has involuntary muscle contraction in the uterine wall and appears friightened. This disorder is
vaginismus
Which of the following findings requires referral for further evaluation of abnormal vaginal bleeding?
Ultrasound shows ovarian tumor
Polycystic ovarian syndrome exhibits all of the following symptoms, which one is the most accurate?
hirsutism, alopecia, acne, virilization, menstrual irregularity and infertility, polycystic ovaries, obesity, insulin resistance adn metabolic syndrome
Primary dysmeorrhea can be caused by endometriosis, tumors, ovarian cysts, or PID.
False
All of the following are characteristics of BV except:
postcoital bleeding
Most common benign vulvar dermatoses
primary irritant and allergic dermatitis, lichen sclerosus, lichen planus, squamous cell hyperplasia and psoriasis
Most common presenting symptom of lichen sclerosus
vulvar pruritis
Physical finding associated with lichen sclerosus
classic figure 8 formation that surrounds vulva and perianal area
Presenting symptom of lichen planus
irritating vaginal discharge
Three major classifications for vulvar LP
papulosquamous, erosive and hypertrophic
Vaginal involvement is more likely for which: lichen planus or lichen sclerosus?
lichen planus
Usually begins as a benign disorder that causes vaginal pruritis but over time progresses to this; usually occurs prior to menopause; women think they have chronic yeast infections
squamous cell hyperplasia
Erythema is more common and scaling is finer with thick plaque seldomly seen
vulvar psoriasis
Mucus collection and creates a smooth, often shiny bulge on this cyst; usually requires no treatment
Nabothian cyst
These polyps appear moist, red and glandular; can become malignant if infected with HPV
cervical polyp
Other names for uterine fibroids
myomas or leiomyomatas-benign growth that arise from the smooth muscle of the uterus; often asymptomatic
Used to reduce the size of uterine fibroids prior to surgery or attempts at pregnancy
Gonadotropin-releasing hormone (GnRH) agonists also levonorgestrel intrauterine system (Mirena)
Adenomyosis
presence of endometrial tissue in the myometrium; diffuse or nodular
common symptoms of adenomyosis
pelvic pain and menorrhagia, pain with deep intercourse and increase w/clotting during menses
Definitive treatment for adenomyosis
hysterectomy
Endometriosis
presence of endometrial glands and stroma outside of the uterus; most common sites are ovaries, anterior and posterior cul de sac, posterior broad ligaments, uterosacral ligaments, fallopian tubes, sigmoid colon, appendix and round ligaments
Most common symptoms of endometriosis
pelvic pain, dysmenorrhea, dyspareunia, abnormal menstrual bleeding, and infertility
Most common finding on physical exam of patient with endometriosis
pain with palpation of posterior fornix during bimanual exam
Gold standard for dx of endometriosis
Laparoscopy
Options for medical therapy for endometriosis
progestins, combined OCs, GnRH agonists and danazol
most widely used progestin for endometriosis
medroxyprogesterone acetate
When is surgery indicated for endometriosis
for severe or debilitating symptoms that have not been controlled with medical therapy
Main treatment for adolescents with endometriosis
NSAIDs and OCs
Functional ovarian cysts
two types: follicular and luteal
Follicular phase cysts
more common; usually asymptomatic
luteal ovarian cysts
normally formed withe each menstrual cycle as ovulation occurs; if pregnancy does not occur, the cyst undergoes luteolysis and regresses with the onset of menses
organic cysts
complex cysts, can become very large but grow slowly and have low malignancy potential
Visceral sources of pelvic pain
reproductive, genitourinary or GI
somatic sources of pelvic pain
pelvic bones, ligaments, muscle and facia
leading cause of nongyn pelvic pain originating in GI system
IBS
leading cause of pelvic pain caused by urinary system
interstitial cystitis
Pelvic pain in adolescents is almost always
gynecologic in origin
Adolescence