Deck 14: Female Genitalia

Question 1

A 22-year-old architecture major comes to your office, complaining of severe burning with urination, a fever of 101 degrees, and aching all over. She denies any upper respiratory, gastrointestinal, cardiac, or pulmonary symptoms. Her past medical history consists of severe acne. She is currently on an oral contraceptive. She has had no pregnancies or surgeries. She reports one new partner within the last month. She does not smoke but does drink occasionally. Her parents are both in good health. On examination you see a young woman appearing slightly ill. Her temperature is 100.3 and her pulse and blood pressure are unremarkable. Her head, ears, eyes, nose, throat, cardiac, pulmonary, and abdominal examinations are unremarkable. Palpation of the inguinal nodes shows lymphadenopathy bilaterally. On visualization of the perineum there are more than 10 shallow ulcers along each side of the vulva. Speculum and bimanual examination are unremarkable for findings, although she is very tender at the introitus. Urine analysis has some white blood cells but no red blood cells or bacteria. Her urine pregnancy test is negative. Which disorder of the vulva is most likely in this case?

A) Genital herpes
B) Condylomata acuminata
C) Syphilitic chancre
D) Epidermoid cyst

Answer 1

Genital herpes

Question 2

A 42-year-old realtor comes to your clinic, complaining of "growths" in her vulvar area. She is currently undergoing a divorce and is convinced she has a sexually transmitted disease. She denies any vaginal discharge or pain with urination. She has had no fever, malaise, or night sweats. Her past medical history consists of depression and hypothyroidism. She has had two spontaneous vaginal deliveries and one cesarean section. She has had no other surgeries. She denies smoking or drug use. She has two to three drinks weekly. Her mother also has hypothyroidism and her father has high blood pressure and hypercholesterolemia. On examination you see a woman who is anxious but appears otherwise healthy. Her blood pressure, pulse, and temperature are unremarkable. On visualization of the perineum you see two 2- to 3- mm, round, yellow nodules on the left labia. On palpation they are nontender and quite firm. What diagnosis best fits this description of her examination?

A) Genital herpes
B) Condylomata acuminata
C) Syphilitic chancre
D) Epidermoid cyst

Answer 2

Epidermoid cyst

Question 3

A 30-year-old paralegal analyst comes to your clinic, complaining of a bad-smelling vaginal discharge with some mild itching, present for about 3 weeks. She tried douching but it did not help. She has had no pain with urination or with sexual intercourse. She has noticed the smell increased after intercourse and during her period last week. She denies any upper respiratory, gastrointestinal, cardiac, or pulmonary symptoms. Her past medical history consists of one spontaneous vaginal delivery. She is married and has one child. She denies tobacco, alcohol, or drug use. Her mother has high blood pressure and her father died from a heart disease. On examination she appears healthy and has unremarkable vital signs. On examination of the perineum there are no lesions noted. On palpation of the inguinal nodes there is no lymphadenopathy. On speculum examination a thin gray-white discharge is seen in the vault. The pH of the discharge is over 4.5 and there is a fishy odor when potassium hydroxide (KOH) is applied to the vaginal secretions on the slide. Wet prep shows epithelial cells with stippled borders (clue cells). What type of vaginitis best describes her findings?

A) Trichomonas vaginitis
B) Candida vaginitis
C) Bacterial vaginosis
D) Atrophic vaginitis

Answer 3

Bacterial vaginosis

Question 4

A 48-year-old high school librarian comes to your clinic, complaining of 1 week of heavy discharge causing severe itching. She is not presently sexually active and has had no burning with urination. The symptoms started several days after her last period. She just finished a course of antibiotics for a sinus infection. Her past medical history consists of type 2 diabetes and high blood pressure. She is widowed and has three children. She denies tobacco, alcohol, or drug use. Her mother has high blood pressure and her father died of diabetes complications. On examination you see a healthy-appearing woman. Her blood pressure is 130/80 and her pulse is

A) Trichomonas vaginitis
B) Candida vaginitis
C) Bacterial vaginosis
D) Atrophic vaginitis

Question 5

Her head, eyes, ears, nose, throat, cardiac, lung, and abdominal examinations are unremarkable. Palpation of the inguinal lymph nodes is unremarkable. On visualization of the vulva, a thick, white, curdy discharge is seen at the introitus. On speculum examination there is a copious amount of this discharge. The pH of the discharge is 4.1 and the KOH whiff test is negative, with no unusual smell. Wet prep shows budding hyphae. What vaginitis does this patient most likely have?

A) Trichomonas vaginitis
B) Candida vaginitis
C) Bacterial vaginosis
D) Atrophic vaginitis

Question 6

A 55-year-old married homemaker comes to your clinic, complaining of 6 months of vaginal itching and discomfort with intercourse. She has not had a discharge and has had no pain with urination. She has not had a period in over 2 years. She has no other symptoms. Her past medical history consists of removal of her gallbladder. She denies use of tobacco, alcohol, and illegal drugs. Her mother has breast cancer, and her father has coronary artery disease, high blood pressure, and Alzheimer's disease. On examination she appears healthy and has unremarkable vital signs. There is no lymphadenopathy with palpation of the inguinal nodes. Visualization of the vulva shows dry skin but no lesions or masses. The labia are somewhat smaller than usual. Speculum examination reveals scant discharge, and the vaginal walls are red, dry, and bleed easily. Bimanual examination is unremarkable. The KOH whiff test produces no unusual odor and there are no clue cells on the wet prep. What form of vaginitis is this patient most likely to have?

A) Trichomonas vaginitis
B) Candida vaginitis
C) Bacterial vaginosis
D) Atrophic vaginitis

Question 7

A 28-year-old married clothing sales clerk comes to your clinic for her annual examination. She requests a refill on her birth control pills. Her only complaint is painless bleeding after intercourse. She denies any other symptoms. Her past medical history consists of two spontaneous vaginal deliveries. Her past six Pap smears have all been normal. She is married and has two children. Her mother is in good health and her father has high blood pressure. On examination you see a young woman appearing healthy and relaxed. Her vital signs are unremarkable and her head, eyes, ears, throat, neck, cardiac, lung, and abdominal examinations are normal. Visualization of the perineum shows no lesions or masses. Speculum examination shows a red mass at the os. On taking a Pap smear the mass bleeds easily. Bimanual examination shows no cervical motion tenderness and both ovaries are palpated and nontender. What is the most likely diagnosis for the abnormality of her cervix?

A) Carcinoma of the cervix
B) Mucopurulent cervicitis
C) Cervical polyp
D) Retention cyst

Question 8

An 18-year-old college freshman comes to your clinic, complaining of severe left-sided lower abdominal pain and a foul yellow discharge. The pain began last night while she was having intercourse with her boyfriend. Afterward the pain became more severe and the discharge started. By this morning she had a fever of 101 degrees and walking was making the pain worse. Only lying very still makes the pain better. She has tried ibuprofen and acetaminophen without any improvement. She denies any nausea, vomiting, diarrhea, or constipation. Her past medical history is unremarkable. She has had two past sexual partners. She uses the birth control patch instead of condoms. She smokes a half pack of cigarettes a day and drinks four to five beers per weekend night. She denies any illegal drug use. Her parents are both healthy. On examination you find a young woman who appears ill. Her temperature is 102 degrees and her pulse is elevated at 110. She is tender in the left lower quadrant but has no guarding or rebound. Speculum examination reveals yellow purulent drainage from the os. On palpation there is cervical motion tenderness and the left adnexa is swollen and tender. A urine analysis is unremarkable and the urine pregnancy test is pending. What is the best choice of diagnosis for this adnexal swelling?

A) Ovarian cyst
B) Tubal pregnancy
C) Pelvic inflammatory disease

Question 9

A 34-year-old married daycare worker comes to your office, complaining of severe pelvic pain for the last 6 hours. She states that the pain was at first cramp-like but is now sharp. Nothing makes the pain better or worse. She has had no vaginal bleeding or discharge. She has had no pain with urination. She has had some nausea for the last few days but denies vomiting, constipation, or diarrhea. She states she feels so bad that when she stands up she has fainted. Her past medical history consists of two prior cesarean sections and an appendectomy. She is married and has two children. She denies any tobacco, alcohol, or drug use. Her parents are both healthy. On examination you find a pale young woman who is obviously in a great deal of pain. She is lying on her right side with her eyes closed. Her blood pressure is 90/60 and her pulse is 110. She is afebrile. She has bowel sounds and her abdomen is soft. The speculum examination reveals a bluish cervix but no blood or purulent discharge at the os. There is a mild amount of tenderness with palpation of the cervix. The uterus is nongravid but the right adnexal area is swollen and very tender. Urine analysis is normal and the urine pregnancy test is pending. What type of adnexal disorder is causing her pain?

A) Ovarian cysts
B) Tubal pregnancy
C) Pelvic inflammatory disease

Question 10

A 23-year-old waitress comes to your clinic complaining of severe pelvic pain radiating to her right side. The pain began yesterday and is getting much worse. She has had no burning with urination and denies any recent sexual activity. She has no nausea, vomiting, constipation, diarrhea, fever, or vaginal discharge. Her last period was 3 to 4 weeks ago. Her past medical history consists of severe acne, depression, and mild obesity. She has had no surgeries. She broke up with her boyfriend 6 months ago and denies dating anyone else. She smokes one pack of cigarettes a day, drinks three to four beers two to three times a week, and denies any illegal drug use. Her mother is diabetic and her father has coronary artery disease. On examination you see a mildly obese female in moderate distress. Her blood pressure is 130/80 and her pulse is 90. She is afebrile. On auscultation she has active bowel sounds. She has no rebound or guarding in any abdominal quadrant. Speculum examination shows no lesions on the cervix and no discharge or bleeding from the os. During the bimanual examination she has no cervical motion tenderness, but her right adnexal area is swollen and tender. A urine analysis is normal and the urine pregnancy test is pending. What disorder of the adnexa is most likely the diagnosis?

A) Ovarian cyst
B) Tubal pregnancy
C) Pelvic inflammatory disease

Question 11

A 24-year-old travel agent comes to your clinic, complaining of pain and swelling in her vulvar area. She states that 2 days earlier she could feel a small tender spot on the left side of her vagina but now it is larger and extremely tender. Her last period was 1 year ago, and she is sexually active. She uses the Depo-Provera shot for contraception. She denies any nausea, vomiting, constipation, diarrhea, pain with urination, or fever. Her past medical history is significant for ankle surgery. Her mother is healthy, and her father has type 2 diabetes. On examination she appears her stated age and is standing up. She states she cannot sit down without excruciating pain. Her blood pressure, temperature, and pulse are unremarkable. On visualization of her perineum, a large, red, tense swelling is seen to the left of her introitus. Palpation of the mass causes a great deal of pain. What disorder of the vulva is most likely causing her problems?

A) Bartholin's gland infection
B) Vulvar carcinoma
C) Secondary syphilis
D) Condylomata acuminata

Question 12

Which of the following represents metrorrhagia?

A) Fewer than 21 days between menses
B) Excessive flow
C) Infrequent bleeding
D) Bleeding between periods

Question 13

Jean has just given birth 6 months ago and is breast-feeding her child. She has not had a period since giving birth. What does this most likely represent?

A) Primary amenorrhea
B) Secondary amenorrhea
C) Oligomenorrhea
D) Dysmenorrhea

Question 14

Mrs. Jaeger is a 67-year-old who went through menopause at age 55. She has now had some vaginal bleeding. Which of the following should be considered?

A) Endometrial cancer
B) Hormone replacement therapy
C) Uterine or cervical polyps
D) All of the above

Question 15

Abby is a newly married woman who is unable to have intercourse because of vaginismus. Which of the following is true?

A) This is most likely due to lack of lubrication.
B) This is most likely due to atrophic vaginitis.
C) This is most likely due to pressure on an ovary.
D) Psychosocial reasons may cause this condition.

Question 16

Which of the following is true of human papilloma virus (HPV) infection?

A) Pap smear is a relatively ineffective screening method.
B) It commonly resolves spontaneously in 1-2 years.
C) It is the second most common STI in the United States.
D) HPV infections cause a small but important number of cervical cancers.

Question 17

Which of the following is true of the HPV vaccine?

A) Ideally it should be administered within 3 years of first intercourse.
B) It covers against almost every HPV type.
C) It can be used as adjuvant therapy in cervical cancer.
D) It can protect against anogenital lesions.