Correspondence Course - Assignment 1

In this first assignment, you will read from the textbook the Introduction, Routine GYN Care, Obtaining a Pap Smear, and Pap Smear Interpretation. After completing the reading, answer the questions listed below.

You can read the textbook off the computer screen, but many people find it easier to read a printed copy. To obtain a printed copy, click on Introduction, then print it. You can print each chapter in this way.

When you are ready to begin answering the test questions, call up an Answer Sheet by clicking here, then print the answer sheet.

After you have completed all six assignments and tests, mail them to the Naval School of Health Sciences.

If you need a more detailed explanation of the answer sheets, click here.

Test Questions

Learning Objective: Know the characteristics of the population of women assigned to operational commands and the differences between military and civilian populations.

1-1. In what way(s) does OB-GYN care in military operational settings differ from care provided in civilian settings?

1. Medical resources may be more limited

2. Medical care is provided in isolated settings.

3. Operational commitments may influence medical treatments

4. All of the above

1-2. What is the primary role of a physician attached to an operational command?

1. Preserving the health of the personnel and helping achieve the operational goals of the command

2. Achieving technical expertise and continuing education

3. Maintaining personal fitness and mental health

4. Enforcing weight and grooming standards

1-3. In civilian practice, the provider's primary responsibility is to the patient.

1. True

2. False

1-4. In most cases, the interests of the Command and the interests of the patient are different.

1. True

2. False

1-5. In case of a conflict between the needs of the Command and the needs of the patient, always follow the needs of the patient.

1. True

2. False

1-6. Comparing military to civilian medical practice, the principles of treatment and the application of treatment are the same.

1. True

2. False

1-7. Which of the following statements best describes the utilization of medical services by women?

1. Women used medical services less frequently than men.

2. Women used medical services more frequently than men.

3. Women used medical services with about the same frequency as men.

1-8. For the most part, women's health care needs are the same as men's health care needs.

1. True

2. False

In answering questions 1-9 through 1-18, select from column B the clinical care setting most closely associated with the description in column A. Some responses may be used once, more than once, or not at all.

A. Description	B. Setting
1-9. Isolated	1. Military
1-10. Limited Resources	2. Civilian
1-11. Operational Commitments	3. Both
1-12. Interests of the patient are important.	4. Neither
1-13. Patients are pre-screened for chronic disease.
1-14. Women use health care services more often than men.
1-15. Women are more satisfied with their healthcare than men.
1-16. The interests of the patient are the primary concern.
1-17. The interests of 3rd party payers is the primary concern.
1-18. Patients come from many backgrounds.

In answering questions 1-19 through 1-29, select from column B the gender associated with the conditions described in column A. Some responses may be used once, more than once, or not at all.

Comparing men to women, which group has:

A. Conditions	B. Gender
1-19. Higher illness rates?	1. Male
1-20. More genito-urinary problems?	2. Female
1-21. Higher death rates?	3. Both
1-22. More chronic illness leading to death?	4. Neither
1-23. More self-reported chronic conditions?
1-24. More acute conditions except injuries?
1-25. Fewer days of illness and disability?
1-26. Better vision?
1-27. Better hearing?
1-28. Better dental status?
1-29. About half of new recruits who are victims of physical domestic abuse prior to entry into the Navy?

1-30. Routine care accounts for what proportion of all OB-GYN visits?

1. 1/10

2. 1/3

3. 1/2

4. 2/3

1-31. Which of the following is not among the most common reasons for OB-GYN visits?

1. Menstrual abnormalities.

2. Vaginitis.

3. Urinary tract problems.

4. Sexual assault

1-32. Usually, there is only one way to deal with any particular clinical problem.

1. True.

2. False.

Learning Objective: Know the requirements for routine gynecologic care, including frequency of pelvic/breast exams and Pap smears. Understand the requirements for a chaperone during exams.

1-33. Navy regulations require each active duty servicewoman in the Navy to have a Pap smear once a year within 30 days of her birthday.

1. True

2. False

1-34. Whenever a male Medical Corps Officer examines a female patient’s breasts or genitals custom, tradition and sometimes regulation require the presence of a third person, preferably female.

1. True

2. False

Learning Objective: Understand the use of Pap smears in detecting cervical disease, the clinical significance of various Pap abnormalities, and the role of colposcopy in diagnosis and management of these conditions.

1-35. For what purpose were Pap smears designed?

1. Detection of cervical cancer

2. Detection of lung cancer

3. Detection of anemia

4. Detection of arthritis

1-36. What area of the cervix is most likely to contain abnormal cells?

1. Endocervical canal

2. Vagina

3. Squamo-columnar Junction

4. Columnar epithelium

1-37. What is "cervical ectropion?"

1. A normal finding

2. A fiery-red button of tissue surrounding the cervical os.

3. Columnar epithelium which has grown out onto the surface of the cervix from the endocervical canal.

4. All of the above.

1-38. When sampling for the Pap smear, what areas should be included?

1. The squamo-columnar junction

2. The endocervical canal

3. Both 1 and 2

4. Neither 1 nor 2

1-39. What is the best type of Pap smear to obtain?

1. As thick a smear as possible

2. As thin a smear as possible

3. An average thickness smear

4. As symmetrical a smear as possible

1-40. A Pap smear slide should be sprayed with fixative within seconds.

1. True

2. False

1-41. Once sprayed with fixative and allowed to dry, a Pap smear slide can be kept for weeks before being processed.

1. True

2. False

1-42. How serious is the presence of actinomycosis on a Pap smear report?

1. A very dangerous finding

2. An abnormality requiring immediate evaluation

3. Is usually treated with hysterectomy

4. Usually an incidental finding of no significance

1-43. Which of the following is true regarding "Atrophic vaginitis" found on a Pap smear?

1. It is usually always treated.

2. It is an abnormal finding among menopausal women.

3. It may be treated with Premarin (estrogen).

4. It should not be ignored.

1-44. Which of the following statements regarding "Candida" appearing on a Pap smear is true?

1. It is usually an incidental finding of no clinical significance.

2. It requires thorough evaluation and treatment.

3. It should be followed by repeat Pap smears every 3 months for one year.

4. It is easily confused with invasive cancer of the cervix.

1-45. Which of the following may be caused by Chlamydia in the female genital tract?

1. Cancer

2. Pelvic Inflammatory Disease (PID)

3. Warts (condyloma)

4. All of the above

1-46. What is the safest and most effective treatment of Chlamydia?

1. Triple Sulfa Cream

2. Doxycycline

3. Cryocautery

4. All of the above

1-47. Which of the following best describes the clinical significance of Coccoid bacteria found on a Pap smear?

1. It may be associated with inflammation on the Pap smear.

2. It may be treated with Amoxicillin or Flagyl.

3. It may be associated with a bad-smelling vaginal discharge.

4. All of the above.

1-48. Colposcopy is the first step in evaluation of significant abnormalities found on a Pap smear.

1. True

2. False

1-49. Which of the following is true regarding condyloma (venereal warts):

1. They need immediate evaluation with colposcopy.

2. They are very dangerous.

3. They are caused by Human Papilloma Virus (HPV).

4. All of the above.

1-50. Hair spray is an acceptable alternative to cytologic fixative in preparing Pap smears.

1. True

2. False

1-51. Most Pap smears do not contain endocervical cells.

1. True

2. False

1-52. Among women of childbearing age, the presence of some endometrial cells on the Pap smear is not considered abnormal.

1. True

2. False

1-53. In the Pap smear from a menopausal women, the presence of endometrial cells is not considered abnormal if the woman is taking estrogen replacement therapy

1. True

2. False

1-54. Which of the following is true regarding Gardnerella Vaginalis found on a Pap smear?

1. It may be associated with a foul-smelling vaginal discharge

2. It may not be associated with any symptoms.

3. It may be treated with Flagyl.

4. All of the above

1-55. Which of the following are possible reasons for a Pap smear reported to be "Inadequate,"

1. The slide had an insufficient number of cervical epithelial cells on it.

2. The slide was fixed too rapidly.

3. The slide had an insufficient number of red blood cells on it.

4. All of the above

1-56. Which of the following are proper preparations for repeating a Pap smear found to be "inadequate?"

1. Make sure the women is having her menstrual period.

2. Treat any infection which might be present on the cervix before repeating the smear.

3. Thoroughly dry the slide prior to applying fixative.

4. All of the above

1-57. When repeating a Pap smear found to be "inconclusive," it may be helpful to provide the cytologist with two slides rather than one to make sure they have plenty of material to look at.

1. True

2. False

1-58. "Inflammation" on a Pap smear may interfere with the ability of the cytologist to accurately read the Pap.

1. True

2. False

1-59. "Inflammation" found on a Pap smear should always be treated.

1. True

2. False

1-60. The presence of "IUD changes" on a Pap smear is a danger sign which should be followed by colposcopy.

1. True

2. False

1-61. "Koilocytosis" is always caused by HPV.

1. True

2. False

1-62. "Koilocytosis" should always be evaluated with colposcopy as quickly as possible since it may reflect the presence of an underlying cancer.

1. True

2. False

1-63. Which of the following is the proper clinical response to a finding of "Leptothrix" on a Pap smear?

1. It may be safely ignored.

2. It should be treated with Doxycycline.

3. A follow-up Pap smear should be obtained every 3 months for one year.

4. It should be considered the earliest sign of cancer of the cervix.

1-64. "Nuclear atypia" most commonly occurs in the presence of HPV.

1. True

2. False

1-65. "Nuclear atypia" occurring in a woman with previously normal Pap smears may be safely ignored.

1. True

2. False

1-66. The presence of "reactive changes" or "reparative changes" make the reading of the Pap smear more difficult.

1. True

2. False

1-67. Distinguishing between "reactive changes" and early dysplastic changes in the Pap smear is generally quite simple.

1. True

2. False

1-68. Squamous metaplasia requires no treatment.

1. True

2. False

1-69. Squamous metaplasia is appropriately treated with Flagyl and Doxycycline.

1. True

2. False

1-70. Flagyl is an effective treatment of Trichomonas found on Pap smears.

1. True

2. False

1-71. Trichomonas found on Pap smears simplifies the job of reading the Pap.

1. True

2. False

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