Assignment 2

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Test Questions

Learning Objective: Understand the relationship of Human Papilloma Virus infection to cervical disease and know how to manage such infections.

2-1. What is the appearance of condyloma (venereal warts)?

1. White

2. Flesh-colored

3. Raised, with a cauliflower-like appearance

4. They may be any of the above.

2-2. Clinical warts on the vulva are usually treated while sub-clinical warts are usually not treated.

1. True

2. False

2-3. Effective treatment of visible vulvar warts may include all of the following EXCEPT.

1. Acetaminophen

2. Bichloracetic acid

3. Cryosurgery

4. Podophyllin

2-4. Cryosurgery may be safely used to remove warts in each of the following areas EXCEPT:

1. The vulva

2. The cervix

3. The anterior vaginal wall

4. The perineum

2-5. Which of the following may be used to eliminate Human Papilloma Virus infection from the skin?

1. Cryosurgery

2. Bichloracetic acid

3. Podophyllin

4. None of the above. HPV cannot be eliminated from the skin.

2-6. Condoms are an effective means of preventing HPV transmission during sexual relations.

1. True

2. False

2-7. Which of the following is true regarding cervical dysplasia?

1. It will progress to cancer of the cervix in most cases.

2. While it may remain unchanged, mild dysplasia does not generally regress back to normal.

3. Dysplasia means the same thing as cancer of the cervix.

4. Dysplasia means the skin of the cervix is growing faster than normal.

2-8. How long does it take, on average, for an untreated cervical lesion to progress from dysplasia to invasive cancer of the cervix?

1. 1 year

2. 5 years

3. 10 years

4. 20 years

2-9. A patient with veneral warts may be safely screened for cervical disease with a Pap smear.

1. True

2. False

Learning Objective: Recognize and manage the common vulvar lesions. Recognize the need for referral for biopsy for those women who may have Paget’s disease, vulvar carcinoma or vulvar dystrophy

2-10. A Bartholin’s abscess may be associated with all of the following symptoms EXCEPT:

1. Urinary urgency

2. Unilateral vulvar swelling

3. Vulvar pain

4. Redness of the skin

2-11. All of the following may be effective treatment of a Bartholin’s abscess EXCEPT:

1. Sitz baths

2. Marsupialization

3. Incision and drainage

4. Oral contraceptive pills

2-12. The typical chancroid lesion has no significant induration around the base.

1. True

2. False

2-13. A single injection of 250 mg of Ceftriaxone is considered inadequate treatment of chancroid.

1. True

2. False

2-14. Multiple smooth, raised, painless, flat lesions best describes what condition?

1. Condyloma acuminata

2. Condyloma lata

3. Granuloma inguinale

4. Chancroid

In answering questions 2-15 through 2-23, select from column B the test associated with the disease described in column A. Some responses may be used once, more than once, or not at all.

A. Disease	B. Test
2-15. Chancroid	1. Biopsy
2-16. Condyloma lata	2. Appearance
2-17. Granuloma inguinale	3. Gram stain
2-18. Herpes vulvitis	4. Darkfield
2-19. Molluscum contagiosum
2-20. Paget’ Disease
2-21. Primary syphilis
2-22. Tinea cruris
2-23. Vulvar dystrophy

2-24. The treatment of vulvar herpes includes which of the following?

1. Doxycycline

2. Zovirax

3. Monistat

4. All of the above

2-25. All of the following vulvar diseases are typically associated with itching EXCEPT:

1. Molluscum Contagiosum

2. Candida

3. Paget’s disease

4. Vulvar dystrophy

2-26. Which of the following treatments is appropriate for hypertrophic vulvar dystrophy?

1. Corticosteroid cream

2. Testosterone cream

3. Zovirax ointment

4. Monistat cream

2-27. Which of the following treatments is appropriate for Tinea cruris?

1. Corticosteroid cream

2. Testosterone cream

3. Zovirax ointment

4. Monistat cream

Learning Objective: Learn to diagnose, using clinical history, physical exam, wet mount and other laboratory tests the common gynecologic illnesses characterized by vaginal discharge. Treat them appropriately.

2-28. What two clinical symptoms are most helpful in diagnosing vaginal discharge?

1. Color and texture

2. Itching and odor

3. Duration and severity of symptoms

4. Pain and dysuria

In answering questions 2-29 through 2-36, select from column B the clinical characteristic associated with the disease described in column A. Some responses may be used once, more than once, or not at all.

A. Vulvar Disease	B. Characteristic
2-29. Yeast	1. Deep dyspareunia
2-30. Gardnerella	2. Itching
2-31. Trichomonas	3. Foul-smelling discharge
2-32. Lost tampon	4. Frothy-white discharge
2-33. Cervicitis
2-34. Chlamydia
2-35. Gonorrhea
2-36. Tinea cruris

2-37. For a patient complaining of a malodorous vaginal discharge and itching, your initial treatment should include which of the following?

1. Monistat alone

2. Flagyl alone

3. Monistat and Flagyl alone

4. Monistat, Flagyl and Amoxicillin

2-38. The "Whiff test" consists of mixing one drop of vaginal discharge with one drop of KOH solution. The release of a bad-smelling odor confirms the presence of which of the following organisms?

1. Monilia

2. Gardnerella

3. Trichomonas

4. Gram negative intracellular diplococci

2-39. The presence of a ring of fiery-red, friable tissue surrounding the cervical os usually indicates which of the following?

1. Cancer

2. Cervical dysplasia

3. Gonorrhea

4. None of the above

2-40. Most women with chlamydia trachomatis infection in the cervix will complain of which of the following symptoms?

1. Deep dyspareunia alone

2. Purulent vaginal discharge alone

3. Both deep dyspareunia and purulent vaginal discharge

4. No symptoms at all.

2-41. After removal of a lost and forgotten tampon from the vagina, a course of broad-spectrum antibiotics is normally indicated.

1. True

2. False

2-42. Which of the following medications are considered effective in treating Gardnerella infections in the vagina?

1. Flagyl

2. Clindamycin

3. Amoxicillin

4. All of the above

2-43. Many if not most of the women who carry the gonococcus in the genital tract will have no symptoms.

1. True

2. False

2-44. A single injection of 250 mg of Ceftriaxone is considered inadequate treatment of gonorrhea.

1. True

2. False

2-45. Whenever an IUD is seen partially protruding through the external cervical os, it should be gently pushed back into the uterus, using sterile technique.

1. True

2. False

2-46. The uterus is normally not tender in women using an IUD.

1. True

2. False

2-47. Other than the relative degree of symptoms, the main finding which indicates "moderate to severe PID" rather than "mild PID" is a temperature greater than 100.4�.

1. True

2. False

2-48. Patients with severe PID in isolated settings or at sea are candidates for medical evacuation (MEDEVAC).

1. True

2. False

2-49. In the case of recurrent Trichomonas vaginalis infections, the sexual partner should be treated as well as the patient.

1. True

2. False

2-50. In the case of recurrent vaginal yeast infections, the sexual partner should be treated as well as the patient.

1. True

2. False

2-51. The findings of a thick, cottage-cheese-like vaginal discharge, with vulvar itching, dryness, redness and irritation are most consistent with which of the following diagnoses?

1. Gonorrhea

2. Trichomonas

3. Monilia

4. Gardnerella

Learning Objective: Know who may safely take oral contraceptive pills and how to manage common BCP side-effects.

2-52. Very light menstrual flows or stoppage of flows while taking BCPs is usually due to the uterine lining becoming very thin.

1. True

2. False

2-53. If menstrual flows become extremely light or non-existent while taking BCPs, the BCPs are no longer considered effective in preventing pregnancy.

1. True

2. False

2-54. If menstrual flows become extremely light while taking BCPs it is safe to simply ignore this and not consider it a problem.

1. True

2. False

2-55. SN Porter reports that she forgot to take her birth control pill at her normal time of 1800 last night. It is now 0800 the next morning and she is waiting to see you in Sick Call so you can straighten out this problem. The skipped pill was pill #15 (out of 21). What is the best advise you can give her?

1. Take the rest of the pack all at once with a large glass of water.

2. Take two pills now, two pills tonight, and then finish the pack in sequence.

3. Take the skipped pill now and her next regular pill at 1800.

4. Rest quietly until you can arrange for MEDEVAC.

2-56. LTJG Decatur started her first pack of birth control pills 9 days ago and is experiencing mild nausea, breast tenderness and mild depression. She thinks she might be pregnant. Your ship left Charleston yesterday for 3 weeks of training exercises off Guantanamo before a 6-month deployment to Italy. Your examination is normal. What is your best advise to her now?

1. Immediately stop the birth control pill.

2. Immediately stop the birth control pill and get a pregnancy test.

3. MEDEVAC her for an emergency mammogram.

4. Continue the birth control pill so long as the pregnancy test is negative and the symptoms mild.

2-57. 3 days later, LTJG Decatur returns to the Medical Department. Since her negative pregnancy test the other day, she feels much better. The nausea is gone, she's not depressed, and the breast tenderness doesn't seem so bad. Her division officer has complimented her on the good job she's been doing since being underway. Now she's worried because after PT on the helo deck yesterday, she noticed a tiny amount of spotting. How should you respond to these symptoms?

1. Recommend she transfer off the ship because of these endless gynecologic complaints.

2. Reassure her that spotting during the first month of BCPs is common and not dangerous.

3. Warn her of the great likelihood she has uterine cancer and arrange for prompt gynecologic consultation at the US Naval Hospital, Guantanamo Bay.

4. Advise bed rest for 4 days, followed by a gradual resumption of normal activities.

2-58. LTJG Sampson has been having trouble with headaches since going on birth control pills 4 months ago. She has moderately intense headaches, particularly during the week she is not taking the birth control pills. How should you advise her?

1. She should discontinue the pills she's taking but may try another brand of pills, from a different manufacturer.

2. It is possible that she will continue to have headaches even after the change.

3. She may need to discontinue pills altogether if the headaches persist.

4. All of the above.

2-59. ENS Mahan has successfully used birth control pills for 3 years. This month, she didn't get a period when she was supposed to, although she has taken her birth control pills every day. How should you respond to this symptom?

1. Get a pregnancy test

2. Perform a pelvic examination

3. Inquire about the preceding several month's menstrual flows

4. All of the above

2-60. LT Semmes complains that over the last 6 months, her menstrual flows have become increasingly painful. She also experiences painful intercourse on deep penetration. She uses condoms for contraception and is a 25 year old non-smoker. Reasonable approaches to this problem might include all of the following EXCEPT:

1. Try birth control pills for a while.

2. Pelvic exam

3. Obtain cultures for gonorrhea and chlamydia.

4. Reassure LT Semmes that this is a normal occurrence and should disappear within the next 3 months.

2-61. Generally, menstrual cramps improve among women who begin taking oral contraceptive pills.

1. True

2. False

2-62. Because BCPs prevent conception by inhibiting ovulation, women who ovulate despite the use of BCPs have a very high chance of conceiving.

1. True

2. False

2-63. Mild depression, lowered sex drive and headaches which persist beyond the first month of taking BCPs can be safely treated by switching to a different BCP from a different manufacturer.

1. True

2. False

2-64. Current low-dose BCPs rarely cause significant weight gain.

1. True

2. False

2-65. Breast pain is uncommon during the first month of BCP usage.

1. True

2. False

2-66. Most spotting which occurs during the first month of BCP usage will gradually and spontaneously resolve.

1. True

2. False

2-67. Which of the following is true regarding gynecologic cancers?

1. Uterine malignancy in a woman under age 35 is rare.

2. Cervical malignancy can reasonably be excluded by a normal Pap smear within the previous year.

3. Vaginal cancer is ruled out by a normal pelvic exam.

4. All of the above

Learning Objective: Know the advantages and disadvantages of contraceptive implants and injectables. Know how and when to remove contraceptive implants.

2-68. BM3 Luce receives injections of depot medroxyprogesterone acetate (Depo-Provera) for contraception every 12 weeks (150 mg). She is one week late in getting her next injection. How should you react?

1. Give the injection but caution her to use backup contraception for the next month.

2. Give the injection and reassure her she needs no additional protection.

3. Advise her to wait for her next normal menstrual period, then come in to restart the Depo-Provera injections.

4. Sternly lecture her about taking personal responsibility for her health care.

2-69. Which of the following best describes the frequency of menstrual abnormalities with DMPA (depot medroxyprogesterone acetate)?

1. Abnormalities are rare.

2. Abnormalities are common.

3. Abnormalities are unimportant.

2-70. Within how many months does ovulation typically resume after the last injection of DMPA?

1. 1

2. 4.5

3. 9

4. 18

2-71. Ovulation typically resumes within how many month(s) after Norplant subdermal implants are removed.

1. 1

2. 4.5

3. 9

4. 18

2-72. The pregnancy failure rate among Depo-Provera users is less than 1%.

1. True

2. False

2-73. Unwanted side-effects of Depo-Provera may be reversed instantly through the use of estrogen.

1. True

2. False

2-74. The rate of infection following the insertion of a Norplant device is less than 1%.

1. True

2. False

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