Operational Obstetrics &
Gynecology Correspondence Course
Naval School of Health Sciences
Portsmouth, Virginia
Nonresident Training Course
No. 13109-A
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Assignment 4
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Medical Support of Women in Field Environments
Appendix A
OPNAVINST 6000.1A
Management of Pregnant Servicewomen
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After you have completed all six assignments and tests, mail them to the Naval School of Health Sciences.
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After completing this assignment, you will be ready for Assignment 5.
Test Questions
Learning Objective: Understand the basic medical evaluation and treatment of sexual assault.
4-1. Sexual assault is any sexual act performed by one person on another person without that person’s consent.
1. True
2. False
4-2. During an examination of a possible sexual assault, which of the following is important?
1. Gather all necessary material and supplies before examining the patient in detail.
2. Use Paper, not plastic bags for your specimens.
3. Discuss contraception and VD prophylaxis.
4. All of the above.
4-3. In evaluating a patient with both a history of sexual assault and serious injuries, treat the serious injuries first and deal with the sexual assault second.
1. True
2. False
4-4. For which purposes should consent be obtained?
1. Examination and treatment
2. Collection of evidence including the taking of photographs, if indicated
3. Release of reports and evidence to legal authorities
4. All of the above
4-5. All specimens need to be labeled with the patient’s name, SSN, date, time, identity of specimen, location of specimen and the examiner’s initials.
1. True
2. False
4-6. Which of the following gynecologic history is not necessary for you to obtain?
1. LMP
2. Current use of contraceptives
3. Significant past gynecologic history
4. Detailed sexual history
4-7. Clothing containing any moist stains should be allowed to dry, then placed in a paper bag and sealed.
1. True
2. False
4-8. The ship’s photographer, if available, should take photographs of any visible genital injuries.
1. True
2. False
4-9. Vaginal secretions should always be examined immediately for the presence of motile sperm.
1. True
2. False
4-10. What is the estimate given by the Center for Disease Control in Atlanta of the approximate risk of acquiring gonorrhea from a sexual assault?
1. 1%
2. 6-12%
3. 25-30%
4. 60-70%
4-11. What is the estimate given by the Center for Disease Control in Atlanta of the approximate risk of acquiring AIDS from a sexual assault?
1. Quite low
2. 6-12%
3. 25-30%
4. 60-70%
4-12. What is the approximate risk of becoming pregnant from a sexual assault?
1. 2-4%
2. 6-12%
3. 25-30%
4. 60-70%
4-13. What is estimated effectiveness of "morning after" contraception in preventing pregnancy?
1. Reduces the risk by 25%.
2. Reduces the risk by 50%.
3. Reduces the risk by 75%.
4. Is 100% effective.
4-14. Which of the following statements is true regarding the release of a sexual assault victim from the medical department?
1. They should not go home alone.
2. They should be accompanied by someone they know and trust.
3. It is important that the victim knows she is going to a safe place.
4. All of the above
Learning Objective: Evaluate and treat the common urinary tract problems which may occur
in women.
4-15. Which of the following is a common cause of painful urination?
1. Detrusor Dyssynergia.
2. Herpes vulvitis.
3. Birth Control Pill usage.
4. All of the above.
4-16. BM2 Bainbridge appears at 0800 for Sick Call. She complains of urinary urgency, frequency, burning, and a little blood in the urine since 2300 last night. Her bladder is tender to the touch. She is afebrile and has no flank tenderness. She had a similar episode three years ago. How should you respond to these complaints?
1. Remind her of Naval regulations against malingering and send her back to her division.
2. Obtain a urine culture and await the results.
3. Begin oral antibiotic therapy.
4. Begin IV antibiotic therapy.
4-17. Which of the following is not commonly associated with cystitis?
1. Proteinuria
2. Hematuria
3. Urinary urgency
4. Urinary frequency
4-18. The persistence of symptoms of urinary frequency burning and urgency despite conventional antibiotic therapy and with a negative urine culture suggests which of the following?
1. Stress urinary incontinence
2. Non-gonorrheal urethritis
3. Urethral diverticulum
4. Pyelonephritis
4-19. The symptom of urinary frequency may be seen in all of the following EXCEPT:
1. Excessive fluid intake
2. Bladder infection
3. Herpes vulvitis
4. Pelvic mass
4-20. Which of the following is true regarding tenderness of the bladder to palpation?
1. May be a sign of infection
2. May be a sign of endometriosis
3. Is not normally present
4. All of the above
4-21. HN2 Leahy was given Bactrim to treat a presumed cystitis after complaining of urinary frequency, burning and gross hematuria. All symptoms have now cleared and a subsequent urine culture and urinalysis are normal. This is the first episode of hematuria she has ever experienced. What additional tests should be ordered to evaluate this problem?
1. Urology consultation
2. Intravenous pyelogram
3. Cystoscopy
4. No additional tests are necessary
4-22. Which of the following is the most appropriate first step in dealing with a woman who states she cannot urinate, is in obvious distress and whose bladder is visibly distended..
1. Put in a Foley catheter
2. Ask her to return during normal sick call hours
3. Perform urine analysis and urine culture
4. Obtain serum creatinine, BUN and uric acid levels
In answering questions 4-23 through 4-26, select from column B the illness which most closely matches the symptoms described in column A. Some responses may be used once, more than once, or not at all.
| A. Symptom | B. Illness |
| 4-23. Loss of urine when coughing or sneezing | 1. Irritable bladder |
| 4-24. Loss of urine upon arising | 2. Stress incontinence |
| 4-25. Sudden urgency with loss of urine | 3. Neurologic disorder |
| 4-26. Unpredictable urine loss | 4. Urethral diverticulum |
4-27. You are the Medical Officer aboard the USS Arkansas CGN 41, a guided missile cruiser. You are in the Indian Ocean, en route from Diego Garcia to the Arabian Gulf. It is 2300 and the weather is bad. Your immediate problem is LTJG Spruance who presented during sick call at 0900 with left-sided flank pain, temperature of 105.7° , lethargy, and tachypnea. You have treated her for pyelonephritis with IV antibiotics, vasopressors for her low blood pressure and are now manually ventilating her with a bag because of respiratory failure and septic shock. Which of the following do you wish you would have done 4 days ago when you saw her in sick call for urinary frequency, urgency and dysuria and she was afebrile?
1. Started broad-spectrum oral antibiotics regardless of the results of the urine analysis and urine culture.
2. Asked her to return if her symptoms did not resolve promptly after initiation of treatment.
3. Encouraged her to drink plenty of fluids, particularly cranberry juice or citric juices.
4. All of the above
Learning Objective: Understand a basic flow of management of women with vulvar itching.
4-28. What percentage of women complaining of vulvar itching will have yeast present as at least a portion of the problem?
1. 1%
2. 25%
3. 50%
4. 90%
4-29. For women complaining of vulvar itching, it is appropriate to first give a therapeutic trial of a reliable antifungal agent before proceeding to other diagnostic tests, such as vulvar biopsy.
1. True
2. False
4-30. Which of the following has been associated with contact dermatitis of the vulva?
1. Vaginal hygiene sprays
2. Semen
3. Saliva
4. All of the above
4-31. Which of the following is true regarding pubic lice?
1. Can only be spread through sexual contact
2. May be spread through close living quarters
3. Can be treated with wet compresses of Burrow’s solution (1:20 aluminum acetate)
4. Is confirmed by suspending scrapings of the lesion in KOH solution
In answering questions 4-32 through 4-38, select from column B the illness which most closely matches the description in column A. Some responses may be used once, more than once, or not at all.
| A. Description | B. Illness |
| 4-32. Skin is too thin | 1. Hypertrophic vulvar dystrophy |
| 4-33. Skin is too thick | 2. Lichen sclerosis |
| 4-34. Malignancy | 3. Paget’s disease |
| 4-35. Treated with corticosteroid cream | 4. All of the above |
| 4-36. Treated with testosterone cream | |
| 4-37. Treated with surgery | |
| 4-38. May present with itching |
Learning Objective: Know and understand the contents of OPNAVINST 6000.1A
4-39. The safe completion of a pregnancy includes consideration of which of the following factors?
1. Worksite
2. Current pregnancy status
3. Adequate obstetrical care meeting ACOG guidelines
4. All of the above
4-40. The overriding concern of personnel involved in the management of pregnant servicewomen is to safeguard the health of the woman and her unborn child.
1. True
2. False
4-41. Diving during pregnancy is allowed only after certification by a medical officer that the pregnancy has been normal.
1. True
2. False
4-42. Physical readiness testing during pregnancy is suspended for what duration of time?
1. From 3 months until delivery
2. From conception until delivery
3. From conception until 6 weeks after delivery
4. From conception until 6 months after delivery
4-43. Which of the following is disallowed for pregnant women?
1. Standing at attention
2. Standing at parade rest
3. Standing at attention or parade rest for longer than 15 minutes
4. Standing at attention or parade rest for longer than 5 minutes
4-44. After 28 weeks of pregnancy, which of the following restrictions do not apply?
1. 20 minute rest period every 4 hours
2. No watchstanding
3. 40-hour work week unless wavered
4-45. Women whose pregnancies existed prior to or during initial training will be discharged from the service without maternity benefits.
1. True
2. False
4-46. Pregnant women will not remain aboard a ship beyond the 20th week of pregnancy.
1. True
2. False
4-47. Which of the following is not true regarding pregnancy occurring among designated flight status personnel?
1. Pregnancy is considered disqualifying.
2. Waivers may be issued to Transport aircrewmembers, within certain limits, only after a local board of flight surgeons, with the addition of an OB-GYN specialist, has considered the case.
3. Pregnant aircontrollers are normally restricted from tower duties after the 20th week of pregnancy.
4-48. Exceeding weight standards while pregnant is not a cause for an adverse fitness report.
1. True
2. False
4-49. Outer uniform garments (e.g. sweater, overcoat) may be worn unbuttoned by the pregnant servicewoman if the buttoned garment no longer fits properly.
1. True
2. False
4-50. What is the normal duration of Convalescent Leave following an uncomplicated pregnancy?
1. 2 weeks
2. 4 weeks
3. 6 weeks
4. 6 months
4-51. Breast-feeding is not allowed on US government property.
1. True
2. False
4-52. The individual servicewoman is responsible for which of the following?
1. Not becoming pregnant while on an overseas tour
2. Planning her pregnancy to allow her to meet both her family and military obligations.
3. Notifying her commanding officer of her intention to become pregnant.
4. All of the above.
4-53. When is light duty status normally assigned to the pregnant servicewoman?
1. Between the 32nd and 36th week of pregnancy
2. Between the 36th to the 38th week of pregnancy
3. Between the 38th and 40th week of pregnancy
4. When contractions are coming every 5 minutes and lasting at least 45 seconds
4-54. Pregnancy is not compatible with confinement to a brig.
1. True
2. False