uWise OBGYN EXAM QUESTIONS WITH
VERIFIED SOLUTIONS LATEST UPDATE
GRADED A+ WITH RATIONALES
A 68-year-old G2P2 woman who has recently moved in with her daughter (a long-standing
patient of yours) comes in for a health maintenance examination. A vaginal hysterectomy was
done in her fifties for uterine prolapse. She is not sure if her ovaries were removed. She has
never had an abnormal mammogram or Pap smear and has had yearly exams. She stopped
hormone replacement therapy 10 years ago. She was recently widowed after being married
for 50 years. She does not smoke or drink. Her diabetes is well-controlled with Metformin;
she takes a daily baby aspirin and is on a lipid-lowering agent. On examination, she is a thin
elderly woman with a dowager's hump. Her breast exam is unremarkable. Her lower genital
tract is notable for atrophy. No masses are noted on bimanual and recto-vaginal exam. A
fecal occult blood test is negative. Which of the following tests is not necessary?
A. Bone density
B. Colonoscopy
C. Pap sme --CORRECT ANSWER--C
Pap smear screening is not indicated in patients who have had a hysterectomy, unless it was
done for cervical cancer or a high-grade cervical dyspalsia. Patients with a uterus can
discontinue cervical cancer screening between the ages of 65 - 70 if they have had three
consecutive negative smears or two negative consecutive cotesting in the last 10 years and no
history of high-grade cervical intraepithelial neoplasia or cancer. Patients still need yearly
bimanual and rectovaginal exam. Mammograms are done annually, as breast cancer increases
with age. Colon cancer screening is recommended at age fifty. The patient has an exaggerated
thoracic spine curvature, termed a dowager's hump, likely secondary to thoracic compression
fractures secondary to osteoporosis. If this is confirmed on a bone density test, she may
benefit from the addition of bisphosphonates.
Page 1 of 377
,A 32-year-old G2P2 woman presents for a health maintenance examination. She is in good
health and has no concerns. She does not have a history of abnormal Pap smears and her last
one was three years ago. Her examination is normal including her pelvic exam. A Pap smear
is performed and returns as normal with HPV negative. What is the most appropriate
screening recommendation for cervical cancer in this patient?
A. Pap smear and HPV testing in one year
B. Pap smear and HPV testing in three years
C. Pap smear and HPV testing in five years
D. HPV testing alone in one year
E. HPV testing alone in three years --CORRECT ANSWER--C
According to the American Cancer Society (ACS), the American Society for Colposcopy and
Cervical Pathology (ASCCP), and the American Society for Clinical Pathology (ASCP)
guidelines for the Prevention and Early Detection of Cervical Cancer, women ages 30 to 65
years should be screened with cytology and HPV testing (''cotesting'') every five years
(preferred) or cytology alone every three years (acceptable). Screening by HPV testing alone
is not recommended for most clinical settings and there is insufficient evidence to change
screening intervals in this age group following a history of negative screens.
A 25-year-old G0 woman is scheduled to discuss her recent abnormal Pap smear which
showed atypical squamous cells of undetermined significance (ASCUS). She has had one Pap
smear at age 22 which was normal. Her only significant gynecologic history is genital warts
that have not responded to treatment with local application of trichloroacetic acid. She has
had eight sexual partners. She uses condoms and oral contraceptives. She has smoked a pack
a day for the past two years. Which of the following is the most appropriate next step in the
management of this patient?
A. HPV typing
B. Repeat Pap smear in three years
Page 2 of 377
,C. Cone biopsy
D. Cryotherapy
E. Loop Electrosurgical Excision Procedure (LEEP) --CORRECT ANSWER--A
HPV typing is an option in the initial triage of the finding of atypical squamous cells of
undetermined significance (ASCUS) on a Pap smear. If a high-risk HPV type is detected,
then the patient needs a colposcopy with biopsies. An alternative approach can be close
surveillance with repeat Pap smears in 12 months and if normal, she may return to routine
screening. Initiation of treatment by way of cone biopsy, LEEP, or cryotherapy is not
indicated at this time without a biopsy-confirmed diagnosis of cervical dysplasia.
A 28-year-old G2P2 woman returns today for follow up on her abnormal pap smear which
reveals atypical squamous cells of undetermined significance (ASCUS). Reflex HPV testing
is positive for high risk type. She has never had a prior abnormal pap smear, and has been
following the recommended screening guidelines. She is asymptomatic. Her pelvic exam
reveals a normal cervix with a small amount of cervical mucous. What is the next best step in
the management of this patient?
A. Routine screening
B. Repeat Pap smear in one year
C. Repeat HPV testing in one year
D. Repeat co-testing with Pap and HPV in one year
E. Colposcopy --CORRECT ANSWER--E. Colposcopy
A 17-year-old G0 high school student is brought in by her mother for her first gynecologic
examination. She began her menses at age 12 and has had regular periods for the past three
years. Her last menstrual period was one week ago. For privacy, you ask to examine the
Page 3 of 377
, patient without her mother. Further history is obtained in the examination room. She admits
that she has been sexually active with her boyfriend for the past three years. She uses
condoms occasionally and is fearful about possible pregnancy. She requests that her mother
not be informed about her sexual activity. On physical examination, she is anxious, but
normally developed. Her pelvic examination reveals no vulvar lesions, minimal non-
malodorous discharge, and a nulliparous appearing cervix. The bimanual examination reveals
a normal size uterus, and her adnexa are non-tender and not enlarged. Urine pregnancy test is
negative. In addition to discussing --CORRECT ANSWER--C
Counseling about and screening for sexually transmitted infections is the best next step. This
patient does not require treatment due to a lack of diagnostic criteria. A serum Beta-hCG is
not indicated in the setting of normal menstrual cycles with last menstrual period a week ago
and a negative urine pregnancy test. Guidelines for initiation of cervical cancer screening is
recommended at age 21 regardless of coitarche. A pelvic ultrasound would not be indicated at
this time especially since the pregnancy test is negative and given her lack of menstrual or
pelvic symptoms.
A 19-year-old G0 woman presents with lower abdominal cramping. The pain started with her
menses and has persisted, despite resolution of the bleeding. She thinks she may have a fever,
but has not taken her temperature. No urinary frequency or dysuria are present. Her bowel
habits are regular. She denies vomiting, but has mild nausea. A yellow blood-tinged vaginal
discharge preceded her menses. No pruritus or odor was noted. She is sexually active, uses
oral contraceptives and states that her partner does not like condoms. On examination:
temperature is 100.2°F (37.9°C); pulse 90; blood pressure 110/60. She is well-developed and
nourished and in mild distress. No flank pain is elicited. Her abdomen has normal bowel
sounds, but is very tender with guarding in the lower quadrants. No rebound is present. Pelvic
examination reveals a moderate amount of thick yellow discharge. The cervix is friable with
yellow mucoid disch --CORRECT ANSWER--B
Page 4 of 377
VERIFIED SOLUTIONS LATEST UPDATE
GRADED A+ WITH RATIONALES
A 68-year-old G2P2 woman who has recently moved in with her daughter (a long-standing
patient of yours) comes in for a health maintenance examination. A vaginal hysterectomy was
done in her fifties for uterine prolapse. She is not sure if her ovaries were removed. She has
never had an abnormal mammogram or Pap smear and has had yearly exams. She stopped
hormone replacement therapy 10 years ago. She was recently widowed after being married
for 50 years. She does not smoke or drink. Her diabetes is well-controlled with Metformin;
she takes a daily baby aspirin and is on a lipid-lowering agent. On examination, she is a thin
elderly woman with a dowager's hump. Her breast exam is unremarkable. Her lower genital
tract is notable for atrophy. No masses are noted on bimanual and recto-vaginal exam. A
fecal occult blood test is negative. Which of the following tests is not necessary?
A. Bone density
B. Colonoscopy
C. Pap sme --CORRECT ANSWER--C
Pap smear screening is not indicated in patients who have had a hysterectomy, unless it was
done for cervical cancer or a high-grade cervical dyspalsia. Patients with a uterus can
discontinue cervical cancer screening between the ages of 65 - 70 if they have had three
consecutive negative smears or two negative consecutive cotesting in the last 10 years and no
history of high-grade cervical intraepithelial neoplasia or cancer. Patients still need yearly
bimanual and rectovaginal exam. Mammograms are done annually, as breast cancer increases
with age. Colon cancer screening is recommended at age fifty. The patient has an exaggerated
thoracic spine curvature, termed a dowager's hump, likely secondary to thoracic compression
fractures secondary to osteoporosis. If this is confirmed on a bone density test, she may
benefit from the addition of bisphosphonates.
Page 1 of 377
,A 32-year-old G2P2 woman presents for a health maintenance examination. She is in good
health and has no concerns. She does not have a history of abnormal Pap smears and her last
one was three years ago. Her examination is normal including her pelvic exam. A Pap smear
is performed and returns as normal with HPV negative. What is the most appropriate
screening recommendation for cervical cancer in this patient?
A. Pap smear and HPV testing in one year
B. Pap smear and HPV testing in three years
C. Pap smear and HPV testing in five years
D. HPV testing alone in one year
E. HPV testing alone in three years --CORRECT ANSWER--C
According to the American Cancer Society (ACS), the American Society for Colposcopy and
Cervical Pathology (ASCCP), and the American Society for Clinical Pathology (ASCP)
guidelines for the Prevention and Early Detection of Cervical Cancer, women ages 30 to 65
years should be screened with cytology and HPV testing (''cotesting'') every five years
(preferred) or cytology alone every three years (acceptable). Screening by HPV testing alone
is not recommended for most clinical settings and there is insufficient evidence to change
screening intervals in this age group following a history of negative screens.
A 25-year-old G0 woman is scheduled to discuss her recent abnormal Pap smear which
showed atypical squamous cells of undetermined significance (ASCUS). She has had one Pap
smear at age 22 which was normal. Her only significant gynecologic history is genital warts
that have not responded to treatment with local application of trichloroacetic acid. She has
had eight sexual partners. She uses condoms and oral contraceptives. She has smoked a pack
a day for the past two years. Which of the following is the most appropriate next step in the
management of this patient?
A. HPV typing
B. Repeat Pap smear in three years
Page 2 of 377
,C. Cone biopsy
D. Cryotherapy
E. Loop Electrosurgical Excision Procedure (LEEP) --CORRECT ANSWER--A
HPV typing is an option in the initial triage of the finding of atypical squamous cells of
undetermined significance (ASCUS) on a Pap smear. If a high-risk HPV type is detected,
then the patient needs a colposcopy with biopsies. An alternative approach can be close
surveillance with repeat Pap smears in 12 months and if normal, she may return to routine
screening. Initiation of treatment by way of cone biopsy, LEEP, or cryotherapy is not
indicated at this time without a biopsy-confirmed diagnosis of cervical dysplasia.
A 28-year-old G2P2 woman returns today for follow up on her abnormal pap smear which
reveals atypical squamous cells of undetermined significance (ASCUS). Reflex HPV testing
is positive for high risk type. She has never had a prior abnormal pap smear, and has been
following the recommended screening guidelines. She is asymptomatic. Her pelvic exam
reveals a normal cervix with a small amount of cervical mucous. What is the next best step in
the management of this patient?
A. Routine screening
B. Repeat Pap smear in one year
C. Repeat HPV testing in one year
D. Repeat co-testing with Pap and HPV in one year
E. Colposcopy --CORRECT ANSWER--E. Colposcopy
A 17-year-old G0 high school student is brought in by her mother for her first gynecologic
examination. She began her menses at age 12 and has had regular periods for the past three
years. Her last menstrual period was one week ago. For privacy, you ask to examine the
Page 3 of 377
, patient without her mother. Further history is obtained in the examination room. She admits
that she has been sexually active with her boyfriend for the past three years. She uses
condoms occasionally and is fearful about possible pregnancy. She requests that her mother
not be informed about her sexual activity. On physical examination, she is anxious, but
normally developed. Her pelvic examination reveals no vulvar lesions, minimal non-
malodorous discharge, and a nulliparous appearing cervix. The bimanual examination reveals
a normal size uterus, and her adnexa are non-tender and not enlarged. Urine pregnancy test is
negative. In addition to discussing --CORRECT ANSWER--C
Counseling about and screening for sexually transmitted infections is the best next step. This
patient does not require treatment due to a lack of diagnostic criteria. A serum Beta-hCG is
not indicated in the setting of normal menstrual cycles with last menstrual period a week ago
and a negative urine pregnancy test. Guidelines for initiation of cervical cancer screening is
recommended at age 21 regardless of coitarche. A pelvic ultrasound would not be indicated at
this time especially since the pregnancy test is negative and given her lack of menstrual or
pelvic symptoms.
A 19-year-old G0 woman presents with lower abdominal cramping. The pain started with her
menses and has persisted, despite resolution of the bleeding. She thinks she may have a fever,
but has not taken her temperature. No urinary frequency or dysuria are present. Her bowel
habits are regular. She denies vomiting, but has mild nausea. A yellow blood-tinged vaginal
discharge preceded her menses. No pruritus or odor was noted. She is sexually active, uses
oral contraceptives and states that her partner does not like condoms. On examination:
temperature is 100.2°F (37.9°C); pulse 90; blood pressure 110/60. She is well-developed and
nourished and in mild distress. No flank pain is elicited. Her abdomen has normal bowel
sounds, but is very tender with guarding in the lower quadrants. No rebound is present. Pelvic
examination reveals a moderate amount of thick yellow discharge. The cervix is friable with
yellow mucoid disch --CORRECT ANSWER--B
Page 4 of 377
