1|Page
NUR 2026 Week 9 i-Human: 30-Year-Old Female
with Lower Abdominal Pain & Spotting - Complete
OB/GYN Case Study, SOAP Note & Plan | 2025/2026
A+ Guide.
A 33-year-old G1P0 presents for evaluation of her inability to conceive a
pregnancy for six months. She menstruates monthly. Her past medical
history is significant for PID x 2, for which she was hospitalized for IV
antibiotics. Her Chlamydia, GC, and pap smear are normal. When
should a more comprehensive evaluation for her infertility begin?
A. Now
B. 6 months
C. 12 months
D. 18 months
E. 24 months - ANSWER-A. Now
A comprehensive work up should begin now, due to her advancing age
and history of significant PID, which may require surgical treatment.
A 27-year-old woman and her male partner come to the emergency
department for assistance with emergency contraception. They
experienced condom failure during intercourse an hour ago and neither
desires pregnancy. Her last menstrual period was approximately two
weeks ago and her cycles occur every 28-30 days. Her medical history
includes a deep venous thrombosis during labor and delivery 5 years
ago. What is the most appropriate course of action at this time?
,2|Page
A. Administration of an ethinyl estradiol and levonorgestrel combination
now and in 12 hours
B. Dilation and curettage
C. Insertion of a copper-containing intrauterine device
D. Serial beta hCG determinations
E. Testing for factor V Leiden - ANSWER-C. Insertion of a copper-
containing intrauterine device
Insertion of a copper-containing IUD is an effective means of preventing
an unintended pregnancy in this case.
During her active phase of labor, a provider has placed an external fetal
monitor on a patient. The fetal heart rate (FHR) is noted to have a base
line rate of 109, there are no late or variable decelerations, and the
baseline variability is 0 beats per minute. What is this monitor tracing
indicative of?
A. A normal FHR pattern
B. An indeterminate FHR pattern
C. An unreadable FHR pattern
D. Poor contact with monitor
E. A distress FHR pattern - ANSWER-E. A distress FHR pattern
According to the Three-Tier Fetal Heart Interpretation System,
recommended by the 2008 NICHD workshop on electronic fetal
monitoring, the definition of fetal distress includes absence of baseline
variability, and either bradycardia (FHR<110) or recurrent variable or
late decelerations.
A 46 year-old female has just been diagnosed with ovarian cancer.
Where would you expect the ovarian neoplasm to most likely arise
from?
A. Germ cell
B. Stromal cell
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C. Epithelial cell
D. A Metastatic tumor
E. Endometrial cel - ANSWER-C. Epithelial cell
The most common and most lethal of the ovarian neoplasms arise from
the ovarian epithelium found both on the surface of the ovary and in
subsurface locations. The ovarian epithelium generally is in good health
and appears as a simple epithelium. With neoplastic transformation there
undergoes metaplastic changes into what is termed Müllerian
epithelium. The Müllerian epithelium has a variety of subtypes, each
providing a specific phenotype of the tumor and may have a different
clinical presentation. Epithelial tumors are the most common ovarian
neoplasm and may be: benign (50%); malignant (33%); or borderline
malignancy (16%). Tumors may also metastasize (D) to the ovary from
the breast, gastric, pancreatic, and colon primary cancers, but is not as
common. Germ cell tumors (A) are more similar to testicular tumors in
males. Stromal tumors (B) arise from steroid hormone producing cells.
Endometrial (E) is usually specific to the uterus.
A 26-year-old athlete presents complaining of scant menses x 4 months.
She is a G0P0, menarche was at age 13, and her menses have been
mostly regular. She is a non-smoker and non-drinker, and has been
trying to achieve pregnancy x 8 months. Physical exam reveals a thin,
white female in no distress. Vitals are normal, BMI is 17.5, her pelvic
exam is normal, and STD cultures are negative. A pregnancy test is
negative in clinic. What is the most likely cause for her amenorrhea?
A. Idiopathic
B. Hypothalamic
C. Hypothyroid
D. Polycystic ovarian syndrome
E. Androgenic - ANSWER-B. Hypothalamic
A young healthy woman with a low BMI, no other signs of virilization,
and a history of normal menarche is most likely to have induced
, 4|Page
amenorrhea, due to suppression of the hypothalamic axis from low
weight and fat index.
A 26-year-old female presents to clinic complaining of increasing
headaches for one year, irritability, bloating and fluid retention, and
abdominal discomfort with loose stools during her menstrual cycle. The
symptoms begin a day or two before her menses, and last until the
middle of her cycle. She has tried acetaminophen and ibuprofen without
improvement. On physical exam she is a well-developed, well-nourished
female in no acute distress. Vitals are normal, CV and lungs are normal,
pelvis exam is normal, pap smear is normal, and GC and Chlamydia
testing are negative. What would be the most appropriate next step?
A. Pelvic ultrasound
B. FSH, LH levels
C. Fluoxetine on cycle day 21-7
D. Paroxetine daily
E. Serum HCG - ANSWER-C. Fluoxetine on cycle day 21-7
Hx and Px are key to diagnosing premenstrual syndrome. Laboratory
and radiologic procedures are not useful, particularly in light of a normal
exam. With failure of NSAIDS, treatment is aimed at reducing
symptoms. For mild to moderate symptoms, SSRI therapy prior to and
through the menstrual cycle has become a primary therapy.
A 23-year-old woman presents to clinic complaining of amenorrhea for
3 months. She also complains of increasing facial hair and weight gain.
On exam, PMH: menarche age 13. Physical exam reveals a well-
developed, slightly obese female with a BMI of 29. Her amenorrhea can
likely be improved with which therapy?
A. Testosterone administration
B. Progesterone administration
C. Estrogen administration
D. Estrogen suppression
NUR 2026 Week 9 i-Human: 30-Year-Old Female
with Lower Abdominal Pain & Spotting - Complete
OB/GYN Case Study, SOAP Note & Plan | 2025/2026
A+ Guide.
A 33-year-old G1P0 presents for evaluation of her inability to conceive a
pregnancy for six months. She menstruates monthly. Her past medical
history is significant for PID x 2, for which she was hospitalized for IV
antibiotics. Her Chlamydia, GC, and pap smear are normal. When
should a more comprehensive evaluation for her infertility begin?
A. Now
B. 6 months
C. 12 months
D. 18 months
E. 24 months - ANSWER-A. Now
A comprehensive work up should begin now, due to her advancing age
and history of significant PID, which may require surgical treatment.
A 27-year-old woman and her male partner come to the emergency
department for assistance with emergency contraception. They
experienced condom failure during intercourse an hour ago and neither
desires pregnancy. Her last menstrual period was approximately two
weeks ago and her cycles occur every 28-30 days. Her medical history
includes a deep venous thrombosis during labor and delivery 5 years
ago. What is the most appropriate course of action at this time?
,2|Page
A. Administration of an ethinyl estradiol and levonorgestrel combination
now and in 12 hours
B. Dilation and curettage
C. Insertion of a copper-containing intrauterine device
D. Serial beta hCG determinations
E. Testing for factor V Leiden - ANSWER-C. Insertion of a copper-
containing intrauterine device
Insertion of a copper-containing IUD is an effective means of preventing
an unintended pregnancy in this case.
During her active phase of labor, a provider has placed an external fetal
monitor on a patient. The fetal heart rate (FHR) is noted to have a base
line rate of 109, there are no late or variable decelerations, and the
baseline variability is 0 beats per minute. What is this monitor tracing
indicative of?
A. A normal FHR pattern
B. An indeterminate FHR pattern
C. An unreadable FHR pattern
D. Poor contact with monitor
E. A distress FHR pattern - ANSWER-E. A distress FHR pattern
According to the Three-Tier Fetal Heart Interpretation System,
recommended by the 2008 NICHD workshop on electronic fetal
monitoring, the definition of fetal distress includes absence of baseline
variability, and either bradycardia (FHR<110) or recurrent variable or
late decelerations.
A 46 year-old female has just been diagnosed with ovarian cancer.
Where would you expect the ovarian neoplasm to most likely arise
from?
A. Germ cell
B. Stromal cell
,3|Page
C. Epithelial cell
D. A Metastatic tumor
E. Endometrial cel - ANSWER-C. Epithelial cell
The most common and most lethal of the ovarian neoplasms arise from
the ovarian epithelium found both on the surface of the ovary and in
subsurface locations. The ovarian epithelium generally is in good health
and appears as a simple epithelium. With neoplastic transformation there
undergoes metaplastic changes into what is termed Müllerian
epithelium. The Müllerian epithelium has a variety of subtypes, each
providing a specific phenotype of the tumor and may have a different
clinical presentation. Epithelial tumors are the most common ovarian
neoplasm and may be: benign (50%); malignant (33%); or borderline
malignancy (16%). Tumors may also metastasize (D) to the ovary from
the breast, gastric, pancreatic, and colon primary cancers, but is not as
common. Germ cell tumors (A) are more similar to testicular tumors in
males. Stromal tumors (B) arise from steroid hormone producing cells.
Endometrial (E) is usually specific to the uterus.
A 26-year-old athlete presents complaining of scant menses x 4 months.
She is a G0P0, menarche was at age 13, and her menses have been
mostly regular. She is a non-smoker and non-drinker, and has been
trying to achieve pregnancy x 8 months. Physical exam reveals a thin,
white female in no distress. Vitals are normal, BMI is 17.5, her pelvic
exam is normal, and STD cultures are negative. A pregnancy test is
negative in clinic. What is the most likely cause for her amenorrhea?
A. Idiopathic
B. Hypothalamic
C. Hypothyroid
D. Polycystic ovarian syndrome
E. Androgenic - ANSWER-B. Hypothalamic
A young healthy woman with a low BMI, no other signs of virilization,
and a history of normal menarche is most likely to have induced
, 4|Page
amenorrhea, due to suppression of the hypothalamic axis from low
weight and fat index.
A 26-year-old female presents to clinic complaining of increasing
headaches for one year, irritability, bloating and fluid retention, and
abdominal discomfort with loose stools during her menstrual cycle. The
symptoms begin a day or two before her menses, and last until the
middle of her cycle. She has tried acetaminophen and ibuprofen without
improvement. On physical exam she is a well-developed, well-nourished
female in no acute distress. Vitals are normal, CV and lungs are normal,
pelvis exam is normal, pap smear is normal, and GC and Chlamydia
testing are negative. What would be the most appropriate next step?
A. Pelvic ultrasound
B. FSH, LH levels
C. Fluoxetine on cycle day 21-7
D. Paroxetine daily
E. Serum HCG - ANSWER-C. Fluoxetine on cycle day 21-7
Hx and Px are key to diagnosing premenstrual syndrome. Laboratory
and radiologic procedures are not useful, particularly in light of a normal
exam. With failure of NSAIDS, treatment is aimed at reducing
symptoms. For mild to moderate symptoms, SSRI therapy prior to and
through the menstrual cycle has become a primary therapy.
A 23-year-old woman presents to clinic complaining of amenorrhea for
3 months. She also complains of increasing facial hair and weight gain.
On exam, PMH: menarche age 13. Physical exam reveals a well-
developed, slightly obese female with a BMI of 29. Her amenorrhea can
likely be improved with which therapy?
A. Testosterone administration
B. Progesterone administration
C. Estrogen administration
D. Estrogen suppression
