OBGYN Shelf Exam (uWISE)
Questions & Answers (Grade A+)
A 28-year-old G2P2 woman returns today for follow up on her
abnormal Pap test 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 test, 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 test 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 is indicated for all abnormal Pap
test results including ASCUS Pap test when HPV is positive. Reflex
HPV testing for high-risk DNA types should be performed in
patients with ASCUS. If negative, then co-testing with cytology and
HPV can be repeated in three years. Repeat cytology in one year is
also an acceptable option for ASCUS if HPV testing cannot be done.
http://www.asccp.org/Portals/9/docs/ASCCP%20Updated
%20Guidelines%20Algorithms%206.3.13.pdf
,OBGYN Shelf Exam (uWISE)
Questions & Answers (Grade A+)
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 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.
,OBGYN Shelf Exam (uWISE)
Questions & Answers (Grade A+)
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 test
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 -
correct answer ✅C. Pap test 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
, OBGYN Shelf Exam (uWISE)
Questions & Answers (Grade A+)
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
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 test and her last one was three
years ago. Her examination is normal including her pelvic exam. A
Pap test is performed and returns as normal with HPV negative.
What is the most appropriate screening recommendation for
cervical cancer in this patient?
A. Pap test and HPV testing in one year
B. Pap test and HPV testing in three years
C. Pap test and HPV testing in five years
D. HPV testing alone in one year
Questions & Answers (Grade A+)
A 28-year-old G2P2 woman returns today for follow up on her
abnormal Pap test 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 test, 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 test 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 is indicated for all abnormal Pap
test results including ASCUS Pap test when HPV is positive. Reflex
HPV testing for high-risk DNA types should be performed in
patients with ASCUS. If negative, then co-testing with cytology and
HPV can be repeated in three years. Repeat cytology in one year is
also an acceptable option for ASCUS if HPV testing cannot be done.
http://www.asccp.org/Portals/9/docs/ASCCP%20Updated
%20Guidelines%20Algorithms%206.3.13.pdf
,OBGYN Shelf Exam (uWISE)
Questions & Answers (Grade A+)
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 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.
,OBGYN Shelf Exam (uWISE)
Questions & Answers (Grade A+)
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 test
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 -
correct answer ✅C. Pap test 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
, OBGYN Shelf Exam (uWISE)
Questions & Answers (Grade A+)
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
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 test and her last one was three
years ago. Her examination is normal including her pelvic exam. A
Pap test is performed and returns as normal with HPV negative.
What is the most appropriate screening recommendation for
cervical cancer in this patient?
A. Pap test and HPV testing in one year
B. Pap test and HPV testing in three years
C. Pap test and HPV testing in five years
D. HPV testing alone in one year
