MCN 538 LATEST 2026 EXAMS QUESTIONS AND ANSWERS
GRADED A+
✔✔Adolescent Development Erikson - ✔✔Identity vs Role Confusion (early
adolescents), Intimacy vs Isolation (early adulthood); overlap may persist into early
adulthood.
✔✔what should you know about Adolescent Informed Consent? - ✔✔Adults 18+ give
consent. Minors may consent to certain OB/GYN services vary.... consent to
contraception may or may not be included; Title X requires minors can consent to
funded services. so even if a state law saws the child needs parental consent, if its a
title x funded clinic, the adolescent can make their own choice and the clinic will not
notify the parents o 21 states & DC - ALL minors are explicitly allowed to consent to
contraceptive services
o Additional 25 states - minors CAN provide their own consent for contraception under
certain circumstances
o Only 4 states have no explicit policy
✔✔Pelvic Exam Indications in Adolescents - ✔✔- these may be indicated: general
exam, visual breast exam, external pelvic exam is more typical
- internal exam if abnormal bleeding, discharge, abdominal/pelvic pain; - initiation of
OCs does NOT require exam. - G/C screening should be done using nucleic acid
amplication techniques
- Urine sample or vaginal swab specimen that is obtained by the pt
- Vaginal swabs are more sensitive than urine tests
- Both are acceptable to young pts
· PAP smear for cervical cancer screening is NOT RECOMMENDED UNTIL AGE 21
✔✔G/C Screening in Adolescents is done how? - ✔✔NAAT recommended; urine or
vaginal swab; swabs more sensitive; both acceptable.
✔✔Cervical Cancer Screening in Adolescents should be done at what age? - ✔✔PAP
smear not recommended until age 21.
✔✔Menstrual Cycle Puberty Markers: thelarche, adrenarche, and first menses normal
age ranges - ✔✔Thelarche (breast budding) or Adrenarche (sexual hair growth);
average onset 9.7 yrs (range 7-13); first menses follows thelarche ~2 yrs later.
✔✔Primary Amenorrhea Diagnosis meets what requirements? - ✔✔No
adrenarche/thelarche by 13; no menses by 15; menses not started within 5 yrs of
thelarche/adrenarche onset. primary amenorrhea differential dx should inclue: Dx:
anatomical, genetic, hormonal, enzymatic, psychological. Examples: imperforate
hymen, transverse vaginal septum, or in
- uterus but no breasts: ovarian estrogen deficiency (Turner's), enzyme deficiency,
ovarian damage, breast present but congenital absence of uterus: Mullerian agenesis
, ✔✔Menstrual Irregularities Early Puberty include what? - ✔✔Average cycle: 21-45 days;
up to 7 bleeding days; ACOG recommends evaluation if cycles >90 days apart, <21 or
>45 days, lasting >7 days, heavy, frequent pad changes, or delayed menarche with risk
factors.
✔✔what is Toxic Shock Syndrome (TSS)? - ✔✔Caused by Staphylococcus aureus;
associated with continuous tampon use, contraceptive sponge/diaphragm; peak
occurence on day 4 of menses; symptoms: fever >102, diffuse rash like a sunburn,
desquamation, hypotension, negative cultures.
✔✔what are the criteria to dx TSS? - ✔✔Any 3: GI (vomiting/diarrhea)
- muscular (myalgia/CPK >2x)
- renal (BUN/Cr >2x)
- mucous membranes (hyperemia)
- hepatic (bilirubin/AST/ALT >2x)
- hematologic (PLT <100k)
- CNS (disorientation without fever/hypotension)
✔✔how to Manage TSS? - ✔✔Antibiotics, vaginal irrigation, advise no tampon/vaginal
contraceptive use (≥8 months).
✔✔Mood Disorders - Major Depression symptoms include: - ✔✔Symptoms: sleep
disturbances, low energy, appetite changes, digestive issues, HA, body pain, anxiety,
memory loss, weight change, decreased libido, preoccupation with physical complaints,
guilt, hopelessness, slowed speech/thoughts.
✔✔Depression Diagnosis is made from what ? - ✔✔a structured assessment called the
Patient health questionnaire (PHQ-9)
- gives a numeric score that can be followed to evaluate treatment success
- Any person expressing self-harm or harming others requires emergent intervention
-PHQ-9: 1-4 minimal, 5-9 mild, 10-14 moderate, 15-19 moderately severe, 20-27 severe
- emergent intervention if self-harm or harm to others expressed.
✔✔Depression Treatment includes: - ✔✔Psychotherapy + pharmacotherapy; goal: 50%
symptom reduction in 10-12 weeks; rule out bipolar before antidepressants; first-line:
SSRIs, SNRIs, dopamine/norepi reuptake inhibitors; monitor for GI upset, jitteriness, HA
(resolve in 2 weeks); reassess 4-8 weeks.
✔✔what is Dysthymia? - ✔✔Chronic low mood; patient may not perceive as depression;
treatment pharmacotherapy effective; vulnerable to MDD including PTSD.
✔✔what Bipolar 1-2? - ✔✔Bipolar 1: manic & depressive episodes, often undiagnosed
for years, screening via M-3 checklist, MDO, WHO CIDI; treatment: psych referral,
GRADED A+
✔✔Adolescent Development Erikson - ✔✔Identity vs Role Confusion (early
adolescents), Intimacy vs Isolation (early adulthood); overlap may persist into early
adulthood.
✔✔what should you know about Adolescent Informed Consent? - ✔✔Adults 18+ give
consent. Minors may consent to certain OB/GYN services vary.... consent to
contraception may or may not be included; Title X requires minors can consent to
funded services. so even if a state law saws the child needs parental consent, if its a
title x funded clinic, the adolescent can make their own choice and the clinic will not
notify the parents o 21 states & DC - ALL minors are explicitly allowed to consent to
contraceptive services
o Additional 25 states - minors CAN provide their own consent for contraception under
certain circumstances
o Only 4 states have no explicit policy
✔✔Pelvic Exam Indications in Adolescents - ✔✔- these may be indicated: general
exam, visual breast exam, external pelvic exam is more typical
- internal exam if abnormal bleeding, discharge, abdominal/pelvic pain; - initiation of
OCs does NOT require exam. - G/C screening should be done using nucleic acid
amplication techniques
- Urine sample or vaginal swab specimen that is obtained by the pt
- Vaginal swabs are more sensitive than urine tests
- Both are acceptable to young pts
· PAP smear for cervical cancer screening is NOT RECOMMENDED UNTIL AGE 21
✔✔G/C Screening in Adolescents is done how? - ✔✔NAAT recommended; urine or
vaginal swab; swabs more sensitive; both acceptable.
✔✔Cervical Cancer Screening in Adolescents should be done at what age? - ✔✔PAP
smear not recommended until age 21.
✔✔Menstrual Cycle Puberty Markers: thelarche, adrenarche, and first menses normal
age ranges - ✔✔Thelarche (breast budding) or Adrenarche (sexual hair growth);
average onset 9.7 yrs (range 7-13); first menses follows thelarche ~2 yrs later.
✔✔Primary Amenorrhea Diagnosis meets what requirements? - ✔✔No
adrenarche/thelarche by 13; no menses by 15; menses not started within 5 yrs of
thelarche/adrenarche onset. primary amenorrhea differential dx should inclue: Dx:
anatomical, genetic, hormonal, enzymatic, psychological. Examples: imperforate
hymen, transverse vaginal septum, or in
- uterus but no breasts: ovarian estrogen deficiency (Turner's), enzyme deficiency,
ovarian damage, breast present but congenital absence of uterus: Mullerian agenesis
, ✔✔Menstrual Irregularities Early Puberty include what? - ✔✔Average cycle: 21-45 days;
up to 7 bleeding days; ACOG recommends evaluation if cycles >90 days apart, <21 or
>45 days, lasting >7 days, heavy, frequent pad changes, or delayed menarche with risk
factors.
✔✔what is Toxic Shock Syndrome (TSS)? - ✔✔Caused by Staphylococcus aureus;
associated with continuous tampon use, contraceptive sponge/diaphragm; peak
occurence on day 4 of menses; symptoms: fever >102, diffuse rash like a sunburn,
desquamation, hypotension, negative cultures.
✔✔what are the criteria to dx TSS? - ✔✔Any 3: GI (vomiting/diarrhea)
- muscular (myalgia/CPK >2x)
- renal (BUN/Cr >2x)
- mucous membranes (hyperemia)
- hepatic (bilirubin/AST/ALT >2x)
- hematologic (PLT <100k)
- CNS (disorientation without fever/hypotension)
✔✔how to Manage TSS? - ✔✔Antibiotics, vaginal irrigation, advise no tampon/vaginal
contraceptive use (≥8 months).
✔✔Mood Disorders - Major Depression symptoms include: - ✔✔Symptoms: sleep
disturbances, low energy, appetite changes, digestive issues, HA, body pain, anxiety,
memory loss, weight change, decreased libido, preoccupation with physical complaints,
guilt, hopelessness, slowed speech/thoughts.
✔✔Depression Diagnosis is made from what ? - ✔✔a structured assessment called the
Patient health questionnaire (PHQ-9)
- gives a numeric score that can be followed to evaluate treatment success
- Any person expressing self-harm or harming others requires emergent intervention
-PHQ-9: 1-4 minimal, 5-9 mild, 10-14 moderate, 15-19 moderately severe, 20-27 severe
- emergent intervention if self-harm or harm to others expressed.
✔✔Depression Treatment includes: - ✔✔Psychotherapy + pharmacotherapy; goal: 50%
symptom reduction in 10-12 weeks; rule out bipolar before antidepressants; first-line:
SSRIs, SNRIs, dopamine/norepi reuptake inhibitors; monitor for GI upset, jitteriness, HA
(resolve in 2 weeks); reassess 4-8 weeks.
✔✔what is Dysthymia? - ✔✔Chronic low mood; patient may not perceive as depression;
treatment pharmacotherapy effective; vulnerable to MDD including PTSD.
✔✔what Bipolar 1-2? - ✔✔Bipolar 1: manic & depressive episodes, often undiagnosed
for years, screening via M-3 checklist, MDO, WHO CIDI; treatment: psych referral,
