Module 2- Rosh Review
1. A 32-year-old woman with fluctuating menstrual intervals presents to the primary care clinic for an
evaluation. She is not currently pregnant but has had two normal pregnancies with healthy births. Vital
signs include a BP of 120/82 mm Hg, HR of 75 bpm, RR of 17/minute, and T of 98.6°F. On pelvic
examination, the left adnexa is appreciably larger than the right on palpation. There is no cervical motion
tenderness, bleeding, or vaginal discharge. Which one of the following conditions is most likely suggested
by her ovarian enlargement?
a. Benign cystic teratoma
b. Endometriosis
c. Functional ovarian cyst
d. Ovarian carcinoma
e. Stromal cell ovarian neoplasm
2. A 60-year-old woman presents to the clinic with severe vulvar itching and burning that has persisted for 8
months. She reports she has been treated with diflucan three separate times and terconazole externally
without complete resolution of symptoms. Physical exam reveals labial agglutination, ivory white plaques
with purpura, and excoriations in a figure-eight pattern around the vulva and perianal area. Wet prep
shows negative whiff, negative hyphae, negative clue cells, and positive lactobacillus. Which of the
following is the most likely diagnosis?
a. Atrophic vaginitis
b. Lichen sclerosus
c. Psoriasis
d. Vulvovaginal candidiasis
3. A 26-year-old woman presents with yellow vaginal discharge after starting a relationship with a new sexual
partner. Physical exam reveals purulent discharge from the external os of the cervix. Microscopy reveals
gram-negative diplococci. What is the most likely diagnosis
a. Bacterial vaginosis
b. Chlamydial cervicitis
c. Gonococcal cervicitis
d. Mycoplasma genitalium cervicitis
e. Trichomonas vaginitis
4. Which of the following diagnostic studies should be ordered for an adolescent suspected of having an
ovarian cyst?
a. Computed tomography
b. Magnetic resonance imaging
c. Ultrasound
d. X-ray
, 5. A 32-year-old woman reports her menstrual periods are increasing in length more often. They used to last
about 4 days, but for the past 3 months, she has noticed they last about 9 days, even though she still cycles
every 28 days. She also reports heavier blood flow in the first 3 days of these new 9-day periods. She has no
other concerning health history and does not take any medications. Vital signs are a BP of 110/70 mm Hg,
HR of 90 bpm, RR of 12/min, and T of 98.9°F. Which of the following terms best characterizes this abnormal
uterine bleeding?
a. Amenorrhea
b. Intermenstrual bleeding
c. Perimenopausal bleeding
d. Polymenorrhea
e. Prolonged menstrual bleeding
6. A 35-year-old woman presents for routine gynecologic screening. Cervical cytology shows atypical
squamous cells of undetermined significance. Reflex human papillomavirus testing is positive for strain 16.
Which of the following is the best next step in management?
a. Ablation
b. Colposcopy
c. Excision
d. Repeat cytology with HPV co-test in one year
7. A 49-year-old woman presents to the office with irregular menses and a shorter duration between
menstrual cycles. She has associated sleep disturbances and hot flashes, as well. Menarche was age 11, and
she has had regular menstrual cycles typically lasting about 27 days. Now she is having cycles that are 23 to
25 days in length. Which of the following diagnostic tests would be most helpful in establishing the
diagnosis?
a. Follicle-stimulating hormone level
b. Pelvic ultrasound
c. Prolactin level
d. Thyroid-stimulating hormone level
1. A 32-year-old woman with fluctuating menstrual intervals presents to the primary care clinic for an
evaluation. She is not currently pregnant but has had two normal pregnancies with healthy births. Vital
signs include a BP of 120/82 mm Hg, HR of 75 bpm, RR of 17/minute, and T of 98.6°F. On pelvic
examination, the left adnexa is appreciably larger than the right on palpation. There is no cervical motion
tenderness, bleeding, or vaginal discharge. Which one of the following conditions is most likely suggested
by her ovarian enlargement?
a. Benign cystic teratoma
b. Endometriosis
c. Functional ovarian cyst
d. Ovarian carcinoma
e. Stromal cell ovarian neoplasm
2. A 60-year-old woman presents to the clinic with severe vulvar itching and burning that has persisted for 8
months. She reports she has been treated with diflucan three separate times and terconazole externally
without complete resolution of symptoms. Physical exam reveals labial agglutination, ivory white plaques
with purpura, and excoriations in a figure-eight pattern around the vulva and perianal area. Wet prep
shows negative whiff, negative hyphae, negative clue cells, and positive lactobacillus. Which of the
following is the most likely diagnosis?
a. Atrophic vaginitis
b. Lichen sclerosus
c. Psoriasis
d. Vulvovaginal candidiasis
3. A 26-year-old woman presents with yellow vaginal discharge after starting a relationship with a new sexual
partner. Physical exam reveals purulent discharge from the external os of the cervix. Microscopy reveals
gram-negative diplococci. What is the most likely diagnosis
a. Bacterial vaginosis
b. Chlamydial cervicitis
c. Gonococcal cervicitis
d. Mycoplasma genitalium cervicitis
e. Trichomonas vaginitis
4. Which of the following diagnostic studies should be ordered for an adolescent suspected of having an
ovarian cyst?
a. Computed tomography
b. Magnetic resonance imaging
c. Ultrasound
d. X-ray
, 5. A 32-year-old woman reports her menstrual periods are increasing in length more often. They used to last
about 4 days, but for the past 3 months, she has noticed they last about 9 days, even though she still cycles
every 28 days. She also reports heavier blood flow in the first 3 days of these new 9-day periods. She has no
other concerning health history and does not take any medications. Vital signs are a BP of 110/70 mm Hg,
HR of 90 bpm, RR of 12/min, and T of 98.9°F. Which of the following terms best characterizes this abnormal
uterine bleeding?
a. Amenorrhea
b. Intermenstrual bleeding
c. Perimenopausal bleeding
d. Polymenorrhea
e. Prolonged menstrual bleeding
6. A 35-year-old woman presents for routine gynecologic screening. Cervical cytology shows atypical
squamous cells of undetermined significance. Reflex human papillomavirus testing is positive for strain 16.
Which of the following is the best next step in management?
a. Ablation
b. Colposcopy
c. Excision
d. Repeat cytology with HPV co-test in one year
7. A 49-year-old woman presents to the office with irregular menses and a shorter duration between
menstrual cycles. She has associated sleep disturbances and hot flashes, as well. Menarche was age 11, and
she has had regular menstrual cycles typically lasting about 27 days. Now she is having cycles that are 23 to
25 days in length. Which of the following diagnostic tests would be most helpful in establishing the
diagnosis?
a. Follicle-stimulating hormone level
b. Pelvic ultrasound
c. Prolactin level
d. Thyroid-stimulating hormone level
