CE 2 Flashcards

Which pelvic bone forms the broad, fan-shaped wing of the pelvis?

A) Ischium

B) Ilium

C) Pubis

D) Coccyx

What is the expanded upper portion of the ilium called?

A) True pelvis

B) Pelvic outlet

C) Pelvic inlet

D) False pelvis

What is the primary function of the iliac wing?

A) Supports the lower abdomen

B) Supports the pelvic outlet

C) Forms the pubic symphysis

D) Supports the coccyx

How many vertebrae fuse to form the sacrum?

A) Three

B) Four

C) Five

D) Six

Which structure attaches inferiorly to the sacrum?

A) Pubis

B) Ilium

C) Ischium

D) Coccyx

Which structure forms the posterior border of the pelvic outlet?

A) Coccyx

B) Pubic symphysis

C) Iliac crest

D) Sacral promontory

Which pelvic bone contains the ischial spine?

A) Ilium

B) Pubis

C) Sacrum

D) Ischium

Which ligament attaches to the ischial spine?

A) Round ligament

B) Sacrospinous ligament

C) Broad ligament

D) Cardinal ligament

Which anatomical landmark is used for a pudendal nerve block?

A) Pubic tubercle

B) Iliac crest

C) Ischial spine

D) Sacral promontory

Which pelvic landmark helps determine fetal station during labor?

A) Ischial spine

B) Iliac crest

C) Pubic tubercle

D) Coccygeal apex

Which surgical procedure uses the ischial spine as an important landmark?

A) Tubal ligation

B) Cervical conization

C) Endometrial ablation

D) Sacrospinous ligament suspension

Which ligament is listed among the four major pelvic ligaments?

A) Inguinal ligament

B) Cardinal ligament

C) Annular ligament

D) Cruciate ligament

Which ligament is associated with the uterus and listed among the major pelvic ligaments?

A) Patellar ligament

B) Coronary ligament

C) Round ligament

D) Nuchal ligament

Which ligament is another major pelvic support structure?

A) Broad ligament

B) Deltoid ligament

C) Collateral ligament

D) Interspinous ligament

Which ligament connects the uterus toward the sacrum?

A) Round ligament

B) Broad ligament

C) Inguinal ligament

D) Uterosacral ligament

According to these notes, some pelvic ligaments represent thickenings of which tissue? A) Cartilage B) Fascia C) Bone D) Muscle

What should a patient be instructed to empty before a pelvic examination?

A) Only her bladder

B) Only her bowels

C) Bladder and bowels

D) Neither bladder nor bowels

Where should the patient's buttocks be positioned on the examination table?

A) Near the table's edge

B) Near the headrest

C) At the center

D) Beyond the heel rests

Where should the patient's heels be placed during the examination?

A) On the abdominal drape

B) On the table's headrest

C) Directly against the table

D) In the heel rests

What can be placed over metal heel rests to improve patient comfort?

A) Adhesive tape

B) Cloth or foam coverings

C) Elastic compression bandages

D) Sterile gauze packing

What is the effect of shortening the heel rest brackets?

A) Straightens the patient's knees

B) Increases cervical elevation

C) Encourages knee flexion

D) Prevents hip abduction

Why might heel rest brackets be shortened during a pelvic examination?

A) To lower cervical position

B) To increase hip extension

C) To prevent knee flexion

D) To elevate the cervix

Which patient may benefit from longer heel rest brackets?

A) Patient with normal joint mobility

B) Patient with increased flexibility

C) Patient with mild abdominal discomfort

D) Patient with osteoarthritis

Why should the head of the examination table be elevated?

A) To prevent cervical movement

B) To maintain patient-provider eye contact

C) To increase abdominal pressure

D) To prevent knee flexion

What optional item can help patients observe their pelvic examination?

A) Stethoscope

B) Measuring tape

C) Mirror

D) Penlight

How should the clinician decide whether to use an examination drape?

A) Ask the patient's preference

B) Always require the drape

C) Never offer a drape

D) Decide without asking

Which instruction appropriately encourages relaxation during pelvic examination?

A) Keep both knees tightly together

B) Straighten both legs completely

C) Contract the abdominal muscles

D) Let your knees relax outward

The vulvar epithelium is susceptible to which types of pathology?

A) Only reproductive tract disorders

B) Common skin pathologies

C) Only sexually transmitted infections

D) Only hormonal disorders

What lighting is recommended for examination of the vulva and external genitalia?

A) Dim lighting

B) Indirect lighting

C) Natural lighting only

D) Good, adequate lighting

Why should the labia be spread during vulvar examination?

A) To assess cervical dilation

B) To evaluate uterine position

C) To reveal hidden vulvar lesions

D) To measure vaginal length

What should be assessed when inspecting pubic hair?

A) Hair follicle depth

B) Hair shaft diameter

C) Hair distribution, lice, and nits

D) Hair growth rate

Which findings should be assessed during vulvar skin inspection?

A) Uterine size and position

B) Cervical dilation and effacement

C) Ovarian size and mobility

D) Redness, lesions, and pigmentation changes

At approximately which clock position is the right Bartholin gland examined?

A) 1–2 o'clock

B) 7–8 o'clock

C) 10–11 o'clock

D) 12 o'clock

Which technique is used to palpate the right Bartholin gland?

A) Both fingers inside the vagina

B) Index finger inside, thumb outside

C) Both thumbs over the abdomen

D) Index finger over the cervix

Which portion of the right labia is grasped during Bartholin gland palpation?

A) Posterior portion

B) Anterior portion

C) Superior portion

D) Medial clitoral portion

Which characteristic describes the overall appearance and form of a vulvar lesion?

A) Morphology

B) Distribution

C) Consistency

D) Tenderness

Which measurements are important when describing an individual vulvar lesion?

A) Depth and temperature

B) Mobility and vascularity

C) Size and shape

D) Pressure and sensation

Which characteristic describes whether the edge of a vulvar lesion is clearly defined? A) Texture B) Border demarcation C) Tenderness D) Pigmentation

Which features should be documented when multiple vulvar lesions are present?

A) Number, location, and distribution

B) Temperature, pulse, and pressure

C) Depth, mobility, and sensation

D) Vascularity, reflexes, and tone

Which visual characteristic should be recorded when examining vulvar lesions?

A) Mobility

B) Temperature

C) Color

D) Elasticity

Which characteristics help describe the consistency of vulvar lesions?

A) Location and distribution

B) Number and color

C) Diameter and symmetry

D) Hard, soft, firm, or fluctuant

Which finding represents a secondary change in a vulvar lesion?

A) Excoriation

B) Cervical dilation

C) Uterine retroversion

D) Ovarian enlargement

Which combination describes the classic signs of acute inflammation?

A) Redness, swelling, heat, pain, dysfunction

B) Pallor, numbness, dryness, weakness

C) Cyanosis, tremor, spasm, fatigue

D) Pigmentation, scaling, atrophy, scarring

What is the primary purpose of a vaginal speculum examination?

A) Assessing uterine mobility

B) Measuring pelvic outlet size

C) Visualizing the cervix

D) Palpating the ovaries

Which procedures can be performed using a vaginal speculum?

A) Cervical cultures and Pap testing

B) Abdominal palpation and percussion

C) Ovarian palpation and measurement

D) Uterine mobility and positioning

What materials are commonly used to manufacture vaginal speculums?

A) Wood and silicone

B) Rubber and glass

C) Ceramic and latex

D) Plastic and metal

Which combination lists the three speculum types in your notes?

A) Graves, Sims, Cusco

B) Pederson, Sims, Graves

C) Pediatric, Graves, Pederson

D) Pediatric, Cusco, Sims

Which speculum is characterized by a flat, narrow design?

A) Graves

B) Pediatric

C) Cusco

D) Pederson

Which speculum is described as having a duckbill appearance?

A) Pederson

B) Pediatric

C) Graves

D) Sims

Which speculum type is specifically designed for smaller anatomy?

A) Graves

B) Pediatric

C) Pederson

D) Standard adult

What should be applied to the speculum before insertion?

A) Antiseptic powder

B) Alcohol-based cleanser

C) Lubricant

D) Dry gauze

Which additional structure may be lubricated when depressing the vaginal introitus?

A) Dominant thumb

B) Nondominant index finger

C) Dominant middle finger

D) Nondominant little finger

Why should the speculum be touched against the patient's thigh before insertion?

A) To assess skin sensation

B) To evaluate muscle tone

C) To measure tissue resistance

D) To check temperature comfort

At what angle should the speculum initially enter the vagina?

A) Slight angle

B) Directly perpendicular

C) Completely horizontal

D) Sharply vertical

Where should the speculum pass relative to the finger depressing the introitus?

A) Below the finger

B) Behind the cervix

C) Outside the labia

D) Above the finger

When should the speculum be opened and locked into position?

A) Before vaginal insertion

B) When the cervix is visualized

C) After completing cytology

D) Before examining the vulva

Which cervical features should be inspected during speculum examination?

A) Ovarian size and mobility

B) Cervical os, discharge, and lesions

C) Uterine fundus and position

D) Pelvic ligaments and muscles

Which cervical characteristic can help distinguish prior vaginal childbirth?

A) Cervical pigmentation

B) Cervical temperature

C) Appearance of the cervical os

D) Cervical mucus viscosity

Why is proper Pap smear specimen collection important?

A) It determines uterine size

B) It measures vaginal elasticity

C) It prevents cervical contraction

D) It reduces false-negative results

Which additional testing method can accompany cervical cytology screening?

A) Serum progesterone measurement

B) Ovarian biopsy

C) HPV cotesting

D) Endometrial thickness measurement

Which innovation allows cervical cells to be processed in a liquid medium?

A) Frozen-section analysis

B) Conventional tissue biopsy

C) Direct smear fixation

D) Liquid-based cytology

According to your notes, approximately what proportion of Pap smear false negatives relate to collection conditions and technique?

A) One tenth

B) One half to two thirds

C) Nearly all cases

D) Less than one percent

According to your notes, cervical cancer incidence decreased by approximately how much over 30 years?

A) 20%

B) 50%

C) 70%

D) 90%

Approximately what percentage of women diagnosed with cervical cancer have never had a Pap test?

A) 10%

B) 25%

C) 75%

D) 50%

According to your notes, what percentage of cervical cancer patients had no screening during the preceding five years?

A) 10%

B) 30%

C) 50%

D) 70%

How do most cases of cervical cancer initially present?

A) Severe pelvic pain

B) Persistent vaginal bleeding

C) Asymptomatic

D) Urinary retention

Which anatomical region is most commonly examined using colposcopy?

A) Uterine fundus

B) Ovaries

C) Cervix

D) Fallopian tubes

Colposcopy can also be performed on which external genital structure?

A) Urethra

B) Bladder

C) Rectum

D) Vulva

What concentration of acetic acid is applied during colposcopy?

A) 1%

B) 5%

C) 10%

D) 20%

How long after acetic acid application do involved areas typically become visible?

A) 3–5 minutes

B) 10–15 minutes

C) 20–30 minutes

D) 30–60 minutes

Which instrument helps visualize abnormal areas during colposcopy?

A) Otoscope

B) Magnifying instrument

C) Reflex hammer

D) Tuning fork

Which technique is used to palpate the uterus and cervix during a bimanual examination?

A) Both hands on abdomen

B) Both hands inside vagina

C) One hand over lower back

D) Vaginal fingers and abdominal hand

Which characteristics should be evaluated when palpating the cervix?

A) Consistency and tenderness

B) Color and pigmentation

C) Length and temperature

D) Hair distribution and texture

Which descriptions are used to assess cervical consistency?

A) Warm, cool, moist

B) Large, small, round

C) Mobile, fixed, elevated

D) Soft, firm, nodular

Normally, the cervix can be moved approximately how far without pain?

A) 1–2 mm

B) 2–4 cm

C) 5–7 cm

D) 8–10 cm

Cervical motion tenderness most strongly suggests which underlying process?

A) Normal ovulation

B) Physiologic pregnancy

C) Peritoneal inflammation

D) Normal uterine mobility

Which inflammatory condition commonly produces cervical motion tenderness?

A) Pelvic inflammatory disease

B) Iron deficiency anemia

C) Stress urinary incontinence

D) Uterine prolapse

Which pregnancy-related condition can produce cervical motion tenderness?

A) Normal intrauterine pregnancy

B) Uncomplicated implantation

C) Physiologic fetal movement

D) Ectopic pregnancy

Which combination includes other possible causes of cervical motion tenderness?

A) Anemia, asthma, migraine

B) Appendicitis, endometriosis, ovarian torsion

C) Hypothyroidism, diabetes, hypertension

D) Fibromyalgia, osteoporosis, scoliosis

Which abdominal emergency may also cause cervical motion tenderness?

A) Uncomplicated cholelithiasis

B) Chronic constipation

C) Perforated abdominal viscus

D) Gastroesophageal reflux

Why is the cervix pushed upward and backward during bimanual examination?

A) To improve uterine palpation

B) To measure vaginal length

C) To inspect cervical discharge

D) To assess ovarian hormone levels

During bimanual examination, the uterus should be palpated between which structures?

A) Both vaginal fingers

B) Speculum blades

C) Vaginal and rectal walls

D) Vaginal fingers and abdominal hand

Which uterine characteristics should be assessed during bimanual examination?

A) Color, discharge, pigmentation

B) Size, position, mobility, tenderness

C) Hair pattern, texture, moisture

D) Heart rate, pressure, temperature

Which uterine position is most common and easiest to palpate bimanually?

A) Retroverted and retroflexed

B) Retroverted and anteflexed

C) Anteverted and anteflexed

D) Anteverted and retroflexed

Why is a retroverted uterus more difficult to palpate bimanually?

A) It points toward the spine

B) It is always enlarged

C) It lacks muscular tissue

D) It is fixed anteriorly

What is the normal size and shape of the uterus commonly compared to?

A) A flattened disc

B) An elongated cylinder

C) A spherical ball

D) An upside-down pear

Which structures are palpated after evaluating the uterus during a bimanual examination?

A) Right and left adnexa

B) Cervix and vaginal walls

C) Rectum and anal canal

D) Bladder and urethra

If a patient reports unilateral pelvic pain, which side should be examined first?

A) The unaffected side

B) The painful side

C) Both sides simultaneously

D) The right side always

Where should the vaginal fingers move to examine the left adnexa?

A) Posterior vaginal fornix

B) Right lateral fornix

C) Left lateral fornix

D) Anterior vaginal fornix

Where should the abdominal hand be positioned when examining the left adnexa?

A) Right upper quadrant

B) Left upper quadrant

C) Left lower quadrant

D) Right lower quadrant

What is the function of the vaginal fingers during adnexal palpation?

A) Depress the bladder

B) Rotate the cervix

C) Compress the rectum

D) Lift adnexa toward abdominal hand

Which characteristics should be evaluated when examining an adnexal mass?

A) Size, shape, consistency, mobility, tenderness

B) Color, discharge, pigmentation, temperature

C) Hair distribution, texture, moisture, elasticity

D) Pulse, reflexes, sensation, muscle tone

How does a normal ovary typically respond when squeezed during palpation?

A) Completely painless

B) Produces severe burning

C) Becomes immediately enlarged

D) Sensitive to pressure

In which patients are normal ovaries more frequently palpable?

A) Patients with obesity

B) Patients with ascites

C) Patients with abdominal distention

D) Thin patients

Adnexal tenderness or enlargement is relatively specific for which finding?

A) Normal ovarian function

B) Underlying pathology

C) Physiologic uterine movement

D) Normal cervical anatomy

After examining the adnexa, where should the vaginal fingers move?

A) Anterior vaginal wall

B) External cervical os

C) Urethral opening

D) Posterior fornix

Which structures are palpated through the posterior vaginal fornix?

A) Uterosacral ligaments and pouch of Douglas

B) Ovaries and fallopian tubes

C) Bladder and urethra

D) Round ligaments and pubic symphysis

Which findings in the posterior fornix suggest endometriosis?

A) Marked tenderness and nodularity

B) Increased mobility without tenderness

C) Smooth tissue without nodules

D) Normal consistency and elasticity

Which fingers are typically used for bimanual vaginal palpation in a patient who has borne children?

A) Thumb and index finger

B) Index and little finger

C) Middle and ring finger

D) Index and middle fingers

When the vaginal introitus is small, which finger should be introduced first?

A) Middle finger

B) Index finger

C) Ring finger

D) Little finger

During a rectovaginal examination, where are the index and middle fingers placed?

A) Both fingers in vagina

B) Both fingers in rectum

C) Index rectal, middle vaginal

D) Index vaginal, middle rectal

What should the patient be asked to do during rectal finger insertion?

A) Bear down

B) Hold her breath

C) Contract abdominal muscles

D) Raise both legs

Which clinical complaints commonly indicate a rectovaginal examination?

A) Headache and dizziness

B) Chest pain and cough

C) Pelvic pain or pelvic mass

D) Shoulder pain and weakness

Which additional indications may warrant a rectovaginal examination?

A) Visual changes and headache

B) Hearing loss and tinnitus

C) Rectal symptoms or fecal sampling

D) Upper respiratory symptoms

Which characteristics of the rectovaginal septum are assessed during examination?

A) Color and pigmentation

B) Temperature and sensation

C) Length and elasticity

D) Thickness and masses

Which structures are palpated for thickening or nodularity during rectovaginal examination?

A) Round ligaments

B) Cardinal ligaments

C) Uterosacral ligaments

D) Inguinal ligaments

Approximately how far does the examining finger extend during rectovaginal examination?

A) 2–3 cm

B) 7–8 cm

C) 11–12 cm

D) 15–16 cm

Approximately how long is the rectal mucosa according to the notes?

A) 5 cm

B) 8 cm

C) 11 cm

D) 15 cm

Which uterine position can be better appreciated during rectovaginal examination?

A) Anteverted uterus

B) Retroflexed uterus

C) Anteflexed uterus

D) Midposition uterus

Nodularity along the uterosacral ligaments and posterior cul-de-sac may suggest which conditions?

A) Cervicitis or vaginitis

B) Endometriosis or cancer

C) Cystitis or urethritis

D) Fibroids or adenomyosis

How can the uterosacral ligaments be stretched to facilitate rectal palpation?

A) Push the fundus downward

B) Rotate the uterus laterally

C) Pull the cervix anteriorly

D) Compress the abdominal wall

What is the main purpose of examining the adnexa during rectovaginal assessment?

A) Determine cervical dilation

B) Identify masses and tenderness

C) Measure vaginal length

D) Assess cervical pigmentation

When are pelvic examinations recommended based on the patient's clinical presentation?

A) When indicated by history or symptoms

B) Only after menopause

C) Only during pregnancy

D) Before every medication prescription

How should the decision to perform a pelvic examination generally be made?

A) Solely by the physician

B) Solely by the institution

C) Through shared decision-making

D) Through laboratory results alone

Which patients require condition-specific gynecologic screening and management?

A) Patients with seasonal allergies

B) Patients with mild headaches

C) Patients with uncomplicated hypertension

D) Patients with prior cervical dysplasia

Which historical exposure requires condition-specific gynecologic screening recommendations?

A) Prenatal iron exposure

B) In utero diethylstilbestrol exposure

C) Childhood vitamin supplementation

D) Previous influenza vaccination

After discussing risks and benefits, what patient factor can support performing a pelvic examination?

A) Physician scheduling preference

B) Insurance coverage alone

C) Patient preference

D) Examination room availability

According to the notes, how often should women receive well-woman care regardless of pelvic examination?

A) Every five years

B) Annually

C) Every three years

D) Every six months

For which contraceptive method is a pelvic examination necessary before insertion?

A) Oral contraceptives

B) Contraceptive patch

C) Contraceptive implant

D) Intrauterine device

Is a pelvic examination necessary solely to screen for sexually transmitted infections?

What is the greatest diagnostic value of colposcopy?

A) Measuring uterine size

B) Determining ovarian position

C) Directing biopsy toward suspicious tissue

D) Assessing pelvic ligament mobility

What is the most common abnormal finding during colposcopy?

A) Cervical stenosis

B) Acetowhite epithelium

C) Cervical prolapse

D) Uterine enlargement

Which three types of tissue primarily make up the breast?

A) Muscle, cartilage, and fat

B) Glandular, fibrous, and fatty tissue

C) Bone, muscle, and connective tissue

D) Epithelial, nervous, and cartilage tissue

Breast tissue is hormonally sensitive to which physiological changes?

A) Menstrual cycling and aging

B) Blood pressure and respiration

C) Temperature and hydration

D) Exercise and oxygenation

At which intercostal space is the nipple typically located in males and young women?

A) Fourth intercostal space

B) Second intercostal space

C) Third intercostal space

D) Fifth intercostal space

What causes the nipple to become firm and prominent during tactile stimulation?

A) Increased glandular secretion

B) Smooth muscle contraction

C) Increased lymphatic drainage

D) Fibrous tissue relaxation

What is the areola?

A) Glandular tissue beneath the nipple

B) Duct connecting breast lobes

C) Pigmented skin surrounding the nipple

D) Fibrous tissue supporting the breast

What happens to areolar pigmentation during pregnancy?

A) It darkens

B) It becomes lighter

C) It disappears

D) It remains unchanged

Approximately how many lobes does each breast contain?

A) 5–10

B) 20–40

C) 10–100

D) 15–20

What is the primary function of the breast lobes?

A) Milk production

B) Lymphatic filtration

C) Hormone metabolism

D) Fat storage

Approximately how many terminal ductal lobular units are found in each breast lobe?

A) 5–10

B) 10–15

C) 50–100

D) 20–40

What is the functional unit of the breast?

A) Cooper's ligament

B) Lactiferous duct

C) Terminal ductal lobular unit

D) Axillary lymph node

Which duct connects the lobule to the larger ductal system?

A) Intralobar terminal duct

B) Main lactiferous duct

C) Collecting lymphatic duct

D) Extralobar terminal duct

Which duct continues the ductal system into the lobule?

A) Main lactiferous duct

B) Extralobar terminal duct

C) Intralobar terminal duct

D) Axillary collecting duct

Into which structure do the acini of a TDLU open?

A) Intralobar terminal duct

B) Extralobar terminal duct

C) Main lactiferous duct

D) Axillary lymphatic duct

Each breast lobe empties into which structure?

A) Intralobar terminal duct

B) Extralobar terminal duct

C) Lactiferous duct

D) Central lymphatic duct

Approximately how many main lactiferous ducts open at the nipple?

A) 2–4

B) 5–10

C) 15–20

D) 20–40

Where do the main lactiferous ducts ultimately open?

A) Axilla

B) Areolar skin

C) Breast fascia

D) Nipple

What is another name for Cooper's ligaments?

A) Cardinal ligaments

B) Uterosacral ligaments

C) Suspensory ligaments

D) Round ligaments

What is the primary function of Cooper's ligaments?

A) Produce breast milk

B) Regulate nipple pigmentation

C) Maintain breast structural integrity

D) Drain breast lymph

Cooper's ligaments connect which structures?

A) Nipple and areola

B) Lobules and ducts

C) Axillary and cervical nodes

D) Skin and underlying fascia

Which artery provides the principal blood supply to the breast?

A) Internal mammary artery

B) Lateral thoracic artery

C) Thoracoacromial artery

D) Posterior intercostal artery

Approximately one-third of breast blood supply comes from which arteries?

A) Internal mammary arteries

B) Posterior intercostal arteries

C) Superior epigastric arteries

D) Lateral thoracic arteries

The lateral thoracic artery arises from which artery?

A) Axillary artery

B) Subclavian artery

C) Internal mammary artery

D) Brachial artery

Approximately what percentage of breast lymphatic vessels drain into axillary lymph nodes according to the notes?

A) 50%

B) 97%

C) 75%

D) 85%

Which axillary lymph nodes are most likely to be palpable?

A) Apical nodes

B) Pectoral nodes

C) Subscapular nodes

D) Central nodes

Where are the central axillary lymph nodes typically located?

A) Near the clavicle anteriorly

B) High in the axilla

C) Along the inferior sternum

D) Beneath the nipple

Central axillary lymph nodes drain toward which additional lymph node groups?

A) Inguinal and femoral nodes

B) Infraclavicular and supraclavicular nodes

C) Cervical and mesenteric nodes

D) Popliteal and iliac nodes

What is a sentinel lymph node?

A) Largest lymph node near tumor

B) Most distant lymph node

C) First likely node receiving tumor spread

D) Last lymph node before circulation

What is the purpose of sentinel lymph node biopsy?

A) Measure breast glandular secretion

B) Determine breast arterial flow

C) Assess nipple muscle function

D) Detect cancer cells in draining nodes

How is the breast commonly divided when describing clinical findings?

A) Two equal halves

B) Three anatomical regions

C) Five equal segments

D) Four quadrants

What is considered the fifth anatomical area of the breast?

A) Axillary tail

B) Central areola

C) Inframammary fold

D) Supraclavicular region

What is another name for the axillary tail of the breast?

A) Tail of Cooper

B) Tail of Montgomery

C) Tail of Spence

D) Tail of Bartholin

The axillary tail of the breast extends toward which landmark?

A) Posterior axillary fold

B) Midclavicular line

C) Anterior axillary fold

D) Inferior sternal border

Which screening method is better at detecting breast cancer?

A) Mammography

B) Clinical breast examination

C) Visual breast inspection

D) Breast palpation alone

What is the potential benefit of adding clinical breast examination to mammography?

A) Eliminates false-positive results

B) Replaces mammography screening

C) Prevents all breast cancers

D) Modestly improves early cancer detection

Which disadvantage is associated with adding clinical breast examinations to screening?

A) Reduced examination time

B) Reduced healthcare costs

C) Increased false-positive workups

D) Elimination of diagnostic procedures

What is an important patient-positioning goal during clinical breast examination?

A) Increase breast tissue movement

B) Elevate both shoulders

C) Flatten breast against chest wall

D) Compress the abdominal muscles

Which approach helps ensure a high-quality clinical breast examination?

A) Random palpation

B) Rapid examination

C) Examination of symptomatic areas

D) Systematic and consistent technique

What must be ruled out in a nonlactating patient presenting with mastitis?

A) Fibroadenoma

B) Carcinoma

C) Galactocele

D) Lactational engorgement

According to the notes, which finding distinguishes a breast abscess from mastitis?

A) Nipple inversion

B) Pitting edema

C) Breast asymmetry

D) Areolar pigmentation

Paget disease of the breast is associated with which underlying pathology?

A) Benign fibrocystic changes

B) Simple breast cysts

C) Invasive or intraductal carcinoma

D) Normal glandular proliferation

What is the characteristic appearance of Paget disease of the breast?

A) Smooth, painless breast nodule

B) Eczematous nipple lesion

C) Diffuse breast enlargement

D) Bilateral axillary swelling

Which characteristic helps distinguish Paget disease from ordinary eczema?

A) Absence of skin changes

B) Bilateral nipple involvement

C) Unilateral involvement

D) Absence of pigmentation

What should the clinician do before beginning a breast examination?

A) Immediately begin palpation

B) Ask the patient to stand

C) Explain and obtain permission

D) Apply firm pressure

Which patient position is generally used for breast palpation?

A) Standing upright

B) Lying down

C) Sitting forward

D) Prone position

Why should breast tissue lie evenly over the chest wall during examination?

A) To increase nipple sensitivity

B) To stimulate milk secretion

C) To improve lymphatic circulation

D) To facilitate breast palpation

How may women with small breasts position their arms during examination?

A) Arms at their sides

B) Hands behind their head

C) Arms crossed over chest

D) Arms raised overhead

From which side should the examiner generally palpate both breasts in small-breasted women?

A) Patient's left side

B) Foot of examination table

C) Head of examination table

D) Patient's right side

How should women with larger breasts position their hands during palpation?

A) Behind their head

B) Across their abdomen

C) Along their thighs

D) Over their chest

Which central structures must be included during breast examination?

A) Uterus and cervix

B) Abdominal wall and diaphragm

C) Nipple-areolar complex

D) Thyroid and trachea

Which lateral breast region must be included during examination?

A) Tail of Spence

B) Inguinal canal

C) Popliteal fossa

D) Carotid triangle

Which additional regions should be examined along with the breast?

A) Axillae, supraclavicular area, chest wall

B) Abdomen, pelvis, inguinal region

C) Neck, thyroid, cervical spine

D) Lumbar spine, sacrum, buttocks

Which parts of the hand should be used during breast palpation according to the notes?

A) Fingernails and knuckles

B) Thumb and little finger

C) Dorsal hand and wrist

D) Flat hand and fingertips

Which combination lists the three breast palpation techniques described in the notes?

A) Percussion, auscultation, inspection

B) Spokes, concentric circles, vertical strips

C) Compression, percussion, vibration

D) Sliding, rotating, tapping

Where does palpation begin using the spokes-of-a-wheel method?

A) Axillary fold

B) Inframammary crease

C) Outer breast border

D) Nipple

How should the location of a breast lesion be documented?

A) Color and temperature

B) Clock position and nipple distance

C) Breast weight and diameter

D) Axillary depth and angle

How is palpation performed using the concentric circle method?

A) In straight vertical strips

B) From axilla toward clavicle

C) In continuous circles around nipple

D) Through random palpation

Which direction is examined first in the spokes-of-a-wheel method?

A) 12 o'clock

B) 3 o'clock

C) 6 o'clock

D) 9 o'clock

When should nipple discharge be assessed during the breast examination?

A) During breast inspection

B) During abdominal palpation

C) During pelvic percussion

D) During rectovaginal examination

How should the examiner assess for nipple discharge?

A) Compress the entire chest wall

B) Apply pressure over the axilla

C) Pull the nipple outward firmly

D) Gently compress either side of nipple

What option may be offered when examining for nipple discharge?

A) Patient performs this portion herself

B) Patient skips all breast inspection

C) Patient performs abdominal palpation

D) Patient measures nipple diameter

When is the ideal time to perform a clinical breast examination?

A) During menstruation

B) Immediately before menstruation

C) The week after menstruation

D) During menstrual bleeding

Why is breast examination ideally performed after menstruation?

A) Increased breast tissue engorgement

B) Increased axillary node enlargement

C) Reduced breast tenderness and engorgement

D) Increased nipple discharge

What is the classic patient position for clinical breast examination?

A) Prone with arms extended

B) Supine with arm overhead

C) Standing with arms crossed

D) Sitting with knees flexed

Which combination of examination positions does Dr. C recommend?

A) Prone and lateral

B) Sitting and prone

C) Standing and lithotomy

D) Supine and upright

Which regions should be examined during the recommended breast examination?

A) Abdomen, pelvis, and groin

B) Breast, axilla, and clavicular nodes

C) Neck, thyroid, and shoulders

D) Back, sternum, and abdomen

What defines a dominant palpable breast mass?

A) Diffuse bilateral breast thickening

B) Generalized breast tenderness

C) Symmetric nodularity in both breasts

D) Distinct three-dimensional lesion

How does a dominant breast mass compare with the opposite breast?

A) Always identical in size

B) Asymmetric relative to opposite breast

C) Always bilateral and symmetric

D) Completely indistinguishable from normal tissue

What does finding a dominant breast mass increase suspicion for?

A) Normal hormonal changes

B) Physiologic breast development

C) Malignant disease

D) Normal glandular tissue

Can physical examination findings reliably distinguish benign from malignant breast masses?

A) Yes, based on tenderness

B) Yes, based on shape

C) Yes, based on mobility

D) No, not reliably

What additional evaluation is generally warranted for a dominant breast mass?

A) Breast imaging

B) Routine observation

C) Immediate reassurance

D) No additional assessment

What type of margins are generally associated with benign breast masses?

A) Discrete, well-defined margins

B) Irregular, poorly defined margins

C) Diffuse infiltrative margins

D) Indistinguishable surrounding borders

Which consistency is commonly associated with benign breast masses?

A) Rock-hard and irregular

B) Smooth, soft to firm

C) Firm with diffuse fixation

D) Hard and infiltrative

Which mobility finding is typically associated with benign breast masses?

A) Fixed to chest wall

B) Freely mobile

C) Fixed to skin

D) Attached to underlying muscle

Which consistency is more suspicious for malignant breast masses?

A) Soft

B) Fluctuant

C) Hard

D) Compressible

Which mobility finding is more suspicious for malignancy?

A) Freely mobile

B) Immobile

C) Easily displaced

D) Independently movable

Malignant breast masses may be fixed to which structures?

A) Skin and surrounding tissue

B) Nipple ducts

C) Axillary hair follicles

D) Superficial sweat glands

Which border characteristic is more suspicious for breast malignancy?

A) Smooth and discrete

B) Uniformly rounded

C) Irregular and poorly defined

D) Clearly demarcated

Which additional examination finding may accompany a malignant breast mass?

A) Normal axillary examination

B) Reduced nipple sensitivity

C) Symmetric glandular enlargement

D) Lymphadenopathy

What should be documented when multiple breast masses are palpated?

A) Number of masses

B) Patient's heart rate

C) Respiratory rate

D) Body temperature

Which unit is used to document breast mass size?

A) Millimeters of mercury

B) Grams

C) Liters

D) Centimeters

Which method is commonly used to describe breast mass position?

A) Dermatome method

B) Clock-face method

C) Reflex grading

D) Spinal level numbering

What additional measurement helps identify the position of a breast mass?

A) Distance from clavicle

B) Distance from sternum

C) Distance from nipple

D) Distance from umbilicus

What does delimitation describe when examining a breast mass?

A) Degree of tenderness

B) Relative temperature

C) Mobility during palpation

D) Definition of mass borders

Which type of mass generally has clearly defined borders?

A) Well-delimited cyst

B) Diffuse infiltrative lesion

C) Poorly defined mass

D) Irregular invasive lesion

What does consistency describe when documenting a breast mass?

A) Clock-face location

B) Number of lesions

C) Hardness of the mass

D) Distance from nipple

What does mobility describe during breast mass examination?

A) Color of overlying skin

B) Movement relative to surrounding tissue

C) Shape of glandular tissue

D) Presence of nipple discharge

Which structures may a fixed breast mass be attached to?

A) Axillary hair follicles

B) Skin, muscle, or chest wall

C) Lactiferous ducts

D) Nipple smooth muscle

What is the position of many expert groups regarding routine breast self-examination (BSE)?

A) Recommend it daily

B) Require it before mammography

C) Do not routinely encourage it

D) Recommend it twice weekly

What have several studies shown regarding routine breast self-examination?

A) Limited demonstrated benefit

B) Complete prevention of cancer

C) Elimination of false positives

D) Replacement of mammography

What concept do many expert groups encourage instead of routine breast self-examination?

A) Daily breast compression

B) Monthly breast imaging

C) Breast self-awareness

D) Routine nipple stimulation

What should patients do if they notice concerning breast changes?

A) Seek medical attention promptly

B) Ignore changes until menstruation

C) Wait until severe pain develops

D) Avoid discussing the findings

What is the primary role of the posterior pituitary gland?

A) Synthesizes oxytocin and ADH

B) Produces anterior pituitary hormones

C) Synthesizes prolactin

D) Stores and releases hypothalamic hormones

Which hypothalamic nuclei primarily produce oxytocin?

A) Arcuate nuclei

B) Paraventricular nuclei

C) Ventromedial nuclei

D) Dorsomedial nuclei

Which hypothalamic nuclei primarily produce ADH?

A) Mammillary nuclei

B) Arcuate nuclei

C) Paraventricular nuclei

D) Supraoptic nuclei

How do oxytocin and ADH reach the posterior pituitary?

A) Through the portal venous system

B) Through cerebrospinal fluid

C) Through hypothalamic neuronal axons

D) Through lymphatic drainage

Where are hypothalamic hormones stored before posterior pituitary release?

A) Neuronal axon terminals

B) Anterior pituitary follicles

C) Hypothalamic capillaries

D) Cerebral ventricles

What triggers oxytocin and ADH release from the posterior pituitary?

A) Direct adrenal stimulation

B) Increased thyroid hormone

C) Pancreatic insulin secretion

D) Signals from hypothalamic neurons

Which hormone-receptor system is implicated in female-selective pain signaling?

A) Insulin and insulin receptor

B) Growth hormone and GHR

C) Prolactin and prolactin receptor

D) Cortisol and glucocorticoid receptor

Dysregulation of prolactin receptor isoforms may contribute to which conditions?

A) Congenital heart disorders

B) Primary renal diseases

C) Inherited bleeding disorders

D) Female-prevalent pain disorders

How does breast cancer incidence in the United States compare with Europe and Asia?

A) Approximately equal

B) Higher

C) Slightly lower

D) Much lower

Which racial and ethnic groups have the highest breast cancer incidence?

A) Black and Hispanic females

B) Asian and Hispanic females

C) White and Black females

D) White and Asian females

How do early menarche and late menopause affect breast cancer risk?

A) Unchanged risk

B) Increased risk

C) Variable risk

D) Decreased risk

From which ribs does the breast extend?

A) First–second to sixth–seventh

B) First–second to fifth–sixth

C) Second–third to sixth–seventh

D) Third–fourth to seventh–eighth

Which quadrant contains the most mammary tissue and frequently develops neoplasia?

A) Upper inner quadrant

B) Lower inner quadrant

C) Upper outer quadrant

D) Lower outer quadrant

Which breast structure serves as a milk reservoir during lactation?

A) Terminal duct

B) Areolar gland

C) Mammary lobule

D) Milk sinus

How many lobes comprise breast glandular tissue?

A) 5–10 lobes

B) 10–15 lobes

C) 25–35 lobes

D) 15–25 lobes

How many lobules subdivide each breast lobe?

A) 50–75 lobules

B) 25–40 lobules

C) 100–125 lobules

D) 75–100 lobules

Which glands surround the nipple and cluster near milk sinuses?

A) Apocrine glands

B) Eccrine glands

C) Sebaceous glands

D) Mucous glands

What are the sebaceous glands of the areola called?

A) Cooper ligaments

B) Milk lines

C) Mammary sinuses

D) Montgomery tubercles

Which breast tissue projections fuse with outer superficial fascial layers to provide support?

A) Cooper ligaments

B) Milk sinuses

C) Areolar glands

D) Mammary lobules

Which artery supplies blood to the breast according to these notes?

A) Internal mammary artery

B) Facial artery

C) Inferior mesenteric artery

D) Superior thyroid artery

What is prepubertal elevation of the breast and nipple called?

A) Areolar expansion

B) Breast engorgement

C) Lactational budding

D) Breast bud stage

What describes breast enlargement, density, and nodularity 3–5 days before menstruation?

A) Engorgement

B) Retraction

C) Galactorrhea

D) Inversion

What thin, yellowish breast secretion may appear as pregnancy approaches the third trimester?

A) Bloody discharge

B) Serous discharge

C) Colostrum

D) Mature milk

As pregnancy approaches which trimester may colostrum appear?

A) Third trimester

B) First trimester

C) Second trimester

D) Fourth trimester

Where do nerve impulses from suckling travel?

A) Adrenal medulla

B) Hypothalamus

C) Anterior pituitary

D) Thyroid gland

Which hormone does the anterior pituitary secrete following hypothalamic stimulation to produce milk?

A) Estrogen

B) Prolactin

C) Oxytocin

D) Progesterone

Where does prolactin act to stimulate milk production?

A) Muscle surrounding glandular tissue

B) Areolar sebaceous glands

C) Glandular breast tissue

D) Cooper ligaments

Which hormone contracts cells around glandular tissue to force milk into ducts?

A) Oxytocin

B) Progesterone

C) Prolactin

D) Estrogen

Which epithelial ridge can give rise to extra nipples or areolas?

A) Milk line

B) Mammary duct

C) Milk sinus

D) Cooper ligament

Where does each milk line extend?

A) Clavicle to nipple

B) Sternum to umbilicus

C) Nipple to axilla

D) Axilla to inguinal region

Which nipple finding is concerning for breast cancer?

A) Premenstrual fullness

B) Cyclic breast tenderness

C) Normal areolar pigmentation

D) Nipple inversion

Which type of nipple secretion is concerning for breast cancer?

A) Normal sweat

B) Nipple discharge

C) Areolar sebum

D) Skin moisture

What is concerning when it occurs in skin overlying a breast lump?

A) Unchanged coloration

B) Normal pores

C) Skin changes

D) Uniform texture

A lump enlarging during premenstrual and menstrual phases may indicate what? A) Cooper ligament rupture B) Paget disease C) Natural nodularity or fibrocystic changes D) Intraductal carcinoma

According to these notes, what commonly causes cyclic breast pain?

A) Arterial blockage

B) Ligament rupture

C) Hormonal fluctuations

D) Duct obstruction

According to these notes, what evaluation is needed for cyclic breast pain?

A) Immediate imaging

B) Surgical exploration

C) Diagnostic biopsy

D) No further evaluation

Which nipple discharge is thin, watery, and may leave yellowish stains?

A) Milky discharge

B) Serous discharge

C) Purulent discharge

D) Bloody discharge

Bloody nipple discharge is associated with which lesion?

A) Fibrocystic nodule

B) Paget lesion

C) Cooper fibrosis

D) Intraductal papilloma

Among which females is intraductal papilloma noted as common?

A) Pregnant and menstruating females

B) Postmenopausal females

C) Prepubertal females

D) Only nursing females

What is milk secretion while not nursing called?

A) Engorgement

B) Galactorrhea

C) Colostrum

D) Serous discharge

What term describes prominent breast skin pores caused by edema?

A) Areolar tubercles

B) Peau d'orange

C) Nipple inversion

D) Retraction phenomena

What is dimpling caused by a neoplasm and its fibrotic response called?

A) Retraction phenomena

B) Galactorrhea

C) Peau d'orange

D) Engorgement

Which structures are abnormally pulled by malignancy causing skin retraction?

A) Areolar glands

B) Cooper ligaments

C) Mammary lobules

D) Milk sinuses

Paget disease of the breast is a surface manifestation of which underlying condition?

A) Areolar sebaceous enlargement

B) Benign duct dilation

C) Hormonal engorgement

D) Invasive or intraductal carcinoma

Where may extramammary Paget disease occur?

A) Chest or abdomen

B) Neck or scalp

C) Arms or legs

D) Anus or genitalia

What is enlargement of one or both male breasts called?

A) Gynecomastia

B) Engorgement

C) Colostrum

D) Galactorrhea

Which two tumor suppressor genes confer breast cancer susceptibility and participate in gene repair?

A) BRCA1 and RAD51

B) BRCA2 and p53

C) BRCA1 and BRCA2

D) p53 and RAD51

Which proteins associated with BRCA1 and BRCA2 participate in DNA repair and transcriptional activation?

A) BRCA1 and p53

B) p53 and RAD51

C) BRCA2 and RAD51

D) BRCA1 and BRCA2

Which chromosomes contain BRCA1 and BRCA2, respectively?

A) 13 and 17

B) 17 and 18

C) 13 and 18

D) 17 and 13

What is the most important risk factor for cervical cancer?

A) BRCA1 mutations

B) Benign HPV papillomas

C) High-risk HPV infection

D) BRCA2 mutations

Which benign tumors are associated with HPV?

A) Adenomas

B) Fibromas

C) Leiomyomas

D) Papillomas

Which HPV types are considered high-risk or oncogenic?

A) Types 6 and 11

B) Types 16 and 18

C) Types 31 and 33

D) Types 52 and 58

Regardless of sexual activity initiation, at what age should females begin cervical cytology screening?

A) 18 years

B) 21 years

C) 25 years

D) 30 years

According to these notes, HPV testing should accompany Pap testing in females older than what age?

A) 18 years

B) 21 years

C) 25 years

D) 30 years

Which HPV vaccine is identified as the only approved vaccine in the United States?

A) Cervarix

B) Gardasil

C) Gardasil9

D) Silgard

Which structure is a rounded prominence of fatty tissue overlying the pubic symphysis?

A) Anterior commissure

B) Labia majora

C) Mons veneris

D) Vaginal vestibule

Which two large skinfolds form the lateral boundaries of the vulva?

A) Labia majora

B) Labia minora

C) Mons veneris

D) Anterior commissure

What is formed when the labia majora meet anteriorly at the mons veneris?

A) Anterior commissure

B) Vaginal introitus

C) Vestibule

D) Hymen

Which female structure corresponds to the male scrotum? A) Labia minora B) Clitoris C) Labia majora D) Mons veneris

Which narrow, pigmented skinfolds lie between the labia majora and enclose the vestibule? A) Hymen B) Labia majora C) Labia minora D) Anterior commissure

What is the area located between the labia minora called? A) Vaginal introitus B) Vestibule C) Mons veneris D) Anterior commissure

Which paraurethral glands open lateral to the urethra? A) Skene glands B) Bartholin glands C) Cowper glands D) Montgomery tubercles

Which major vestibular glands are also called vulvovaginal glands and correspond to male Cowper glands? A) Bartholin glands B) Skene glands C) Montgomery glands D) Sebaceous glands

Which female structure is analogous to the male penis? A) Hymen B) Vestibule C) Clitoris D) Labia minora

Which circular fold of tissue partially occludes the vaginal introitus? A) Anterior commissure B) Labia minora C) Vaginal vestibule D) Hymen

Which structure lies in the lower vestibule and marks the border between external and internal genitalia? A) Hymen B) Vaginal introitus C) Urethral meatus D) Anterior commissure

Which nerve innervates the majority of the vulva? A) Ilioinguinal nerve B) Genitofemoral nerve C) Hypogastric nerve D) Pudendal nerve

Which nerves innervate the vulvar region anterior to the urethral meatus? A) Pudendal and ilioinguinal nerves B) Pudendal and genitofemoral nerves C) Pudendal nerves only D) Ilioinguinal and genitofemoral nerves

Which arteries predominantly supply the external genitalia and perineum? A) Internal pudendal arteries B) Internal iliac arteries C) Uterine arteries D) Middle hemorrhoidal arteries

Which substance in superficial vaginal cells is metabolized by normal vaginal flora? A) Lactic acid B) Oxytocin C) Colostrum D) Glycogen

What does normal vaginal flora produce from glycogen that partly protects against infection? A) Glycogen B) Lactic acid C) Colostrum D) Prolactin

Which three arteries contribute to the arterial supply of the vagina? A) Internal pudendal, uterine, middle hemorrhoidal arteries B) Internal iliac, uterine, internal pudendal arteries C) Internal iliac, internal pudendal, uterine arteries D) Internal iliac, uterine, middle hemorrhoidal arteries

Where does lymph from the lower third of the vagina drain? A) Inguinal nodes B) Hypogastric nodes C) Sacral nodes D) Hypogastric and sacral nodes

Where does lymph from the upper two-thirds of the vagina drain? A) Inguinal and sacral nodes B) Hypogastric and sacral nodes C) Inguinal and hypogastric nodes D) Inguinal nodes alone

What is cervical mucus stretching into a fine thread called? A) Ferning B) Spinnbarkeit C) Retraction phenomena D) Engorgement

What pattern of salt crystals appears when dried cervical mucus is viewed under low-power microscopy? A) Diffuse pattern B) Nodular pattern C) Fern pattern D) Retraction pattern

When do spinnbarkeit and ferning reach their maximum? A) Throughout the menstrual cycle B) Midpoint of the menstrual cycle C) Beginning of the menstrual cycle D) End of the menstrual cycle

Which arteries supply the uterus? A) Ovarian and internal pudendal arteries B) Uterine and ovarian arteries C) Internal pudendal and middle hemorrhoidal arteries D) Uterine and internal pudendal arteries

Which lymph nodes receive drainage from the uterine fundus? A) Sacral nodes B) Hypogastric nodes C) Lumbar nodes D) Inguinal nodes

Where do the left and right ovarian veins drain, respectively? A) Left renal vein; inferior vena cava B) Left renal vein; right renal vein C) Inferior vena cava; left renal vein D) Left iliac vein; right iliac vein

Which structures are collectively called the adnexa? A) Uterus, cervix, fallopian tubes B) Ovaries, vagina, supporting ligaments C) Ovaries, uterus, supporting ligaments D) Ovaries, fallopian tubes, supporting ligaments

What syndrome causes weakness, depression, irritability, and breast tenderness before menstruation? A) Menopause B) Premenstrual syndrome C) Mittelschmerz D) Secondary amenorrhea

What does parity count? A) Live births after 20 weeks B) Pregnancies reaching at least 20 weeks C) Pregnancies reaching at least 37 weeks D) All pregnancies regardless of duration

Which gestational range defines a term pregnancy? A) 30–36 weeks B) 20–36 weeks C) 37–42 weeks D) 42–45 weeks

Which gestational range defines a preterm pregnancy? A) 20 to less than 37 weeks B) 20 to less than 42 weeks C) Before 20 weeks D) 37 to 42 weeks

What is the updated term for menorrhagia, or excessive bleeding during a menstrual period? A) Heavy menstrual bleeding (AUB/HMB) B) Intermenstrual bleeding (AUB/IMB) C) Heavy and intermenstrual bleeding D) Secondary amenorrhea

What is the updated term for metrorrhagia, or normal-amount bleeding at irregular noncyclic intervals between periods? A) Heavy and intermenstrual bleeding B) Primary amenorrhea C) Intermenstrual bleeding (AUB/IMB) D) Heavy menstrual bleeding (AUB/HMB)

What is the updated term for menometrorrhagia, or heavier periods with increased bleeding between cycles? A) Heavy menstrual bleeding (AUB/HMB) B) Premenstrual syndrome C) Intermenstrual bleeding (AUB/IMB) D) Heavy and intermenstrual bleeding

What is amenorrhea called when menstruation has never occurred? A) Menopause B) Premenstrual syndrome C) Primary amenorrhea D) Secondary amenorrhea

What is amenorrhea called when menstruation previously occurred but ceased, as in pregnancy? A) Menopause B) Primary amenorrhea C) Secondary amenorrhea D) Premenstrual syndrome

How many months without a menstrual cycle define menopause? A) 12 months B) 18 months C) 6 months D) 9 months

What forms when the anterior vaginal wall descends, causing urinary frequency and stress incontinence? A) Rectocele B) Cystocele C) Vaginismus D) Procidentia

What forms when the posterior vaginal wall descends, causing constipation, tenesmus, or incontinence? A) Rectocele B) Procidentia C) Vaginismus D) Cystocele

What is complete vaginal inversion with the uterus lying outside the vulva called? A) Cystocele B) Rectocele C) Vaginismus D) Procidentia

Which vulvar dystrophy produces uniformly red, smooth, shiny, almost transparent genital skin? A) Virilization B) Premenstrual syndrome C) Extramammary Paget disease D) Lichen sclerosus

Which malignancy makes lichen sclerosus a premalignant condition? A) Squamous cell carcinoma B) Invasive breast carcinoma C) Cervical papilloma D) Intraductal carcinoma

What is acute unilateral lower pelvic pain at ovulation called? A) Mittelschmerz B) Dyspareunia C) Vaginismus D) Premenstrual syndrome

What is pain during or after sexual intercourse called? A) Procidentia B) Vaginismus C) Mittelschmerz D) Dyspareunia

Which condition involves severe pelvic pain and involuntary spasm with attempted penetration? A) Procidentia B) Vaginismus C) Dyspareunia D) Mittelschmerz

What is extensive hirsutism with receding temporal hair, voice deepening, and clitoral enlargement called? A) Lichen sclerosus B) Premenstrual syndrome C) Gynecomastia D) Virilization

What type of urinary incontinence occurs during straining or coughing? A) Overflow incontinence B) Urge incontinence C) Stress incontinence D) Functional incontinence

Which conditions can cause neurologic incontinence? A) Cerebral, spinal cord, peripheral nerve lesions B) Bladder pressure, urethral injury, uterine prolapse C) Vulvar irritation, vaginal inflammation, pelvic pain D) Hormonal changes, cervical growths, vaginal nodularity

What causes overflow incontinence without bladder contraction? A) Bladder pressure exceeds urethral pressure B) Urethral pressure exceeds bladder pressure C) Bladder pressure equals urethral pressure D) Bladder pressure falls below urethral pressure

Which pattern exemplifies psychogenic incontinence? A) Leakage caused by coughing or straining B) Leakage with excessive bladder pressure C) Leakage from spinal or cerebral dysfunction D) Nighttime bedwetting for warmth; daytime attention-seeking

How long without conception after unprotected, properly timed intercourse defines infertility below versus above age 35? A) 6 months; 12 months B) 12 months; 12 months C) 6 months; 6 months D) 12 months; 6 months

What examination position involves lying on the back with feet in heel rests? A) Dorsolithotomy position B) Lateral examination position C) Prone examination position D) Seated examination position

What is the usual appearance of normal Fordyce spots on the inner labia minora? A) Painful nonindurated ulcers B) Bright red protruding masses C) Asymptomatic yellowish-white papules D) Tender fluid-filled vesicles

What do Fordyce spots represent? A) Inflamed vestibular glands B) Ectopic sebaceous glands C) Enlarged urethral tumors D) Dried cervical salt crystals

Which benign tumor at the urethral orifice is relatively common after menopause? A) Fordyce spot B) Urethral caruncle C) Bartholin gland tumor D) Vaginal papilloma

What is the typical appearance of a urethral caruncle? A) Red or flesh-colored mass protruding through orifice B) Yellowish-white asymptomatic inner labial papules C) Tender nonindurated ulcers with lymphadenopathy D) Transparent thin secretions without odor

How are urethral caruncles differentiated from other tumors? A) Biopsy B) Pap test C) HPV cotesting D) Cervical mucus microscopy

Which speculum and bill shape are commonly used for adult patients? A) Pedersen, with wider curved-sided bills B) Graves, with wider curved-sided bills C) Graves, with narrower flat bills D) Pedersen, with narrower flat bills

Which speculum and bill shape are used for a small introitus? A) Graves, with wider curved-sided bills B) Pedersen, with wider curved-sided bills C) Graves, with narrower flat bills D) Pedersen, with narrower flat bills

Which direction of speculum insertion should be avoided to prevent clitoral or urethral injury? A) Vertical B) Oblique C) Horizontal D) Angled

What may cause bluish discoloration of the cervix? A) Vaginitis or Fordyce spots B) Pregnancy or a large tumor C) Chancroid or lichen sclerosus D) Cystocele or rectocele

What is the external cervical os shape without previous vaginal delivery? A) Slit-shaped B) Triangular C) Round D) Oval

What structures are palpated during bimanual examination? A) Vagina and vulva B) Uterus and adnexa C) Urethra and perineum D) Labia and vestibule

How far can the cervix usually be moved in any direction? A) 1–2 cm B) 4–6 cm C) 6–8 cm D) 2–4 cm

Adnexal tenderness or enlargement is relatively specific for what? A) Normal menstruation B) Normal ovulation C) Typical pelvic anatomy D) Pathologic state

What does uterosacral ligament and pouch of Douglas tenderness with nodularity suggest? A) Vaginitis B) Vaginismus C) Endometriosis D) Chancroid

Which finger alone should be used vaginally for bimanual examination in a virgin according to these notes? A) Right index finger B) Left middle finger C) Right index and middle fingers D) Right middle finger

How much higher can the examiner often reach with a rectovaginal examination? A) 2–4 cm B) 4–6 cm C) 1–2 cm D) 6–8 cm

Which condition inflames the vagina and vulva and causes pain, itching, and discharge? A) Vaginitis B) Vaginismus C) Dyspareunia D) Endometriosis

Which description matches normal vaginal discharge? A) Thick, opaque, strongly odorous discharge B) Thin, bloody, strongly odorous discharge C) Thin, transparent, little or no odor D) Thick, yellowish, foul-smelling discharge

Which disease causes tender, nonindurated, generally painful ulcers and lymphadenopathy after papules or vesicles? A) Vaginitis B) Lichen sclerosus C) Chancroid D) Fordyce spots

How many days after chancroid exposure may papules or vesicles appear? A) 1–3 days B) 20–30 days C) 40–60 days D) 5–15 days

How often should average-risk females aged 21–29 undergo cervical cytology according to these notes? A) Every year B) Every 3 years C) Every 5 years D) Every 10 years

In which age group should HPV cotesting be avoided during cervical screening? A) Older than 30 years B) Ages 30–65 years C) Older than 65 years D) Younger than 30 years

How often should average-risk females aged 30–65 receive cytology with HPV cotesting? A) Every year B) Every 5 years C) Every 3 years D) Every 10 years

When may cervical cancer screening stop with adequate screening history? A) After age 65 B) After age 30 C) After age 35 D) After age 50

When is cervical screening still needed after hysterectomy according to these notes? A) Cervix removed during total hysterectomy B) Cervix absent after hysterectomy C) Cervix remains after supracervical hysterectomy D) All hysterectomies regardless of cervix