Chapter 20: Female Genitalia

Study Questions Chapter 20: Female Genitalia

1. Your patient, a 22-year-old woman, is being treated for sinusitis with an antibiotic. You can further advise her (choose two): (a) that antibiotics can lessen the effectiveness of oral contraceptives. (b) that she can discontinue the antibiotic when she feels better. (c) that antibiotics can increase the chance of contracting an STD. (d) that antibiotics can increase the chance of developing Candida vaginitis. Answer: a, d Rationale: The whole course of antibiotics should be taken as directed to ensure cure and to prevent organisms from becoming resistant to them. Antibiotics do not increase the chance of contracting STDs, but they can interfere with normal vaginal flora and lead to a Candida vaginitis.

2. Undergoing an exam of her genitalia can be a stressful event for some women. Nurses can make this a more positive experience by doing all of the following except: (a) being quiet and not saying a word. (b) allowing her to view and touch any items which do not need to remain sterile. (c) ensure her privacy and drape her properly. (d) educate her about her body and self-care. Answer: a Rationale: Nurses can do much to relieve concerns and discomfort and to empower women in their medical care. Explaining to the patient what will happen helps alleviate fears.

3. Your patient, a 38-year-old woman, presents with a complaint of vaginal discharge. It is summer, and she spends a lot of time at the pool with her children. You examine her and note a white, cottage cheese-like discharge. There is no odor. You suspect: (a) normal physiological discharge. (b) bacterial vaginosis. (c) Trichomonas. (d) Candida. Answer: d Rationale: This is the classic appearance of Candida infections.

Question 4 is about the following patient: A woman brings her 4-year-old daughter to see you because the child has been acting very anxious for the last two days. She screamed about taking a bath yesterday and cried about “hurting” when she sat in the bath water.

4. The mother tells you that she left her daughter with her boyfriend the evening before this started. The little girl agrees to put on the examination gown, but it takes 30 minutes before she will take off her panties. You note a 2” x 3” bruise on her right upper arm and two 1” bruises on her right thigh. Her perineal area is reddened. Parting the labia, you see a tear at the vaginal introitus. The appropriate intervention would be: (a) obtaining samples to test for STDs. (b) reporting the incident to the proper criminal authorities. (c) reporting the incident to the appropriate social service or sexual assault services. (d) obtaining treatment for the child’s wounds, both physical and emotional, by referral to the proper physicians and counselors. (e) all of the above Answer: e Rationale: The child has apparently been a victim of sexual abuse, and several individuals and agencies will need to become involved. Even young children need to deal with emotional issues caused by abuse.

5. You are performing a pelvic exam on your 60-year-old patient. You note a cauliflower- like overgrowth on the cervix. This is highly suggestive of: (a) carcinoma. (b) nabothian cysts. (c) ectropion. (d) cervical polyps. Answer: a Rationale: Carcinoma of the cervix may manifest as a cauliflower-like overgrowth.

6. You are performing a Pap smear on your 25-year-old patient, and after obtaining all other vaginal specimens, you swab the cervix with a cotton-tipped applicator that has been soaked in 5% acetic acid. You note a rapid blanching with jagged borders. This is highly suggestive of: (a) Candida. (b) human papillomavirus. (c) trichomoniasis. (d) Neisseria gonorrhoeae. Answer: b Rationale: This whitening is probably due to human papillomavirus.

7. While assessing the external genitalia of your patient, you see a reddish, round ulcer with a depressed center, and raised, indurated edges. This is the typical appearance of: (a) a Bartholin’s cyst. (b) a condyloma latum. (c) a herpes simplex lesion. (d) a chancre. Answer: d Rationale: This is the chancre of syphilis.

8. Your pregnant patient has a positive Chadwick’s sign. Her cervix is: (a) pink. (b) reddened. (c) blue. (d) pale. Answer: c Rationale: The cervix may be blue during pregnancy.

9. Risk factors for cervical cancer include: (a) infertility treatment. (b) fetal exposure to DES. (c) unopposed estrogen therapy. (d) multiple sexual partners. Answer: d Rationale: Multiple sexual partners, or partners who have had multiple partners, put a woman at greater risk for cervical cancer.