Chapter 14: Female Genitalia

Chapter 14: Female Genitalia

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

Multiple Choice

1. A 22-year-old architecture major comes to your office, complaining of severe burning with urination, a fever of 101 degrees, and aching all over. She denies any upper respiratory, gastrointestinal, cardiac, or pulmonary symptoms. Her past medical history consists of severe acne. She is currently on an oral contraceptive. She has had no pregnancies or surgeries. She reports one new partner within the last month. She does not smoke but does drink occasionally. Her parents are both in good health. On examination you see a young woman appearing slightly ill. Her temperature is 100.3 and her pulse and blood pressure are unremarkable. Her head, ears, eyes, nose, throat, cardiac, pulmonary, and abdominal examinations are unremarkable. Palpation of the inguinal nodes shows lymphadenopathy bilaterally. On visualization of the perineum there are more than 10 shallow ulcers along each side of the vulva. Speculum and bimanual examination are unremarkable for findings, although she is very tender at the introitus. Urine analysis has some white blood cells but no red blood cells or bacteria. Her urine pregnancy test is negative.

Which disorder of the vulva is most likely in this case?

1. A) Genital herpes
2. B) Condylomata acuminata
3. C) Syphilitic chancre
4. D) Epidermoid cyst

Ans:  A

Chapter:  14

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Feedback:  Genital herpes consists of small, shallow, painful ulcers. Primary infections are often associated with fever, malaise, and regional lymphadenopathy. The outbreak occurs generally between 1 and 3 weeks after exposure.  Herpes is contagious and the majority of transmission occurs without the presence of obvious lesions.  Transmission during passage through the birth canal can cause serious illness in affected newborns.

2. A 42-year-old realtor comes to your clinic, complaining of “growths” in her vulvar area. She is currently undergoing a divorce and is convinced she has a sexually transmitted disease. She denies any vaginal discharge or pain with urination. She has had no fever, malaise, or night sweats. Her past medical history consists of depression and hypothyroidism. She has had two spontaneous vaginal deliveries and one cesarean section. She has had no other surgeries. She denies smoking or drug use. She has two to three drinks weekly. Her mother also has hypothyroidism and her father has high blood pressure and hypercholesterolemia. On examination you see a woman who is anxious but appears otherwise healthy. Her blood pressure, pulse, and temperature are unremarkable. On visualization of the perineum you see two 2- to 3-mm, round, yellow nodules on the left labia. On palpation they are nontender and quite firm.

What diagnosis best fits this description of her examination?

1. A) Genital herpes
2. B) Condylomata acuminata
3. C) Syphilitic chancre
4. D) Epidermoid cyst

Ans:  D

Chapter:  14

Page and Header:  546, Table 14-1

Feedback:  These cysts are small, firm, round cystic nodules in the labia that are nonpainful.  These do not represent a sexually transmitted infection, but rather a blocked sebaceous gland.

3. A 30-year-old paralegal analyst comes to your clinic, complaining of a bad-smelling vaginal discharge with some mild itching, present for about 3 weeks. She tried douching but it did not help. She has had no pain with urination or with sexual intercourse. She has noticed the smell increased after intercourse and during her period last week. She denies any upper respiratory, gastrointestinal, cardiac, or pulmonary symptoms. Her past medical history consists of one spontaneous vaginal delivery. She is married and has one child. She denies tobacco, alcohol, or drug use. Her mother has high blood pressure and her father died from a heart disease. On examination she appears healthy and has unremarkable vital signs. On examination of the perineum there are no lesions noted. On palpation of the inguinal nodes there is no lymphadenopathy. On speculum examination a thin gray-white discharge is seen in the vault. The pH of the discharge is over 4.5 and there is a fishy odor when potassium hydroxide (KOH) is applied to the vaginal secretions on the slide. Wet prep shows epithelial cells with stippled borders (clue cells).

What type of vaginitis best describes her findings?

1. A) Trichomonas vaginitis
2. B) Candida vaginitis
3. C) Bacterial vaginosis
4. D) Atrophic vaginitis

Ans:  C

Chapter:  14

Page and Header:  550, Table 14-6

Feedback:  Bacterial vaginosis generally has a homogenous, grayish-white, thin discharge. The pH will be over 4.5 and the KOH wet prep releases a strong fishy odor, known as a “positive whiff test.” Any basic pH fluid (semen or blood) will cause the fish-like odor to occur, often after intercourse, as with this patient. The wet prep will show clue cells, which are epithelial cells with borders stippled by bacteria.

4. A 48-year-old high school librarian comes to your clinic, complaining of 1 week of heavy discharge causing severe itching. She is not presently sexually active and has had no burning with urination. The symptoms started several days after her last period. She just finished a course of antibiotics for a sinus infection. Her past medical history consists of type 2 diabetes and high blood pressure. She is widowed and has three children. She denies tobacco, alcohol, or drug use. Her mother has high blood pressure and her father died of diabetes complications. On examination you see a healthy-appearing woman. Her blood pressure is 130/80 and her pulse is 70. Her head, eyes, ears, nose, throat, cardiac, lung, and abdominal examinations are unremarkable. Palpation of the inguinal lymph nodes is unremarkable. On visualization of the vulva, a thick, white, curdy discharge is seen at the introitus. On speculum examination there is a copious amount of this discharge. The pH of the discharge is 4.1 and the KOH whiff test is negative, with no unusual smell. Wet prep shows budding hyphae.

What vaginitis does this patient most likely have?

1. A) Trichomonas vaginitis
2. B) Candida vaginitis
3. C) Bacterial vaginosis
4. D) Atrophic vaginitis

Ans:  B

Chapter:  14

Page and Header:  550, Table 14-6

Feedback:  Candida is associated with a thick, white, curd-like discharge that causes severe pruritus. The pH will be normal (£4.5) and the KOH whiff test will be normal. The wet prep often shows yeast spores and budding hyphae. Candida is very common in diabetics and after recent use of antibiotics.  It is not thought to be sexually transmitted.