Reproductive System 1: The Audio PANCE and PANRE Board Review Podcast Topic Specific Review Episode 39

June 20, 2016 By Stephen Pasquini PA-C Leave a Comment

Welcome to episode 39 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

Join me as I continue to cover topic specific PANCE and PANRE review from the Academy course content following the NCCPA™ content blueprint.

Click here to download my interactive content blueprint checklist

This week we will be covering 10 topic specific OBGYN/reproductive board review questions.

The reproductive system accounts for 8% of your PANCE/PANRE board exam.

Below you will find an interactive exam to complement the podcast.

I hope you enjoy this free audio component to the examination portion of this site. The full reproductive review includes over 107 reproductive system content blueprint specific questions and is available to all members of the PANCE and PANRE Academy or my new site SMARTY PANCE!!

You can download and listen to past FREE episodes here, on iTunes, Google Play and Stitcher Radio.
You can listen to the latest episode, take an interactive quiz and download your results below.

Listen Carefully Then Take The Quiz

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Reproductive System PANCE and PANRE Podcast Quiz

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Congratulations - you have completed Audio PANCE and PANRE OBGYN 1. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%

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Question 1

On examination of a pregnant patient the physician assistant notes the fundal height is at the level of the umbilicus. This corresponds to what gestational age?

A	16 weeks Hint: See B for explanation.
B	20 weeks
C	24 weeks Hint: See B for explanation.
D	28 weeks Hint: See B for explanation.

Question 1 Explanation:

At 20-22 weeks the fundal height is typically at the level of the umbilicus.

Question 2

A couple presents having not been able to conceive over the past 12 months. Evaluation of the male has been normal. The female has had regular menses. Ovulation can be confirmed with mid-luteal phase measurement of which of the following?

A	Thyroid stimulating hormone Hint: TSH is used only if signs of thyroid disease are present
B	Luteinizing hormone Hint: LH, FSH, and prolactin are used to confirm ovulation in patients with irregular menstrual cycles.
C	Progesterone
D	Prolactin Hint: See B for explanation.

Question 2 Explanation:

Ovulation can best be confirmed by measuring serum progesterone levels in the mid-luteal phase.

Question 3

A 30 year-old presents with persistent vaginal discharge and vulvar pruritus. The discharge is profuse, frothy, greenish, and foul smelling. pH of the vagina is 6.0. Which of the following is the most likely diagnosis?

A	Vulvovaginal candidiasis Hint: Vulvovaginal candidiasis presents with a thick, curd-like discharge and vulvar pruritus.
B	Bacterial vaginosis Hint: Bacterial vaginosis presents with malodorous, gray-white discharge. The pH is typically 5.0-5.5.
C	Trichomoniasis
D	Atrophic vaginitis Hint: Atrophic vaginitis is usually without discharge, but presents with vaginal dryness.

Question 3 Explanation:

Trichomoniasis presents with vulvar pruritus and a profuse, frothy, greenish, foul-smelling vaginal discharge with a pH usually exceeding 5.0.

Question 4

A 30-week pregnant patient presents with sudden onset of profuse, painless vaginal bleeding. Which of the following is the most likely diagnosis?

A	Abruptio placentae Hint: Abruptio placentae presents with abdominal pain and vaginal bleeding.
B	Uterine rupture Hint: Uterine rupture presents with vaginal bleeding or hematuria with suprapubic pain and tenderness.
C	Placenta previa
D	Disseminated intravascular coagulation Hint: Disseminated intravascular coagulation presents with systemic signs of bleeding and thrombosis and typically presents at the time of delivery.

Question 4 Explanation:

Placenta previa presents with sudden, painless, profuse bleeding in the third trimester.

Question 5

A 25 year-old female presents with constant premenstrual pelvic pain. She also notes dysmenorrhea and dyspareunia. Which of the following is the most likely diagnosis?

A	Uterine leiomyoma Hint: Leiomyomas of the uterus may present with abnormal uterine bleeding, but typically do not present with any symptoms.
B	Endometrial polyps Hint: Endometrial polyps present with menorrhagia and intermenstrual and premenstrual bleeding, pain is not typical.
C	Ovarian cysts Hint: Ovarian cysts present with adnexal mass and acute pain upon rupture.
D	Endometriosis

Question 5 Explanation:

Endometriosis presents with premenstrual pelvic pain, dysmenorrhea, and dyspareunia.

Question 6

A female patient presents with a vaginal discharge that has a fishy odor. On wet mount examination of the discharge a few white blood cells and many stippled epithelial cells are noted. Which of the following is the treatment of choice for this patient?

A	Nonoxynol-9 Hint: Nonoxynol-9 is a spermicidal agent and not used to treat bacterial vaginosis.
B	Ceftriaxone Hint: Ceftriaxone is used in the treatment of Neisseria gonorrhoeae.
C	Metronidazole
D	Clotrimazole Hint: Clotrimazole is used in the treatment of candidiasis.

Question 6 Explanation:

Metronidazole is the treatment of choice for bacterial vaginosis. Bacterial vaginosis presents with a vaginal discharge with a fishy odor and clue cells on wet mount exam.

Question 7

A 36-week pregnant patient presents to the ED with hypertension. Physical examination reveals 2+/4+ edema in the lower extremities with hyperreflexia and clonus bilaterally. A urinalysis reveals 3+ protein. Which of the following is the best treatment option for this patient?

A	Magnesium sulfate
B	Nifedipine (Procardia) Hint: Nifedipine can lead to severe hypotension and should be avoided in this case.
C	Diazepam (Valium) Hint: Diazepam may cause respiratory depression, hypotonia, and thermoregulatory problems in the newborn and should be avoided.
D	Captopril (Capoten) Hint: Captopril and other ACE inhibitors should be avoided in pregnant patients due to side effects

Question 7 Explanation:

Magnesium sulfate is indicated in this patient with preeclampsia to reduce the risk of seizures.

Question 8

A 40 year-old female presents with a 1.5 cm well-circumscribed mass noted on mammography in the right upper, outer quadrant. Which of the following procedures is most appropriate and should be done next?

A	Fine needle aspiration
B	BRCA 1 and BRCA 2 genetic testing Hint: Although BRCA 1 and BRCA 2 genetic tests are used in the risk assessment for possible breast and ovarian cancer, it would not replace the need to perform a more definitive evaluation of an identified breast mass.
C	Serum CA-125 Hint: Serum CA-125 is a tumor marker for ovarian, not breast, cancer.
D	Radiation therapy Hint: Radiation therapy is only indicated after a diagnosis of breast cancer is proven and may be used as adjunctive therapy.

Question 8 Explanation:

Fine needle aspiration is fairly accurate, easily performed, and has minimal morbidity.

Question 9

If a woman has a normal 28-day menstrual cycle what tissue and hormonal phase occurs during the last 14 days?

A	Proliferative follicular phase under the influence of estrogen Hint: See B for explanation.
B	Secretory luteal phase under the influence of estrogen and progesterone
C	Proliferative follicular phase under the influence of estrogen and progesterone Hint: See B for explanation.
D	Secretory luteal phase under the influence of estrogen Hint: See B for explanation.

Question 9 Explanation:

The endometrial changes seen in the latter half of the cycle are under the influence of both estrogen and progesterone from the corpus luteum. During this phase, the endometrium becomes more vascularized and slightly edematous.

Question 10

A 72 year-old female presents with vulvar pruritus for the last nine months, which has progressively worsened over the last two months. She states that she went through menopause at age 54 and has been on estrogen and progesterone therapy since that time. Physical examination reveals red lesions with white plaques on the vulva. What should the next course of management include?

A	Refer to a gynecologist for biopsy
B	Refer to a dermatologist for antifungal therapy
C	Treat with a topical steroid
D	Treat with estrogen cream

Question 10 Explanation:

Vulvar squamous cell hyperplasia causes thickening and hyperkeratosis of the vulva. The lesions are red and moist and cause intense pruritus over time the area becomes thickened and a white plaque may develop. Biopsy must be done to evaluate for intraepithelial neoplasm or invasive tumor.

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