Question: A woman complains of infrequent menses with intervals greater than 35 days. This condition is termed: oligomenorrhea. Correct polymenorrhea. metrorrhagia. menorrhagia. Explanation: Oligomenorrhea is infrequent bleeding with menses occurring at greater than 35- day intervals, or 4-9 menstrual cycles per year. Polymenorrhea occurs when there are fewer than 21-day intervals between menses. Menorrhagia refers to excessive or prolonged menstrual flow occurring at regular intervals. Metrorrhagia refers to intermenstrual bleeding. Question: Upon examination of the vagina, a swollen red ring is noted around the urethral opening. This finding is most consistent with a: prolapse of the urethral mucosa. Correct urethral caruncle. cystocele. cystourethrocele. Explanation: A prolapsed urethral mucosa forms a swollen red ring around the urethral meatus. A urethral caruncle is a small, red, benign tumor visible at the posterior part of the urethral meatus. It usually occurs in postmenopausal women. A cystocele is a bulge of the upper two-thirds of the anterior vaginal wall and the bladder above it. It results from weakened supporting tissues. When the entire anterior vaginal wall, together with the bladder and urethra, is involved in the bulge, a cystourethrocele is present. Question: When palpating the cervix during the bimanual exam, cervical motion tenderness (chandelier sign) is noted. This tenderness could be suggestive of: retroversion of the uterus. pelvic inflammatory disease. Correct vulvar lesions. Bartholin gland infection. Explanation: Cervical motion tenderness, also known as Chandelier's sign, and/or adnexal tenderness, suggest pelvic inflammatory disease, ectopic pregnancy, or appendicitis. Question: When performing a rectal exam on a female, a hard nodular rectal "shelf" is palpable at the tip of the examiner's finger. This finding is suggestive of: an ovarian cyst. metastatic tissue in the rectouterine pouch. Correct rectal polyp. carcinoma of the rectum. Explanation: Widespread peritoneal metastases from any source may develop in the area of the peritoneal reflection anterior to the rectum. A firm to hard nodular rectal “shelf” may be just palpable with the tip of the examining finger. In a woman, this shelf of metastatic tissue develops in the rectouterine pouch, behind the cervix and the uterus. Rectal polyps and carcinoma of the rectum, if palpable, are typically located in the lower section of the rectum. To palpate the ovaries, a bimanual pelvic examination would be more appropriate. Question: When performing an examination of the external genitalia of a female patient, a small, firm, round cystic nodule in the labia is identified. This lesion is most consistent with: a syphilitic chancre. an epidermoid cyst. Correct Condylomata acuminata. genital herpes. Explanation: A small, firm, round cystic nodule in the labia suggests an epidermoid cyst. They appear yellowish in color with a dark punctum marking the blocked opening of the gland. A syphilitic chancre appears as a firm, painless ulcer and suggests the chancre of primary syphilis. Because most chancres in women develop internally, they often go undetected. Genital warts or Condylomata acuminata are warty lesions on the labia and within the vestibule resulting from infection with human papillomavirus. Genital herpes appears as shallow, small, painful ulcers on red bases. Question: In a female diagnosed with a first-degree uterine prolapse, the cervix: is located in its normal position. has slipped but is well within the vagina. Correct is located in the introitus. and vagina are outside the introitus. Explanation: Uterine prolapse occurs in progressive stages. The uterus becomes retroverted and descends down the vaginal canal to the exterior. In first-degree prolapse, the cervix is still well within the vagina. In second-degree prolapse, it is at the introitus. In thirddegree prolapse (procidentia), the cervix and vagina are outside the introitus. Question: When performing a bimanual exam of the vagina, the examiner should lubricate the index and middle fingers of a gloved hand. From a standing position, the fingers should be inserted into the vagina while exerting pressure primarily: anteriorly. posteriorly. Correct toward the "4-o"clock" position. toward the "8-o"clock" position. Explanation: When performing a bimanual exam of the vagina, the examiner should lubricate the index and middle fingers of one of the gloved hands, and from a standing position, insert them into the vagina while exerting pressure primarily posteriorly.