A 35-year-old woman presents with a 6-month history of heavy menstrual bleeding and pelvic pressure. She reports soaking through a pad every hour for 2 days each cycle, but denies intermenstrual bleeding. Vital signs are stable. Urine pregnancy test is negative and hemoglobin is 12.5 g/dL. Bimanual examination reveals an enlarged, mobile, non-tender uterus. Which of the following is the most appropriate initial diagnostic test?

Magnetic resonance imaging (MRI)

A 28-year-old woman requests contraception. She has a history of migraines with aura occurring once monthly. She does not smoke and has no other medical conditions. Which of the following contraceptive methods is contraindicated for this patient?

Combined oral contraceptive pill

Progestin-only oral contraceptive

A 58-year-old woman presents with a 2-week history of light vaginal spotting. She had her last menstrual period 6 years ago and has no pelvic pain. Transvaginal ultrasound reveals an endometrial thickness of 8 mm. Which of the following is the most appropriate next step in management?

Hysteroscopy with directed biopsy

Repeat transvaginal ultrasound in 6 months

A 32-year-old woman has a routine cervical cancer screening. Her Pap test result shows atypical squamous cells of undetermined significance (ASC-US). She has no history of abnormal Pap tests and is not immunocompromised. Which of the following is the most appropriate next step in management?

Refer for immediate colposcopy with biopsy

Perform endocervical curettage in the office

A 22-year-old woman presents for her first well-woman examination. She is sexually active with one lifetime partner, uses condoms for contraception, and has no history of abnormal Pap tests or gynecologic problems. According to the U.S. Preventive Services Task Force (USPSTF) guidelines, which of the following is the most appropriate cervical cancer screening for this patient?

Co-testing with cytology and HPV testing

A 24-year-old sexually active woman presents with a 3-day history of lower abdominal pain, dyspareunia, and abnormal vaginal discharge. Vital signs: temperature 38.2°C, BP 110/70 mm Hg, HR 92 bpm. Pelvic examination reveals mucopurulent cervical discharge, cervical motion tenderness, and bilateral adnexal tenderness. A urine pregnancy test is negative. What is the most appropriate next step?

Initiate empiric antibiotic therapy for pelvic inflammatory disease.

Refer for diagnostic laparoscopy to confirm the diagnosis.

Obtain endocervical swabs for chlamydia and gonorrhea testing and await results before treatment.

Perform transvaginal ultrasound to evaluate for tubo-ovarian abscess.

A 24-year-old woman presents with a 5-day history of bilateral lower abdominal pain, dyspareunia, and abnormal vaginal discharge. She has a new sexual partner and uses condoms inconsistently. Vital signs: temperature 38.1°C (100.6°F), pulse 92/min, BP 110/70 mm Hg. She weighs 60 kg (132 lbs). Pelvic examination reveals cervical motion tenderness, bilateral adnexal tenderness, and mucopurulent cervical discharge. A urine pregnancy test is negative. The nurse practitioner diagnoses pelvic inflammatory disease and plans outpatient treatment. Which of the following is the most appropriate initial antibiotic regimen?

Ceftriaxone 500 mg IM once, plus doxycycline 100 mg orally twice daily for 14 days, plus metronidazole 500 mg orally twice daily for 14 days

Levofloxacin 500 mg orally once daily for 14 days, plus doxycycline 100 mg orally twice daily for 14 days, plus metronidazole 500 mg orally twice daily for 14 days

Azithromycin 1 g orally once, plus doxycycline 100 mg orally twice daily for 7 days, plus metronidazole 500 mg orally twice daily for 7 days

Ceftriaxone 250 mg IM once, plus doxycycline 100 mg orally twice daily for 14 days, plus metronidazole 500 mg orally twice daily for 14 days

← Maternal-Child Nursing

Gynecology

15 original SNLE questions on gynecology, each with an explanation for all four options. Part of Maternal-Child Nursing, worth 30% of the Saudi Nursing Licensure Examination.

Q01 / 10medium0 correct

Maternal-Child Nursingmediumq048

A 32-year-old woman presents with severe dysmenorrhea, deep dyspareunia, and chronic pelvic pain. She has been trying to conceive for 18 months without success. Pelvic examination reveals a fixed, retroverted uterus and tender nodules in the posterior cul-de-sac. Which of the following is the most appropriate next step to confirm the suspected diagnosis?

All 15 questions

Every question below, with the reasoning for all four options. Try to answer before you open one.

Gynecology · medium
A 32-year-old woman presents with severe dysmenorrhea, deep dyspareunia, and chronic pelvic pain. She has been trying to conceive for 18 months without success. Pelvic examination reveals a fixed, retroverted uterus and tender nodules in the posterior cul-de-sac. Which of the following is the most appropriate next step to confirm the suspected diagnosis?
- AAbdominal CT scan
- BDiagnostic laparoscopy with biopsy
- CPelvic MRI
- DTransvaginal ultrasound
Show the answer and why the others fail
Answer: B. Diagnostic laparoscopy with biopsy
A
CT imaging has poor sensitivity for detecting endometrial implants and is not recommended for the diagnosis of endometriosis; it is more useful for evaluating other pelvic pathology.
B — correct
Laparoscopy with direct visualization and histological confirmation is the gold standard for diagnosing endometriosis, especially in the presence of infertility and classic examination findings.
C
MRI can identify deep infiltrating endometriosis and endometriomas, but it is not the first-line confirmatory test; laparoscopy remains the definitive diagnostic procedure.
D
Transvaginal ultrasound can detect endometriomas (chocolate cysts) but has limited sensitivity for peritoneal implants and adhesions, making it insufficient to definitively confirm endometriosis.
TakeawayLaparoscopy with biopsy is the gold standard for diagnosing endometriosis, particularly in patients with infertility and classic physical examination findings.
Gynecology · medium
A 35-year-old woman presents with a 6-month history of heavy menstrual bleeding and pelvic pressure. She reports soaking through a pad every hour for 2 days each cycle, but denies intermenstrual bleeding. Vital signs are stable. Urine pregnancy test is negative and hemoglobin is 12.5 g/dL. Bimanual examination reveals an enlarged, mobile, non-tender uterus. Which of the following is the most appropriate initial diagnostic test?
- AAbdominal ultrasound
- BMagnetic resonance imaging (MRI)
- CTransvaginal ultrasound
- DEndometrial biopsy
Show the answer and why the others fail
Answer: C. Transvaginal ultrasound
A
Abdominal ultrasound is less sensitive than transvaginal ultrasound for uterine pathology and is not the preferred initial imaging modality when transvaginal ultrasound is available and not contraindicated.
B
MRI is reserved for cases where ultrasound findings are inconclusive or when detailed mapping is needed before surgical intervention; it is not the initial diagnostic test.
C — correct
Transvaginal ultrasound is the first-line imaging study for evaluating abnormal uterine bleeding and suspected uterine fibroids, providing detailed visualization of the endometrium and myometrium.
D
Endometrial biopsy is indicated for women ≥45 years with abnormal uterine bleeding to evaluate for hyperplasia or cancer; in a 35-year-old without risk factors, it is not indicated as an initial test.
TakeawayAfter ruling out pregnancy and significant anemia, transvaginal ultrasound is the first-line imaging modality for evaluating abnormal uterine bleeding and suspected structural abnormalities such as uterine fibroids.
Gynecology · medium
A 28-year-old woman requests contraception. She has a history of migraines with aura occurring once monthly. She does not smoke and has no other medical conditions. Which of the following contraceptive methods is contraindicated for this patient?
- ACombined oral contraceptive pill
- BCopper intrauterine device
- CProgestin-only oral contraceptive
- DEtonogestrel subdermal implant
Show the answer and why the others fail
Answer: A. Combined oral contraceptive pill
A — correct
Combined hormonal contraceptives containing estrogen are contraindicated in women with migraines with aura due to an increased risk of ischemic stroke.
B
Copper IUDs are non-hormonal and have no estrogen-related risks; they are safe for women with migraines with aura.
C
Progestin-only methods do not contain estrogen and are not associated with increased stroke risk, making them safe for this patient.
D
The etonogestrel implant is a progestin-only method and is not contraindicated in women with migraines with aura.
TakeawayCombined hormonal contraceptives are contraindicated in women with migraines with aura due to an elevated risk of ischemic stroke.
Gynecology · medium
A 58-year-old woman presents with a 2-week history of light vaginal spotting. She had her last menstrual period 6 years ago and has no pelvic pain. Transvaginal ultrasound reveals an endometrial thickness of 8 mm. Which of the following is the most appropriate next step in management?
- AHysteroscopy with directed biopsy
- BEndometrial biopsy
- CRepeat transvaginal ultrasound in 6 months
- DSerum CA-125 measurement
Show the answer and why the others fail
Answer: B. Endometrial biopsy
A
Hysteroscopy is reserved for cases where office biopsy is nondiagnostic, sampling is inadequate, or a focal lesion is suspected; it is not the initial step.
B — correct
Postmenopausal bleeding always warrants evaluation. An endometrial thickness >4 mm on ultrasound increases suspicion for pathology and makes endometrial biopsy the first-line diagnostic step to exclude hyperplasia or carcinoma. Even with a thin endometrium, persistent bleeding would require tissue sampling.
C
Repeating ultrasound is not indicated when the endometrial thickness exceeds 4 mm in a postmenopausal woman with bleeding; tissue sampling is required.
D
CA-125 is a tumor marker for ovarian cancer and is not indicated for the initial evaluation of postmenopausal bleeding.
TakeawayPostmenopausal bleeding requires evaluation; an endometrial thickness >4 mm on transvaginal ultrasound makes endometrial biopsy the first-line diagnostic step to exclude hyperplasia or carcinoma.
Gynecology · easy
A 32-year-old woman has a routine cervical cancer screening. Her Pap test result shows atypical squamous cells of undetermined significance (ASC-US). She has no history of abnormal Pap tests and is not immunocompromised. Which of the following is the most appropriate next step in management?
- ARepeat Pap test in 12 months
- BRefer for immediate colposcopy with biopsy
- CPerform endocervical curettage in the office
- DPerform high-risk HPV testing
Show the answer and why the others fail
Answer: D. Perform high-risk HPV testing
A
Repeat cytology in 1 year is an acceptable alternative if high-risk HPV testing is unavailable, but HPV testing is the preferred triage method for ASC-US in women aged 25 and older.
B
Colposcopy is indicated only if high-risk HPV testing is positive or if the Pap test shows higher-grade abnormalities (e.g., ASC-H, LSIL, HSIL).
C
Endocervical curettage is not a first-line triage test for ASC-US; it may be performed during colposcopy if indicated, but not as an initial step.
D — correct
For women aged 25 and older with ASC-US, reflex high-risk HPV testing is the standard management. A positive result leads to colposcopy; a negative result allows return to routine screening.
TakeawayFor women aged 25 and older with ASC-US on Pap test, reflex high-risk HPV testing is the preferred triage method. If HPV testing is unavailable, repeat cytology in 1 year is an acceptable alternative.
Gynecology · medium
A 24-year-old woman presents with irregular menstrual cycles occurring every 35–45 days and excessive hair growth on her face and chest. She is not pregnant. Physical examination reveals acne and hirsutism. Laboratory studies show elevated free testosterone, normal thyroid-stimulating hormone, and normal 17-hydroxyprogesterone. Transvaginal ultrasound demonstrates multiple small follicles in both ovaries. Which of the following is the most likely diagnosis?
- AHypothyroidism
- BCongenital adrenal hyperplasia
- CPolycystic ovary syndrome
- DOvarian tumor
Show the answer and why the others fail
Answer: C. Polycystic ovary syndrome
A
Hypothyroidism can cause menstrual irregularities but would present with elevated TSH, not normal TSH, and does not cause hyperandrogenism or polycystic ovaries.
B
Nonclassic congenital adrenal hyperplasia (NCCAH) can cause hyperandrogenism and oligo-ovulation in adults, but it is characterized by elevated 17-hydroxyprogesterone, which is normal in this patient.
C — correct
The patient meets the Rotterdam criteria: oligo-ovulation (cycles >35 days), clinical and biochemical hyperandrogenism (hirsutism, acne, elevated free testosterone), and polycystic ovaries on ultrasound, with other causes excluded (normal TSH and 17-hydroxyprogesterone).
D
An androgen-secreting ovarian tumor could cause hyperandrogenism and oligo-ovulation, but the ultrasound shows multiple small follicles consistent with polycystic ovaries, not a discrete mass.
TakeawayPolycystic ovary syndrome is diagnosed when at least two of the three Rotterdam criteria are present (oligo/anovulation, clinical/biochemical hyperandrogenism, polycystic ovaries on ultrasound) after excluding other causes such as nonclassic congenital adrenal hyperplasia (elevated 17-hydroxyprogesterone) and thyroid dysfunction.
Gynecology · easy
A 22-year-old woman presents for her first well-woman examination. She is sexually active with one lifetime partner, uses condoms for contraception, and has no history of abnormal Pap tests or gynecologic problems. According to the U.S. Preventive Services Task Force (USPSTF) guidelines, which of the following is the most appropriate cervical cancer screening for this patient?
- ACo-testing with cytology and HPV testing
- BCytology (Pap test) alone
- CHPV testing alone
- DNo screening until age 25
Show the answer and why the others fail
Answer: B. Cytology (Pap test) alone
A
Co-testing is not recommended for women under 30; it is an option starting at age 30.
B — correct
USPSTF recommends initiating screening at age 21 with cytology alone every 3 years for average-risk women.
C
Primary HPV testing is not recommended for women under 30; it is an option starting at age 30.
D
USPSTF recommends starting screening at age 21, not 25, regardless of sexual history.
TakeawayAccording to USPSTF guidelines, cervical cancer screening should begin at age 21 with cytology alone every 3 years for average-risk women. HPV testing (alone or co-testing) is not recommended before age 30.
Gynecology · medium
A 24-year-old sexually active woman presents with a 3-day history of lower abdominal pain, dyspareunia, and abnormal vaginal discharge. Vital signs: temperature 38.2°C, BP 110/70 mm Hg, HR 92 bpm. Pelvic examination reveals mucopurulent cervical discharge, cervical motion tenderness, and bilateral adnexal tenderness. A urine pregnancy test is negative. What is the most appropriate next step?
- ARefer for diagnostic laparoscopy to confirm the diagnosis.
- BInitiate empiric antibiotic therapy for pelvic inflammatory disease.
- CObtain endocervical swabs for chlamydia and gonorrhea testing and await results before treatment.
- DPerform transvaginal ultrasound to evaluate for tubo-ovarian abscess.
Show the answer and why the others fail
Answer: B. Initiate empiric antibiotic therapy for pelvic inflammatory disease.
A
Laparoscopy is not routinely used to diagnose PID; it is reserved for cases with diagnostic uncertainty, failure to respond to medical therapy, or suspected surgical emergency. The clinical findings here are sufficient to start treatment.
B — correct
According to CDC guidelines, empiric treatment for PID should be initiated in sexually active young women with pelvic or lower abdominal pain if one or more of the following minimum criteria are present on pelvic examination: cervical motion tenderness, uterine tenderness, or adnexal tenderness. Prompt treatment reduces the risk of long-term sequelae.
C
While testing for chlamydia and gonorrhea is recommended, delaying treatment until results are available is inappropriate because it increases the risk of complications such as tubo-ovarian abscess, chronic pelvic pain, and infertility. Empiric therapy should be started immediately.
D
Transvaginal ultrasound is not required for the diagnosis of PID and is reserved for cases where a tubo-ovarian abscess is suspected or the diagnosis is uncertain. The clinical presentation here is classic for PID, so imaging should not delay treatment.
TakeawayEmpiric antibiotic therapy for pelvic inflammatory disease should be initiated promptly based on clinical criteria to prevent long-term sequelae such as infertility, ectopic pregnancy, and chronic pelvic pain.
Gynecology · medium
A 28-year-old woman presents with a thin, grayish-white vaginal discharge and a fishy odor. She denies itching, dysuria, or pelvic pain. Speculum examination reveals no cervical motion tenderness. Vaginal pH is 5.0, and a saline wet mount shows numerous clue cells. Which of the following is the most appropriate treatment?
- AOral fluconazole
- BOral acyclovir
- CIntravaginal clotrimazole
- DOral metronidazole
Show the answer and why the others fail
Answer: D. Oral metronidazole
A
Fluconazole is an antifungal agent used to treat vulvovaginal candidiasis, which typically presents with thick, white, curd-like discharge, itching, and a normal vaginal pH (<4.5). This patient's findings are consistent with bacterial vaginosis, not candidiasis.
B
Acyclovir is an antiviral medication used for herpes simplex virus infections, which typically present with painful vesicular lesions and dysuria, not a malodorous discharge with clue cells.
C
Clotrimazole is a topical antifungal used for vulvovaginal candidiasis. It is not effective against the anaerobic overgrowth characteristic of bacterial vaginosis.
D — correct
The presence of clue cells on wet mount, elevated vaginal pH (>4.5), and a fishy odor are diagnostic of bacterial vaginosis. First-line treatment includes oral metronidazole 500 mg twice daily for 7 days.
TakeawayBacterial vaginosis is diagnosed by the presence of clue cells on wet mount, elevated vaginal pH, and a positive whiff test, and is treated with oral metronidazole.
Gynecology · medium
A 24-year-old woman presents with a 5-day history of bilateral lower abdominal pain, dyspareunia, and abnormal vaginal discharge. She has a new sexual partner and uses condoms inconsistently. Vital signs: temperature 38.1°C (100.6°F), pulse 92/min, BP 110/70 mm Hg. She weighs 60 kg (132 lbs). Pelvic examination reveals cervical motion tenderness, bilateral adnexal tenderness, and mucopurulent cervical discharge. A urine pregnancy test is negative. The nurse practitioner diagnoses pelvic inflammatory disease and plans outpatient treatment. Which of the following is the most appropriate initial antibiotic regimen?
- ALevofloxacin 500 mg orally once daily for 14 days, plus doxycycline 100 mg orally twice daily for 14 days, plus metronidazole 500 mg orally twice daily for 14 days
- BAzithromycin 1 g orally once, plus doxycycline 100 mg orally twice daily for 7 days, plus metronidazole 500 mg orally twice daily for 7 days
- CCeftriaxone 250 mg IM once, plus doxycycline 100 mg orally twice daily for 14 days, plus metronidazole 500 mg orally twice daily for 14 days
- DCeftriaxone 500 mg IM once, plus doxycycline 100 mg orally twice daily for 14 days, plus metronidazole 500 mg orally twice daily for 14 days
Show the answer and why the others fail
Answer: D. Ceftriaxone 500 mg IM once, plus doxycycline 100 mg orally twice daily for 14 days, plus metronidazole 500 mg orally twice daily for 14 days
A
Fluoroquinolones are no longer recommended for PID due to high rates of gonococcal resistance.
B
Azithromycin is not recommended for PID; this regimen lacks a cephalosporin and uses inadequate treatment durations.
C
Ceftriaxone 250 mg is a subtherapeutic dose; 500 mg is required for adequate gonococcal coverage in PID.
D — correct
This triple regimen is the CDC-recommended outpatient treatment for PID, covering Neisseria gonorrhoeae, Chlamydia trachomatis, and anaerobes.
TakeawayThe CDC 2021 STI Treatment Guidelines recommend a triple-therapy outpatient regimen for pelvic inflammatory disease: a single intramuscular dose of ceftriaxone 500 mg (or 1 g if weight ≥150 kg) plus oral doxycycline 100 mg twice daily for 14 days plus oral metronidazole 500 mg twice daily for 14 days.
Gynecology · medium
A 45-year-old woman presents with heavy menstrual bleeding and pelvic pressure. Pelvic ultrasound reveals a 5 cm submucosal fibroid. She desires future fertility. Which of the following is the most appropriate management?
- AHysterectomy
- BEndometrial ablation
- CMyomectomy
- DUterine artery embolization
Show the answer and why the others fail
Answer: C. Myomectomy
A
Hysterectomy is definitive treatment for symptomatic fibroids but eliminates fertility, making it inappropriate for a woman who desires future pregnancy.
B
Endometrial ablation destroys the uterine lining and is contraindicated in women who wish to become pregnant; it also does not treat fibroids.
C — correct
Myomectomy surgically removes fibroids while preserving the uterus, making it the preferred option for women who wish to maintain fertility.
D
Uterine artery embolization may compromise ovarian function and is not recommended for women who desire future fertility.
TakeawayFor symptomatic uterine fibroids in women who desire future fertility, myomectomy is the preferred surgical treatment as it preserves the uterus.
Gynecology · medium
A 28-year-old woman presents to the clinic requesting emergency contraception. She reports having unprotected intercourse 4 days ago. She has a history of migraine with aura but is otherwise healthy. She is not using any regular contraception and does not desire pregnancy in the near future. Which of the following is the most appropriate method of emergency contraception for this patient?
- AUlipristal acetate 30 mg orally as a single dose
- BLevonorgestrel 1.5 mg orally as a single dose
- CCombined oral contraceptive pills (Yuzpe regimen) now and 12 hours later
- DCopper intrauterine device insertion within 5 days
Show the answer and why the others fail
Answer: D. Copper intrauterine device insertion within 5 days
A
Ulipristal acetate is effective up to 120 hours after unprotected intercourse, but it is not the most effective method available. The copper IUD is more effective and provides ongoing contraception, which aligns with the patient's desire to avoid pregnancy in the near future.
B
Levonorgestrel emergency contraception is most effective when taken within 72 hours of unprotected intercourse; its efficacy decreases significantly after this window, making it a suboptimal choice at 4 days post-exposure.
C
The Yuzpe regimen is less effective than other emergency contraception methods and is contraindicated in women with migraine with aura due to the increased risk of stroke associated with estrogen-containing contraceptives.
D — correct
The copper IUD is the most effective form of emergency contraception, with a failure rate of less than 0.1%. It can be inserted up to 5 days after unprotected intercourse and provides long-term contraception, making it the best choice for this patient who does not desire pregnancy in the near future.
TakeawayThe copper intrauterine device is the most effective emergency contraceptive method and can be inserted up to 5 days after unprotected intercourse, offering ongoing contraception.
Gynecology · medium
A 30-year-old woman presents with left lower quadrant abdominal pain and light vaginal spotting for 2 days. She reports amenorrhea for 7 weeks. She has a history of pelvic inflammatory disease. Vital signs: blood pressure 100/60 mm Hg, heart rate 90 bpm, temperature 37.1°C. Urine pregnancy test is positive. Bimanual examination reveals a slightly enlarged uterus and left adnexal tenderness without a palpable mass. What is the most appropriate next step in management?
- AAdminister intramuscular methotrexate
- BAssist with a culdocentesis
- CReassure the patient and schedule a repeat urine pregnancy test in 1 week
- DPrepare the patient for a transvaginal ultrasound
Show the answer and why the others fail
Answer: D. Prepare the patient for a transvaginal ultrasound
A
Methotrexate is a medical treatment for confirmed ectopic pregnancy; it should not be administered without a definitive diagnosis, which is typically made by transvaginal ultrasound.
B
Culdocentesis is an outdated invasive procedure for detecting hemoperitoneum; transvaginal ultrasound is the standard initial diagnostic test for suspected ectopic pregnancy.
C
This is inappropriate because the patient has a positive pregnancy test and symptoms concerning for ectopic pregnancy; delaying appropriate evaluation could lead to rupture and life-threatening hemorrhage.
D — correct
Transvaginal ultrasound is the first-line imaging study to determine pregnancy location in a stable patient with suspected ectopic pregnancy; the nurse should anticipate and prepare the patient for this test.
TakeawayIn a hemodynamically stable patient with suspected ectopic pregnancy, the nurse should anticipate and prepare the patient for transvaginal ultrasound to determine pregnancy location.
Gynecology · medium
A 52-year-old woman reports involuntary urine leakage when she coughs, sneezes, or exercises. She has had three vaginal deliveries. She denies dysuria, urgency, or hematuria. Which of the following is the most appropriate initial nursing intervention?
- AInstruct the patient to take an anticholinergic medication.
- BRefer the patient for urodynamic testing.
- CTeach the patient pelvic floor muscle exercises.
- DPrepare the patient for a surgical bladder suspension.
Show the answer and why the others fail
Answer: C. Teach the patient pelvic floor muscle exercises.
A
Anticholinergic medications are indicated for urge incontinence, not stress incontinence.
B
Urodynamic testing is reserved for complex or refractory cases, not as a first-line step for straightforward stress incontinence.
C — correct
Pelvic floor muscle training (Kegel exercises) is the recommended first-line conservative treatment for stress urinary incontinence.
D
Surgical intervention is considered only after conservative measures have failed.
TakeawayPelvic floor muscle exercises are the first-line treatment for stress urinary incontinence.
Gynecology · easy
A 32-year-old woman presents with a 3-day history of intense vulvar itching and a thick, white, odorless vaginal discharge. She is not pregnant and has no history of recurrent infections. Examination reveals vulvar erythema and a white, curd-like discharge adherent to the vaginal walls. A wet mount shows budding yeasts and pseudohyphae. Vaginal pH is 4.2. Which of the following is the most appropriate treatment?
- AOral fluconazole 150 mg as a single dose
- BTopical clindamycin cream 2% for 7 days
- CIntramuscular ceftriaxone 500 mg as a single dose
- DOral metronidazole 500 mg twice daily for 7 days
Show the answer and why the others fail
Answer: A. Oral fluconazole 150 mg as a single dose
A — correct
This patient has uncomplicated vulvovaginal candidiasis, characterized by thick, curdy discharge, vulvar itching, normal vaginal pH, and pseudohyphae on wet mount. A single oral dose of fluconazole is a first-line treatment.
B
Clindamycin is used for bacterial vaginosis, which typically presents with a thin, gray, fishy-smelling discharge and elevated pH (>4.5), not the thick, white, odorless discharge seen here.
C
Ceftriaxone 500 mg IM is the current recommended dose for uncomplicated gonococcal infections. This patient has no cervical motion tenderness, fever, or purulent discharge, making gonorrhea or PID unlikely.
D
Metronidazole is the treatment for bacterial vaginosis and trichomoniasis, not vulvovaginal candidiasis. The normal vaginal pH and presence of pseudohyphae rule out these conditions.
TakeawayUncomplicated vulvovaginal candidiasis is diagnosed by clinical presentation, normal vaginal pH, and visualization of pseudohyphae on wet mount, and is treated with a single dose of oral fluconazole or a short course of topical azole.

Gynecology

All 15 questions

A 28-year-old woman requests contraception. She has a history of migraines with aura occurring once monthly. She does not smoke and has no other medical conditions. Which of the following contraceptive methods is contraindicated for this patient?

A 58-year-old woman presents with a 2-week history of light vaginal spotting. She had her last menstrual period 6 years ago and has no pelvic pain. Transvaginal ultrasound reveals an endometrial thickness of 8 mm. Which of the following is the most appropriate next step in management?

A 32-year-old woman has a routine cervical cancer screening. Her Pap test result shows atypical squamous cells of undetermined significance (ASC-US). She has no history of abnormal Pap tests and is not immunocompromised. Which of the following is the most appropriate next step in management?

A 45-year-old woman presents with heavy menstrual bleeding and pelvic pressure. Pelvic ultrasound reveals a 5 cm submucosal fibroid. She desires future fertility. Which of the following is the most appropriate management?

A 52-year-old woman reports involuntary urine leakage when she coughs, sneezes, or exercises. She has had three vaginal deliveries. She denies dysuria, urgency, or hematuria. Which of the following is the most appropriate initial nursing intervention?