Williams Gynecology, Second Edition (Schorge,Williams Gynecology), 2nd Edition

Well Woman Care

1–1. A 15-year-old adolescent female who is sexually naïve comes to your office for the recommended initial reproductive health visit. She has no complaints related to her reproductive health. Which of the following is NOT indicated during this encounter?

a. Pelvic examination

b. Establishment of rapport

c. Stage of adolescence evaluation

d. Reproductive health care needs assessment

1–2. The American Cancer Society (ACS) has published guidelines for the conduct of the clinical breast examination. Which of the following components of the examination is no longer recommended?

a. Axillary lymph node palpation

b. Inspection for skin abnormalities

c. Breast palpation with the patient supine

d. Inspection with patient’s arms raised overhead

1–3. In the past, expressing the nipples for the detection of discharge, as shown here, was a standard part of breast examination. This examination component is currently recommended selectively for which of the following indications?


Reproduced, with permission, from Kawada C: Gynecologic history, examination, & diagnostic procedures. In DeCherney AH, Nathan L (eds): CURRENT Diagnosis & Treatment Obstetrics & Gynecology, 10th ed. New York, McGraw-Hill, 2007, Figure 33-1.

a. Breast pain (mastalgia)

b. Current breastfeeding with fever

c. Spontaneous nipple discharge in a nonlactating woman

d. Bilateral milky discharge that is present only when expressed by the patient

1–4. Which of the following components of the routine pelvic examination is more often performed for specific indications rather than routinely?

a. Vulvar inspection

b. Rectovaginal examination

c. Bimanual palpation of the uterus and adnexa

d. Speculum examination of the cervix and vagina

1–5. Assuming that childhood immunizations have been administered correctly, which vaccination warrants repeat dosing at 10-year intervals in adults?

a. Hepatitis B

b. Pneumococcal

c. Herpes zoster

d. Tetanus-diphtheria

1–6. All adults (up to age 64) should be screened regardless of risk factors for which sexually transmitted disease according to the American College of Obstetricians and Gynecologists (ACOG) and the Centers for Disease Control and Prevention (CDC)?

a. Hepatitis B virus

b. Treponema pallidum

c. Chlamydia trachomatis

d. Human immunodeficiency virus (HIV)

1–7. Your patient is a 32-year-old whose previous pregnancy resulted in the birth of a child with anencephaly. A sono-graphic example of anencephaly is shown here. She is currently using oral contraceptive pills to prevent pregnancy. She intends to have another child in the future, but is uncertain when. What is your recommendation for oral folic acid supplementation?


Arrows point to the nose and orbit. Reproduced, with permission, from Cunningham FG, Leveno KJ, Bloom SL, et al (eds): Fetal imaging. In Williams Obstetrics, 23rd ed. New York, McGraw-Hill, 2010, Figure 16-1.

a. Folic acid, 4 mg orally daily beginning now

b. Folic acid, 4 mg orally daily as soon as a pregnancy test is positive

c. Folic acid, 400 μg orally daily beginning 1 month prior to discontinuation of contraception

d. A diet with an increased percentage of foods high in folic acid is sufficient in the United States

1–8. According to current ACOG guidelines (2009), how often should a 26-year-old woman with HIV be screened for cervical cancer, assuming she has no symptoms or physical findings of cervical cancer (as seen below)?


a. Annually

b. Every 2 years

c. Every 3 years

d. Every 5 years

1–9. Routine screening for endometrial cancer in asymptomatic women at average risk is not recommended. However, a woman with a strong family history of which disorder should be offered an endometrial biopsy annually beginning at age 35?

a. Adult-onset diabetes

b. Premenopausal breast cancer

c. Gastric or pancreatic cancer

d. Hereditary nonpolyposis colon cancer (Lynch syndrome)

1–10. Which of the following is currently recommended for ovarian cancer screening in women at average risk?

a. Pelvic examination

b. Pelvic sonography every 2 to 3 years

c. Annual cancer antigen (CA125) level measurement

d. Annual cancer antigen (CA125) level measurement and pelvic sonography

1–11. Which of the following are recommended for breast cancer screening by current ACOG guidelines?

a. Self breast examination

b. Periodic clinical breast exam starting at age 19

c. Screening mammography every 1 to 2 years for women ages 40 to 49 years

d. All of the above

1–12. Which of the following statements is INCORRECT regarding colon cancer and colon cancer screening in asymptomatic woman at average risk?

a. Screening colonoscopy, if negative, should be repeated every 5 to 7 years.

b. Colon cancer is ranked third among the leading causes of cancer death in women.

c. Several organizations recommend that women of average risk begin screening at age 50 years.

d. Annual fecal immunochemical testing (FIT) is more specific (fewer false positive results) than the fecal occult blood test (FOBT), which uses a guaiac paper-based oxidation reaction.

1–13. Skin cancer screening includes assessment of lesions for which of the following characteristics?


Reproduced, with permission, from Berger TG: Dermatologic disorders. In McPhee SJ, Papadakis MA (eds): CURRENT Medical Diagnosis & Treatment 2011. New York, McGraw-Hill, 2011, Figure 6-3.

a. Asymmetry

b. Border irregularity

c. Size greater than 6 mm diameter

d. All of the above

1–14. At what age do current guidelines for osteoporosis prevention recommend initiation of screening with this modality for women at average risk?


Reproduced, with permission, from Bradshaw KD: Menopausal transition. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed. New York, McGraw-Hill, 2008, Figure 21-10A.

a. 45

b. 55

c. 65

d. 75

1–15. Most U.S. women are overweight or obese. Which of the following statements is FALSE regarding the body mass index (BMI) as a clinical tool?

a. A normal BMI in adults ranges from 18.5 to 24.

b. For adolescents, BMI is expressed as a percentile.

c. The calculation of BMI includes age, weight, and height.

d. The BMI reflects risk of obesity-related medical conditions.

1–16. Bariatric surgery has become a more commonly used adjunct to other weight-loss strategies. Which of the following is an INCORRECT statement regarding recommendations for bariatric surgery?


Reproduced, with permission, from Hoffman BL, Horsager R, Roberts SW, et al: Obesity. In Williams Obstetrics, 23rd Edition Study Guide, New York, McGraw-Hill, 2011, Figure 43-22.

a. Pregnancy should be delayed for 12 to 18 months following bariatric surgery.

b. Gastric banding is now the only recommended bariatric surgery method and has replaced the procedure shown here.

c. Patients with comorbid conditions can be considered for bariatric surgery at BMIs of 35 or more.

d. If no comorbid conditions are present, bariatric surgery may be selected for patients with BMIs of 40 or more.

1–17. The effect of obesity on the effectiveness of various contraceptive methods is not fully understood. Which contraceptive method has been determined most conclusively to be less effective in women weighing more than 90 kg?

a. Subdermal contraceptive rod

b. Depot medroxyprogesterone acetate

c. Combination hormone contraceptive patch

d. Combination hormone oral contraceptive pills

1–18. An appropriately sized blood pressure cuff is necessary for the accurate measurement of blood pressure and screening for hypertension. At minimum, what percentage of the arm above the elbow should the air bladder of the cuff encircle?

a. 40%

b. 60%

c. 80%

d. 100%

1–19. Prehypertension increases the risk of developing hypertension at a later time. Respectively, what are the lower limits of systolic and diastolic blood pressure measurements (mm Hg) that define prehypertension?

a. 120, 80

b. 135, 85

c. 140, 90

d. 145, 95

1–20. Identifiable causes of hypertension include the regular use of all EXCEPT which of the following agents?

a. Licorice

b. Valproic acid

c. Combination oral contraceptives

d. Nonsteroidal anti-inflammatory agents

1–21. Upon diagnosing hypertension, which of the following tests are recommended to further investigate possible causes and comorbidities?

a. Urinalysis and serum creatinine

b. Thyroid function and blood glucose

c. Electrocardiogram and lipid profile

d. All of the above

1–22. What fasting venous blood glucose value is the threshold for diagnosis of diabetes mellitus in adults?

a. > 120 mg/dL

b. > 125 mg/dL

c. > 140 mg/dL

d. > 145 mg/dL

1–23. The clinical usefulness of diagnosing the metabolic syndrome is not fully understood at present. What waist circumference in females is the threshold value for one of metabolic syndrome’s current diagnostic criteria?

a. 35 inches (88 cm)

b. 40 inches (101 cm)

c. 45 inches (114 cm)

d. 50 inches (127 cm)

1–24. Which lipoprotein category appears most strongly correlated with atherogenesis?

a. Triglycerides

b. Total cholesterol level

c. Low-density lipoprotein cholesterol

d. High-density lipoprotein cholesterol

1–25. The U.S. Preventive Services Task Force recommends a minimum of how many minutes of moderate-intensity activity per week, performed in episodes of at least 10 minutes?

a. 60

b. 90

c. 120

d. 150

1–26. The U.S. Preventive Services Task Force does not recommend routine screening for thyroid dysfunction in women. However, the American Thyroid Association recommends that women be screened with a serum thyroid-stimulating hormone level measurement every 5 years beginning at what age?

a. 35 years

b. 40 years

c. 50 years

d. 65 years

1–27. In a recent meta-analysis (Wu and colleagues, 2006), which of the following agents was associated with superior rates of smoking cessation after 1 year?

a. Bupropion

b. Varenicline

c. Nicotine replacement agents

d. None of the above was superior


American College of Obstetricians and Gynecologists: Cervical cytology screening. Practice Bulletin No. 109, December 2009

Wu P, Wilson K, Dimoulas P, et al: Effectiveness of smoking cessation therapies: a systematic review and meta-analysis. BMC Public Health 6(1):300, 2006

Chapter 1 ANSWER KEY