Questions
251. A 75-year-old G2P2 presents to your gynecology office for a routine examination. She tells you that she does not have an internist and does not remember the last time she had a physical examination. She says she is very healthy and denies taking any medication, including hormone replacement therapy. She has no history of abnormal Pap smears. She is a nonsmoker and has an occasional cocktail with her dinner. She does not have any com- plaints. In addition, she denies any family history of cancer. The patient tells you that she is a widow and lives alone in an apartment in town. Her grown children have families of their own and live far away. She states that she is self-sufficient and spends her time visiting friends and volunteering at a local museum. Her blood pressure is 140/70 mm Hg. Her height is 5 ft 4 in and she weighs 130 lb. Her physical examination is completely nor- mal. Which of the following are the most appropriate screening tests to order for this patient?
a. Pap smear and mammogram
b. Pap smear, mammogram, and colonoscopy c. Mammogram, colonoscopy, and bone densitometry
d. Mammogram, colonoscopy, bone densitometry, and TB skin test
e. Mammogram, colonoscopy, bone densitometry, TB skin test, and auditory testing
183
252. A 72-year-old G5P5 presents to your office for well-woman exami- nation. Her last examination was 7 years ago, when she turned 65. She has routine checks and laboratory tests with her internist each year. Her last mammogram was 6 months ago and was normal. She takes a diuretic for hypertension. She is a retired school teacher. Her physical examination is normal. Which of the following is the best vaccination to recommend to this patient?
a. Diphtheria-pertussis b. Hepatitis B vaccine c. Influenza vaccine d. Measles-mumps-rubella e. Pneumocystis
253. A 65-year-old G3P3 presents to your office for annual checkup. She had her last well-woman examination 20 years before when she had a hys- terectomy for fibroids. She denies any medical problems, except some occasional stiffness in her joints early in the morning. She takes a multivit- amin daily. Her family history is significant for cardiac disease in both her parents and breast cancer in a maternal aunt at the age of 42 years. Her physical examination is normal. Which of the following is the most appro- priate set of laboratory tests to order for this patient?
a. Lipid profile and fasting blood sugar b. Lipid profile, fasting blood sugar, and TSH c. Lipid profile, fasting blood sugar, TSH, and CA-125 d. Lipid profile, fasting blood sugar, TSH, and urinalysis e. Lipid profile, fasting blood sugar, TSH, urinalysis, and CA-125
254. You are following up on the results of routine testing of a 68-year-old G4P3 for her well-woman examination. Her physical examination was nor- mal for a postmenopausal woman. Her Pap smear revealed parabasal cells, her mammogram was normal, lipid profile was normal, and the urinalysis shows hematuria. Which of the following is the most appropriate next step in the management of this patient?
a. Colposcopy b. Endometrial biopsy c. Renal sonogram d. Urine culture
e. No further treatment/evaluation is necessary if the patient is asymptomatic.
255. A 74-year-old woman presents to your office for well-woman exam- ination. Her last Pap smear and mammogram were 3 years ago. She has hypertension, high cholesterol, and osteoarthritis. She stopped smoking 15 years ago, and denies alcohol use. Based on this patient’s history which of the following medical conditions should be this patient’s biggest concern?
a. Alzheimer disease b. Breast cancer
c. Cerebrovascular disease d. Heart disease
e. Lung cancer f. Trauma
256. A 16-year-old G0 female presents to your office for a routine annual gynecologic examination. She reports that she has previously been sexually active, but currently is not dating anyone. She has had three sexual part- ners in the past and says she diligently used condoms. She is a senior in high school and is doing well academically and has many friends. She lives at home with her parents and a younger sibling. She denies any family his- tory of medical problems, but says her 80-year-old grandmother was recently diagnosed with breast cancer. She denies any other family history of cancer. She says she is healthy and has no history of medical problems or surgeries. She reports having had chicken pox. She smokes tobacco and drinks beer occasionally, but denies any illicit drug use. She had her first Pap smear and gynecologic examination last year with another doctor and reports that everything was normal. Her menses started at age 13 and are regular and light. She denies any dysmenorrhea. Her blood pressure is 90/60 mm Hg. Her height is 5 ft 6 in and she weighs 130 lb. Based on this patient’s history, what would be the most likely cause of death if she were to die at age 16?
a. Suicide b. Homicide
c. Motor vehicle accidents d. Cancer
e. Heart disease
Preventive Care and Health Maintenance 185
257. A 17-year-old G1P1 presents to your office for her yearly well- woman examination. She had an uncomplicated vaginal delivery last year.
She has been sexually active for the past 4 years and has had six different sexual partners. Her menses occurs every 28 days and lasts for 4 days. She denies any intermenstrual spotting, postcoital bleeding, or vaginal dis- charge. She denies tobacco, alcohol, or illicit drug use. Which of the fol- lowing are appropriate screening tests for this patient?
a. Pap test
b. Pap test and gonorrhea and chlamydia cervical cultures c. Pap test and herpes simplex cultures
d. Pap test and hemoglobin level assessment e. Pap test and hepatitis C antibody
258. A 15-year-old woman presents to your office for her first well- woman examination while she is on summer break from school. She denies any medical problems or prior surgeries. She had chicken pox at age 4. Her menses started at the age of 12 and are regular. She has recently become sexually active with her 16-year-old boyfriend. She states that they use con- doms for contraception. Her physical examination is normal. Which of the following vaccines is appropriate to administer to this patient?
a. Hepatitis A vaccine b. Pneumococcal vaccine c. Varicella vaccine d. Hepatitis B vaccine e. Influenza vaccine
259. A 26-year-old woman presents to your office for her well-woman examination. She denies any medical problems or prior surgeries. She states that her cycles are monthly. She is sexually active and uses oral contracep- tive pills for birth control. Her physical examination is normal. As part of preventive health maintenance, you recommend breast self-examination and instruct the patient how to do it. Which of the following is the best fre- quency and time to perform breast self-examinations?
a. Monthly, in the week prior to the start of the menses b. Monthly, in the week after cessation of menses c. Monthly, during the menses
d. Every 3 months, in the week prior to the start of the menses e. Every 6 months, in the week prior to the start of the menses