West Coast University Obstetric Nursing
(Gynecology) APGO Questions and
Answers A+ Graded with Rationales
2024-2025.
A 58-year-old G2P2 woman reports developing increased itching on her
vulvar over the past three months. She also reports that she has noted
some spotting on her undergarments. She has tried over-thecounter
antifungals without any improvement. On physical examination, there is a
2 cm red velvety lesion on her right labium majus. She undergoes a
biopsy that reveals adenocarcinoma. Which of the following is the most
likely etiology of her lesion?
A. Melanoma
B. HPV
C. Paget's disease
D. Sarcoma
E. HSV
Verified Answer -C. Paget's disease
This patient has Paget's disease of the vulva. Typically described as a red
velvety appearing lesion with a discharge.
A 45-year-old G3P3 woman comes to the office because she has been
unable to conceive for the last two years. She is healthy and has three
children, ages 10, 12 and 14, whom she conceived with her husband. She
used a copper IUD after the birth of her last child and had it removed two
years ago, hoping to have another child. She has no history of sexually
transmitted infections or abnormal Pap tests. Her cycles are regular every
,28 to 32 days. She is not taking any medications. She has been married
for the last 16 years, and her husband is 52 years old and in good health.
Her physical examination, including a pelvic examination, is completely
normal. In addition to a semen analysis, which of the following is the
most appropriate next step in the management of this patient?
A. Hysteroscopy
B. Hysterosalpingogram
C. Anti-mullerian hormone levels
D. Sperm penetration assay
E. Basal body temperatures for six months
Verified Answer -C. Anti-mullerian hormone levels
This patient most likely has decreased ovarian reserve due to her age.
Anti-mullerian hormone levels will help determine ovarian reserve.
A 27-year-old G0 woman presents to the clinic because of concerns that
she has not been able to get pregnant for the last year. She has been
married for two years and had been using birth control pills for
contraception. She stopped using birth control pills when she decided to
attempt pregnancy one year ago. She is in good health and her only
medication is a prenatal vitamin. Her periods are regular, every 28 days,
with normal flow, and her last period was two weeks ago. She has no
history of sexually transmitted infections and no abnormal Pap tests. Her
husband is also healthy with no medical problems. She is 5 feet, 4 inches
tall and weighs 230 pounds. Her examination, including a pelvic
examination, is completely normal. Laboratory results show normal
thyroid function tests and normal prolactin level. What is the most
appropriate next step in the management of this patient?
A. Reassurance and observation
,B. Per
Verified Answer -D. Order a semen analysis
This patient has primary infertility bc she has not been able to conceive for
one year. She does not appear to have underlying pathology to explain
why she has not conceived and her husband's semen has not yet been
examined. The male factor plays a role in about 30% of infertility cases.
Hysterosalpingogram might be ordered in the future, the male factor needs
to be ruled out.
A 49-year-old G5P5 woman presents for her first health maintenance
examination since she had her last child 10 years ago. She has no
symptoms to report. She has had two sexual partners. She smokes three to
five cigarettes per day, and has been smoking for the past 15 years. Last
month, her mother underwent a radical hysterectomy for stage IB cervical
carcinoma. Her pelvic examination is normal, except for mucopurulent
discharge and genital warts. Which of the following factors places the
patient at greatest risk for developing cervical cancer?
A. Family hx of cervical cancer
B. Smoking history
C. Genital warts
D. Multiparity
E. Age
Verified Answer -C. Genital warts
The majority of risk factors for cervical cancer are related to HPV exposure.
In this patient with multiple risk factors, the presence of an HPV-related
condition (genital warts) already indicates infection with HPV. Although
the HPV type associated with condyloma is typically a low risk strain (6
and 11), she is also at risk of having been associated to high-risk types
, that are typically associated with high grade dysplasia and cervical cancer
(16 and 18). Although smoking is a risk factor for cervical cancer, its effect
is only seen in the presence of prior infection with HPV.
A 21-year-old G0 woman presents for her first pelvic examination. She is
completely asymptomatic, healthy, and reports having only one sexual
partner. She uses condoms for contraception. On examination, the patient
has a normal appearing cervix except for minimal, non-malodorous
vaginal discharge. Chlamydia and gonorrhea screening is performed, as
well as a Pap test. The Pap test is read as ASCUS (atypical squamous cells
of undetermined significance), HPV negative and her cultures are negative.
Which of the following is the most appropriate management strategy for
this patient?
A. Repeat the pap in four to six week after antibiotic treatment for BV
B. Pap test in one year
C. Pap test in three years
D. Colposcopy with endocervical curettage and directed biopsies
E. Cervical conization
Verified Answer -C. Pap test in three years
Management options for ASCUS include performing HPV DNA testing or
repeat cytology at 12 months following the abnormal pap. IF the HPV
testing is negative then routine screening can be resumed at three years. If
the HPV test is positive or if repeat cytology reveals ASCUS or worse then
colposcopy should be performed. For women ages 21 to 24 if HPV is
positive then repeat cytology at 12 months is recommended.
A 52-year-old G3P2 woman reports vaginal spotting and bleeding after
intercourse for the past 18 months. She stopped having menses at the age
of 48 and has not been on menopausal hormone therapy. She also notes
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