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Gynecologic Problems for HIV Infected Women

A Problem-Oriented Approach to Common Gynecologic Complaints

1. Which of the following conditions presents with bleeding that occurs at intervals greater than 35 days and is generally caused by ovulatory dysfunction?

A. Oligomenorrhea

B. Menorrhagia

C. Metrorrhagia

D. Polymenorrhea


2. When compared with uninfected women, HIV infected women are more likely to have all of the following, except:

A. Amenorrhea

B. Oligomenorrhea

C. Polymenorrhea

D. Irregular periods


3. Which of the following has been reported with ritonavir use, and more recently with atazanavir use?

A. Oligomenorrhea

B. Menorrhagia

C. Metrorrhagia

D. Polymenorrhea


Abnormal Pap Smear

4. Compared to women who are not HIV infected, women with HIV have which of the following?

A. Higher prevalence and incidence of HPV.

B. A higher likelihood of infection with multiple HPV subtypes.

C. Greater prevalence of oncogenic subtypes.

D. All of the above.


5. Both the prevalence and incidence of abnormal Pap smears are greater among HIV infected women than among uninfected women.

A. True

B. False


6. ICC behaves differently in HIV infected women, compared to uninfected women with ICC at a similar stage, in which of the following ways?

A. It may metastasize to unusual locations.

B. It recurs more frequently and at short intervals.

C. It responds more poorly to standard therapy.

D. All of the above.


7. Use of effective ART and good adherence are associated with a significant reduction in the prevalence and incident detection of oncogenic HPV infection and with decreased prevalence and more-rapid clearance of oncogenic HPV-positive SILs.

A. True

B. False


8. Liquid-based Pap smears are preferred because they do all of the following, except:

A. Decrease the number of inadequate smears.

B. Eliminate false-negative results.

C. Offer the possibility of direct HPV testing on collected specimens.

D. Liquid-based Pap smears do all of the above.


9. Currently, CDC and the American Congress of Obstetricians and Gynecologists recommend HPV testing for triage of HIV infected women with abnormal cytology results, for follow-up after treatment for CIN, and to lengthen screening intervals.

A. True

B. False


10. Periodic colposcopy should be considered in all of the following situations, except for:

A. After treatment of cervical dysplasia, particularly with recurrence or persistence of cytologic abnormalities.

B. With ASCUS or LSIL after ruling out a high-grade lesion.

C. History of untreated abnormal Pap smear.

D. With cytologic progression of ASCUS or LSIL that is being followed conservatively.


11. HIV infected women have an increase incidence of recurrence of cervical lesions after treatment, particularly with which of the following?

A. Glandular involvement

B. Greater level of immunosuppression

C. Absence of suppressive ART

D. Any of the above


Genital Ulcers

12. The presence of genital ulcers in HIV infected patients increases HIV shedding, which may increase the risk of HIV transmission to partners and also increases vulnerability to HIV acquisition.

A. True

B. False


13. HSV viral shedding, which increases with declining CD4+ cell counts and higher plasma HIV VL, may be more common in all of the following women, except for:

A. Women who use oral contraceptives.

B. Women who use DMPA.

C. Women with severe zinc deficiency.

D. Women with severe vitamin A deficiency.


14. Daily suppressive antiviral therapy is more likely than episodic therapy during outbreaks to be associated with the development of acyclovir-resistant HSV.

A. True

B. False


Vaginal Discharge

15. In HIV infected women T. vaginalis infection increases genital HIV shedding and possibly sexual and perinatal transmission.

A. True

B. False


Pelvic and/or Lower Abdominal Pain

16. Which of the following types of pain is associated with the menstrual cycle?

A. Acute abdominopelvic pain

B. Chronic abdominopelvic pain

C. Cyclic abdominopelvic pain

D. All of the above


Genital Warts

17. HIV infected women are more likely to have HPV co-infection, and both the prevalence and incidence of genital warts are greater in infected than uninfected women.

A. True

B. False


18. Increased immunosuppression is associated with:

A. An increased prevalence and incidence of warts.

B. Larger or more numerous warts.

C. Poorer response to therapy for genital warts.

D. All of the above.


Breast Lump

19. Risk factors for breast cancer include all of the following, except:

A. HIV infection

B. Positive family history

C. Early menarche

D. Nulliparity or late childbearing


Sexual Dysfunction

20. Responses of clinically stable women with HIV that reported sexual dysfunction stated which of the following as the major determinant?

A. Changes in sex hormones

B. Self-perceived body changes

C. CD4+ cell count

D. All of the above


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