Author Question: Your 61-year-old female patient complains of dyspareunia. On pelvic examination, you note atrophic ... (Read 143 times)

jparksx · **on:** Jun 25, 2018

Your 61-year-old female patient complains of dyspareunia. On pelvic examination, you note atrophic vaginitis. The clinician should explain that these are most likely:

A. Signs of vaginismus
B. Postmenopausal symptoms
C. Signs of estrogen deficiency
D. B and C

Question 2

A 19-year-old female complains of sudden severe left-sided lower quadrant abdominal pain as well as nausea and vomiting for the last 2 weeks. Last menstrual period was 2 months ago.

On physical examination, there is left sided lower quadrant abdominal tenderness and heel strike is positive. Pelvic examination reveals bluish discoloration of the cervix and left-sided adnexal tenderness. These signs and symptoms are consistent with:
A. Ovarian cyst
B. Ectopic pregnancy
C. Pelvic inflammatory disease
D. Follicular cyst

Jsherida · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

ANS: B
There are no special examinations to be done for sexual dysfunction, although hormonal assessment may be helpful. A thorough gynecological examination is adequate to determine whether there is a physical cause for the problem. Decreases in libido and sexual response are not uncommon with aging, although it is an erroneous stereotype to assume that sexual desire or functioning automatically declines with age. In the aging client, lubricating agents may be helpful to deal with decreased or uncomfortable stimulation due to loss of lubrication. Decreased estrogen can cause atrophic vaginitis and thus decreased lubrication, leading to dyspareunia. Serum for free testosterone can be drawn if loss of libido is a problem in the postmenopausal woman.

Answer to Question 2

ANS: B
These are key signs of ectopic pregnancy. Amenorrhea in a female of childbearing age should be treated as pregnancy until proven otherwise. Sudden pain is characteristic of tubal ectopic pregnancy, when the embryo outgrows the space within the fallopian tube. The nausea and vomiting are symptoms of early pregnancy. Left-sided lower quadrant pain, bluish discoloration of the cervix, and left-sided adnexal tenderness are all signs of tubal pregnancy. Positive heel strike indicates peritoneal irritation.