ynecologic examinatio - stefan78

[ArchivalUser]

A 16-year-old girl is brought to the office for a gynecologic examination a week after her first sexual
experience. You have been her physician since she was a baby, performing camp and school physical
examinations, and providing immunizations. You know that she has never had a pelvic examination
before, and can tell that she is very nervous. She is sitting on the examination table, biting her cuticles
and looking down at the floor. After you ask her mother to leave the room, the patient tells you that she
and her boyfriend had sexual intercourse for the first time, and that they used condoms and spermicidal
lubricant as contraception. You inquire about any other pertinent issues, and she tells you that she has
no specific concerns, and that everything else is going pretty well. She lies down on the examination
table and places her heels on the foot rests. You drape a sheet over her knees and sit down at the end
of the table. You can see that she is clenching her teeth. The most appropriate statement at this time is:


A. "How many times have you and your boyfriend had sexual intercourse?"

B. "Please try to relax as much as you can. I know that is easier said than done."

C. "Relax! This is not going to hurt."

D. "Why are you clenching your teeth? I'm not going to hurt you."

E. "Why are you so nervous? You've already had sex so this shouldn't hurt."

[ArchivalUser]

A 14-year-old boy is brought to the office by his mother because of "bedwetting" episodes that have
been occurring about twice a week for the past few months. The mother says that she noticed this
"problem" when she washed his pajamas, and he "refused" to talk about it when she tried to bring it up.
She is hoping that he will talk to you. You ask her to leave the room so you can have some privacy with
her son. He starts the conversation by stating that "this is getting embarrassing" and he "doesn't
understand what's going on." He says that he gets up and finds his pajamas "wet and sticky." He denies
any dysuria or frequency during the day, and denies any problems at school or at home. He is on the
basketball team, socializes with friends, and gets good grades. Physical examination is unremarkable
and shows a pubic hair stage of Tanner IV and genital development Tanner stage III. The next best step
is to


A. advise him to stop drinking water at 8 pm and urinate before bed

B. begin a 3-day treatment regimen with trimethoprim-sulfamethoxazole

C. obtain a urine sample for culture and sensitivity

D. order a renal ultrasound

E. reassure him that this is a completely normal part of puberty

[ArchivalUser]

ADD G before ! who did night duty? u or me?

[ArchivalUser]

A 14-year-old girl is brought to the office by her mother for a "camp check-up." She will be going to
sleep away camp in a month, and needs you to fill out a form about her medical and immunization
history. She has been a patient of yours since she was 4 years old, but has not been in for an
examination in 18 months. The mother tells you that she is a "wonderful child" who gets A's in school,
participates in after school sports, and gets along well with her siblings. She is not allowed to date
boys until she is 16 years old. The patient is very quiet while her mother talks, and fails to make eye
contact with you. The most appropriate next step is to


A. ask the girl if she wants her mother to leave the room

B. ask the girl to leave the room while you talk to the mother

C. ask the mother to leave the room while you evaluate the girl

D. do a complete physical and pelvic examination

E. recommend that the mother and daughter go to a psychiatrist together

[ArchivalUser]

BB

[ArchivalUser]

B
E
C

[ArchivalUser]

C
E
E

[ArchivalUser]

B
E
C

[ArchivalUser]

B. "Please try to relax as much as you can. I know that is easier said than done."

[ArchivalUser]

B
E
C