Care of Women KSA 2024 Exam Questions with Correct Answers A 24-year-old graduate student comes to your office to be tested for sexually transmitted infections.The medical assistant tells you that the patient was upset when she saw how much she weighed. On questioning, the patient says that for the past year she has experienced episodes of uncontrollable eating followed by self-induced vomiting. Her weight is 82 kg (181 lb) and her BMI is 32 kg/m2.Which one of the following is true regarding treatment for this condition?
- Cognitive behavioral therapy has the best evidence for treatment
- SSRI monotherapy is a first-line treatment option
- Anemia is an indication for hospitalization
- More than half of patients will relapse after treatment - Correct Answer ANSWER: A
- added avoidant/restrictive food intake disorder, rumination disorder, and pica to this group in 2014.
Eating disorders include anorexia nervosa, bulimia nervosa, and binge eating disorder, and the DSM-
Mood disorders, anxiety, substance use, and personality or somatic disorders are common in these patients. Screening can include regularly asking questions about mood, body image concerns, and eating behaviors. Before establishing the diagnosis based on history, it is important to perform a physical examination that includes measurement of orthostatic vital signs and obtain a metabolic panel that includes magnesium and phosphate levels.This patient appears to have bulimia nervosa, which consists of eating an excessive amount of food in a short period of time (often >2000 calories in one sitting), with a concomitant feeling of loss of control. Because patients with bulimia base their self-worth on their body shape and weight, they follow this binge eating with compensatory behaviors to prevent weight gain, such as vomiting, laxative use, food restriction, excessive exercise, or taking diuretics. Episodes occur, on average, one or more times a week for 3 months or longer, and the disorder is associated with a two- to sixfold increase in age-adjusted mortality.After the diagnosis is established and a goal weight has been accepted, the patient is best served with treatment delivered by a team that includes a therapist, a nutritionist, and a clinician, preferably with each having prior experience in caring for patients with eating disorders. Cognitive behavioral therapy (CBT) has the best evidence for treatment of adults with bulimia, while family-based therapy is the first-line treatment for adolescents with this condition. Early behavioral response, with rapidly declining episodes of binge eating, is associat A 35-year-old female presents to your office for treatment of insomnia. You ask if she has experienced any trauma in her life and she discloses that she was sexually assaulted 6 weeks ago.She has not sought medical, legal, or psychological counseling since the assault. During today's visit, you should do which one of the following? 1 / 4
- Assess for symptoms of posttraumatic stress disorder
- Prescribe levonorgestrel (Plan B One-Step), 1.5 mg
- Prescribe HIV postexposure prophylaxis
- Perform a forensic examination to collect evidence, such as a rape kit evaluation
E. Refer her for cognitive behavioral therapy - Correct Answer ANSWER: A
Sexual assault affects 43.6% of women in the United States during their lifetimes, with increased risks seen in adolescents, college students, LGBTQ persons, and active-duty military personnel. The risk is also increased by physical or mental disabilities, poverty, homelessness, incarceration, and substance use disorders. The majority of assaults are committed by someone known to the victim, and assaults are often unreported. It has been estimated that only 16%-38% of victims seek help from law enforcement or obtain a medical evaluation.Both short- and long-term consequences can occur after sexual assault. Short-term consequences include physical injuries, unintended pregnancy, and sexually transmitted infections (most commonly Chlamydia, gonorrhea, and trichomoniasis). Over time, additional sequelae may include chronic pelvic pain, headaches, fibromyalgia and other chronic pain syndromes, and irritable bowel syndrome. The most common long-term consequence is posttraumatic stress disorder (PTSD), while other psychological sequelae include insomnia, depression, anxiety, substance use disorder, eating disorders, and suicidality.The American College of Obstetrics and Gynecology recommends screening all women for sexual violence, while the U.S. Preventive Services Task Force recommends intimate partner violence (IPV) screening for women of reproductive age. Most women will not disclose IPV or sexual violence unless asked, and a validated two-question screening tool can be most easily incorporated into a primary care practice: "Have you ever been hit, slapped, kicked, or otherwise hurt by your partner?Have you ever been forced to participate in sexual activities?"This patient should have a urine pregnancy test and be tested for Chlamydia, gonorrhea, bacterial vaginosis, syphilis, and trichomoniasis. Blood shoul You are developing a practice improvement activity in your office centered on substance use disorder (SUD). As part of the training for your clinical staff, you plan to review a variety of clinical vignettes of patients with SUD. One of your goals is to illustrate how SUD has different clinical presentations in women and men. Which one of the following statements is accurate regarding these differences?
- Compared to men, women have a quicker progression from first using a substance to developing
- Compared to men, women with SUD have less severe adverse consequences
- Smaller quantities of drug consumption are associated with development of SUD among men
- Women are less likely to relapse after treatment than men - Correct Answer ANSWER: A 2 / 4
dependence
compared to women
Substance use disorder (SUD) in women is often associated with more severe adverse medical, psychiatric, and functional consequences than in men, often related to the interacting contributions of biological and environmental factors. Physiologically, women with SUD have variation in cravings and drug consumption at different times of the menstrual cycle. There is also evidence that women metabolize nicotine more rapidly than men, making it harder for them to quit using nicotine- containing products. This differential metabolism is a possible reason that nicotine replacement therapies are less efficacious in women.Environmentally, women often attribute their substance use to different reasons than men, including self-treatment of mental health problems, management of chronic pain, and controlling weight. Use of smaller quantities of drugs and a shorter time progression from initial use to dependence are both more likely among women with SUD. Treatment outcomes are not substantially different by sex, but women are more likely to relapse after treatment.A 23-year-old patient comes to your office 4 weeks after the uncomplicated vaginal birth of her first child, and reports that she feels tired all the time. On further questioning, she describes significant emotional lability during the first week after delivery. She has continued to have a low mood most days and worries about her ability to care for her child. She reports no personal or family history of depressive illness. Her infant is feeding and growing well, and now requires only one nighttime feeding. Which one of the following would be most appropriate at this point?
- Reassurance that the problem will most likely be resolved within 4 weeks
- Reassurance that this condition is unlikely to recur in subsequent pregnancies
- Appropriate screening for underlying medical conditions, including a urinalysis and an erythrocyte
- Avoiding pharmacologic therapy because she is breastfeeding
sedimentation rate
E. Rec - Correct Answer ANSWER: E
Postpartum depression is relatively common and occurs in up to one in seven women. Untreated, it is associated with significant maternal and neonatal mortality. It is disruptive to the family, and it can lead to a higher risk for paternal depression, marital discord, family violence, substance use and abuse, child abuse and neglect, failure to implement child safety and preventive measures, and poorer management of chronic health conditions in children. Postpartum depression is associated with both the early cessation of breastfeeding and reduced maternal-infant engagement, which can both have an adverse effect on infant development. Consequences of maternal depression include negative effects on cognitive development, social-emotional development, and behavior of the child.Sometimes it can be difficult to distinguish postpartum depression from "baby blues," a period of increased emotional lability, irritability, and fatigue that can begin in the first 24-48 hours post partum, has limited impact on functioning, and usually disappears within 2 weeks. Symptoms that persist beyond 2 weeks, including depressed mood, lack of pleasure, sleep disturbance, diminished concentration, feelings of guilt or worthlessness, loss of energy, or thoughts of death or suicide, are 3 / 4
consistent with the DSM-5 diagnostic criteria for major depression. Women with a prior history of treated depression have a recurrence rate of more than 30% and these women should undergo preventive counseling as recommended by the U.S. Preventive Services Task Force (USPSTF).During the postpartum period, complications of pregnancy and common medical conditions can create symptoms similar to those of depression. Screening for anemia and thyroid disease is appropriate because they are often seen in the postpartum period. Screening tests should inclu At a well woman visit, a 46-year-old female mentions that she is no longer interested in having sex with her husband. She reports that her relationship with her husband is good, their communication is excellent, and he is empathetic about her change in sexual interest. She says that she cannot understand why this is occurring, but that these feelings have been consistently present over the last 10 months. She does not have any symptoms of depression or anxiety. Further sexual history indicates that sex is not painful and lubrication is adequate. A physical examination is normal.Laboratory findings, including a metabolic panel and thyroid studies, are normal. You suspect that she has female sexual interest/arousal disorder. Which one of the following has evidence of effectiveness for treating this problem?
- Estrogen cream
- Flibanserin (Addyi)
- Sertraline (Zoloft)
D. Sildenafil (Viagra) - Correct Answer ANSWER: B
In order for a lack of sexual interest or arousal to qualify as a dysfunction, the problem must be present more than 75% of the time, persist for more than 6 months, and cause significant distress, and must not be explained by other mental health diagnoses, relationship distress, substance abuse, or a medical condition.The DSM-5 criteria for female sexual interest arousal disorder include a lack of, or significantly reduced, sexual interest and arousal, as manifested by at least three of the following:
- Absent or reduced interest in sexual activity
- Absent or reduced sexual or erotic thoughts or fantasies
- Absent or reduced initiation of sexual activity, and typically being unreceptive to a partner's
- Absent or reduced sexual excitement or pleasure during sexual activity in almost all sexual
- Absent or reduced sexual interest and arousal in response to any internal or external sexual or
- / 4
attempts to initiate sexual activity
encounters
erotic written, verbal, or visual cues