Question 1. A 14-year-old boy has been brought to the emergency department by his mother in excruciating pain that is radiating from his scrotum to his inguinal area. The boy's heart rate is 122 beats per minute and he vomited twice before arrival at the hospital. Examination reveals that his scrotum is reddened and slightly swollen and the testes are firm to the touch and tender, with extensive cremaster muscle contraction noted. What is the boy's most likely diagnosis?
Epididymitis
Hydrocele
Testicular torsion
Varicocele

Question 2. Having heard positive reports of the benefits of HT from her sister-in-law and friends, a 49-year-old woman has presented to her nurse practitioner asking to start HT. Her uterus is intact and previous bone scans have indicated low bone density. The patient also has a family history of heart disease. She characterizes her symptoms of menopause as "noticeable, but not debilitating by any means." Based on the most current research, what is her nurse practitioner's best course of action?
Begin estrogen-progesterone HT (EPT) to prevent future menopausal symptoms and coronary heart disease (CHD)
Forgo HT in light of her preexisting low bone density and consequent risk of osteoporosis
Forgo HT but consider alternative therapies and reevaluate if her symptoms significantly affect her quality of life
Begin low-dose HT but perform regular breast cancer screening and heart health checks

Question 3. Long, stretchy cervical mucus that exhibits ferning on a microscope slide is characteristic of which of the following?
High LH levels
Low estrogen levels
High progesterone levels
Low human chorionic gonadotropin levels

Question 4. A 57-year-old woman who has been diagnosed with atrophic vaginitis has expressed her surprise to her care provider, citing a lifetime largely free of gynecological health problems. She has asked what may have contributed to her problem. How can the care provider best respond?
"The lower levels of estrogen since you've begun menopause make your vagina prone to infection."
"Vaginitis is not usually the direct result of any single problem, but rather an inevitability of the vaginal dryness that accompanies menopause."
"This type of vaginitis is most commonly a symptom of a latent sexually transmitted infection that you may have contracted in the distant past."
"The exact cause of this problem isn't known, but it can usually be resolved with a diet high in probiotic bacteria."

Question 5. A 13-year-old patient undergoing puberty is alarmed to find small, white bumps surrounding the areolae on her nipples. You reassure her that these are a normal sign of her sexual maturation and tell her that they are which of the following:
Skene glands
Bartholin glands
Montgomery tubercles
Cooper ligaments

Question 6. A 40-year-old woman has been found to have a deficiency in estrogen. Which of the following physiological phenomena is most likely to remain unaffected?
Parathyroid hormone antagonism and the rate of bone resorption
The regulation of uterine endothelial development
The maintenance of normal skin and blood vessel structure
The synthesis and release of adrenal glucocorticoids

Question 7. A 60-year-old woman who is 11 years menopausal has presented to the emergency department stating, "I haven't had my period in years, but lately I've been bleeding again, and quite heavily in the last few days." The care team needs to rule out endometrial cancer. How should they best explain the most accurate plan for confirming or ruling out the diagnosis?
"We're going to book a CT scan for you as soon as possible so that we can see what is inside your uterus."
"We're going to have to open your cervix with a speculum and take scrapings from the wall of your uterus."
"We are going to order blood work that will measure your hormone levels."
"We can do a Pap smear right now and we will get the results as soon as we can."

Question 8. A 20-year-old male has been diagnosed with a chlamydial infection, and his primary care provider is performing teaching in an effort to prevent the patient from infecting others in the future. Which of the following statements by the patient demonstrates the best understanding of his health problem?
"Either me or a partner could end up with an eye infection from chlamydia that could make us blind."
"Even though I couldn't end up sterile, a woman that I give it to certainly could."
"Each of the three stages of the disease seems to be worse than the previous one."
"Even if I spread it to someone else, there's a good chance she won't have any symptoms or know she has it."

Question 9. During a group prenatal class, the nurse teaching the course is explaining the thinning of the cervix that accompanies the stages of labor leading up to delivery. A participant admits that she is not familiar with either the location or normal role of the cervix. Which of the following responses, by the nurse, would be most appropriate?
"Your cervix is just the term for the lowest part of your uterus and it is tightly shut at all times except in women who are giving birth."
"The cervix is the opening between the uterus and the vagina and so it opens wide during the lead-up to birth."
"Your cervix is the part of your uterus where the fallopian tubes join it and the baby has to pass through it to the vagina."
"The cervix is the soft lining of your uterus that has to expand greatly to accommodate your baby during delivery."

Question 10. Which of the following statements best captures an aspect of normal spermatogenesis?
Testosterone chemically lyses each primary spermatocyte into two secondary spermatocytes with 23 chromosomes each.
Sertoli cells differentiate into spermatids, each of which can contribute half of the chromosomes necessary for reproduction.
Spermatogonia adjacent to the tubular wall undergo meiotic division and provide a continuous source of new germinal cells.

Each primary spermatocyte undergoes two nuclear divisions, yielding four cells with 23 chromosomes each.

Question 11. Which of the following factors are NOT known to contribute to vaginal yeast infections?
Inflammation of the Skene and Bartholin glands
Poorly controlled diabetes'
Recent antibiotic therapy
Use of oral contraceptives
High hormone levels during pregnancy

Question 12. A 20-year-old male has been diagnosed with testicular cancer and is seeking information about his diagnosis from a number of websites. Which of the following statements that he has read is most plausible?
"Testicular cancer is a leading cause of death among males who should be in the prime of their lives."
"Men with cryptorchidism-the term for an undescended testicle-are known to have a higher risk of developing testicular cancer."
"For most men with testicular cancer, bloody urine is their first sign that something is wrong."
"Recent developments in the treatment of testicular cancer mean that few men now need to have a testicle removed."

Question 13. After a long and frustrating course of constant vaginal pain, a 38-year-old woman has been diagnosed with generalized vulvodynia by her nurse practitioner. What treatment plan is her nurse practitioner most likely to propose?
Alternative herbal therapies coupled with antifungal medications
Antidepressant and antiepileptic medications
Lifestyle modifications aimed at accommodating and managing neuropathic pain
Narcotic analgesia and nonsteroidal anti-inflammatory medications

Question 14. A 39-year-old male patient has been recently diagnosed with primary hypogonadism. Which of the following lab results would be most indicative of this diagnosis?
Normal levels of free testosterone; low levels of total testosterone
Low free testosterone, LH, and FSH levels
Low levels of GnRH
Low testosterone levels; normal levels of LH and FSH

Question 15. John presents to the clinic with complaints of scrotal heaviness. Your assessment reveals swelling of the testicle and warm scrotal skin. What would your diagnosis be?
Cryptorchidism
Orchitis
Testicular torsion
Epididymitis

Question 16. A 66-year-old man has presented to a nurse practitioner to get a refill for his antiplatelet medication. The patient has a history of ischemic heart disease and suffered a myocardial infarction 5 years ago and has unstable angina; he uses a transdermal nitroglycerin patch to control his angina. The patient has a 40-pack-year smoking history and uses nebulized bronchodilators at home for the treatment of transient shortness of breath. He has long-standing hypertension that is treated with a potassium-sparing diuretic and a ß-adrenergic blocking medication. During the nurse's assessment, the man notes that he has been unable to maintain his erection in recent months. Which of the following aspects of the man's health problems and treatments would the nurse identify as NOT being contributing to his erectile dysfunction (ED)?
His antihypertensive medications
His use of bronchodilators
His hypertension
His ischemic heart disease
His smoking history
His age

Question 17. Which of the following situations would be considered pathologic in an otherwise healthy 30-year-old female?
The woman's ovaries are not producing new ova.

The woman's ovaries do not synthesize or secrete luteinizing hormone (LH).
The epithelium covering the woman's ovaries is broken during the time of ovulation.
The woman's ovaries are not producing progesterone.

Question 18. A newborn male has been diagnosed with hypospadias following his postpartum assessment by a nurse practitioner. Which of the following diagnostics and treatment options is the nurse practitioner most likely to rule out first?
Chromosomal studies
Circumcision
Surgical repair
Testosterone supplementation

Question 19. A pregnant 23-year-old with a diagnosis of herpes simplex virus (HSV) is receiving prenatal care from her nurse practitioner. What is the nurse practitioner most likely to tell the patient about the precautions that will be taken to prevent transmission of the virus to her baby?
"After your caesarean section, it will be safest if you don't breast-feed your child."
"If there aren't any visible lesions when you enter labor, a vaginal delivery will be safe to go ahead with."
"A vaginal delivery will be safe as long as you are consistent about taking your vancyclovir."
"We'll have to book you for a caesarean delivery in order to ensure that your baby isn't exposed to the virus."

Question 20. Which of the following sexually active women most likely faces the highest risk of developing an ectopic pregnancy?
A 14-year-old who experienced menarche 2 years prior
A 42-year-old who has decided to try to have one more child and has had her tubal ligation reversed
A 27-year-old who stopped using medroxyprogesterone contraceptive injection (Depo-Provera) several months ago
A 22-year-old who has a history of anorexia nervosa and who has a body mass index (BMI) of 12.0 (normal is 18.5 to 24.9).

Question 21. A 24-year-old woman has presented to an inner-city free clinic because of the copious, foul vaginal discharge that she has had in recent days. Microscopy has confirmed the presence of Trichomonas vaginalis. What is the woman's most likely treatment and prognosis?
Abstinence will be required until the infection resolves, since treatments do not yet have proven efficacy.
Oral antibiotics can prevent complications such as infertility and pelvic inflammatory disease.
Antifungal medications are effective against the anovulation and risk of HIV that accompany the infection.
Vaginal suppositories and topical ointments can provide symptom relief but cannot eradicate the microorganism.

Question 22. A couple that has three daughters would like to add a son to their family, and they have recently learned that the woman is pregnant. Which of the following phenomena would most likely be associated with the woman's eventual delivery of a healthy son?
The production of dihydrotestosterone (DHT) by the embryo and DHT's differentiation into testosterone
Development of testes under the influence of the X chromosome
Suppression of female reproductive structures by antimüllerian hormone (AMH)
Atrophy of the wolffian ducts during embryonic development

Question 23. A 40-year-old male patient with multiple health problems has been diagnosed with a testosterone deficiency. Which of the following assessment findings would his care provider attribute to an etiology other than this deficiency?
The patient has a voice that is unusually high in pitch.
The patient has long-standing anemia and low red cell counts.
The patient has a history of susceptibility to upper respiratory infections.
The patient has a low muscle mass as a proportion of total body weight.

Question 24. A 13-year-old female is undergoing rapid development of her breasts after experiencing menarche several months ago. Which of the following hormones are NOT active in the development of her breasts?
Prolactin
Oxytocin
Estrogen
Follicle-stimulating hormone
Progesterone

Question 25. Which of the following conditions usually improves when a woman is taking oral contraceptives?
Human Papillomavirus infection
Migraine headaches
Iron deficiency anemia
Herpes simplex virus