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MSN 621 Final Exam Questions and Answers 2025.
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MSN 621 Final Exam Questions and Answers 2025.A 35-year-old woman presents with the chief complaint of pelvic pain. She has a history
of secondary infertility and has had 1 live birth via Caesarean section. Since childbirth,
her symptoms of pelvic pain have worsened. She functions normally with her tasks of
daily living except for the inability to comfortably place a tampon and have pain-free
vaginal intercourse. The provider performs a pelvic exam and obtains a sample to
screen for sexually transmitted infections. Which of the following is the most appropriate
next step in management?
1. Refer to a pelvic floor physical therapist for further evaluation
2. Order an ultrasound to detect endometriosis
3. Prescribe vaginal estrogen therapy and plan for follow-up in 1 month
4. Perform a Q-tip test as well as a neuromuscular exam of the pelvis - ANSWER4
A 51-year-old woman presents with irregular, heavy menstrual bleeding for the past 6
months. She reports previously regular cycles every 30 days, lasting 4 to 6 days, with
medium flow. She says her cycles are now occurring every 30 to 45 days, lasting 5 to
12 days, with heavy flow and occasional passing of clots. Her BMI is 30.2 kg/m2, and
her vital signs are within normal limits. What is the most appropriate next step in
evaluating this patient?
1. Luteinizing and follicle-stimulating hormone levels
2. Sonohysterography
3. Endometrial sampling
4. Gonorrhea and chlamydia testing - ANSWER3
A 17-year-old girl presents with heavy menstrual cycles that are 28 days apart and last
7 to 8 days. She reports the passage of clots and, on her heaviest days, having to
change her pads every 1 to 2 hours. She is not sexually active and denies any
significant past medical history. She does admit to an episode of heavy bleeding after
tooth extraction for braces when she was 13. The physical exam findings are
unremarkable except for scattered ecchymoses on her bilateral shins. What is the most
appropriate next step in the evaluation of this patient?
1. Endometrial biopsy
2. Thyroid function studies
3. Pelvic ultrasound
4. Coagulopathy studies - ANSWER4
,A postmenopausal 57-year-old woman with a BMI of 34 kg/m2 presents after 3
episodes of vaginal bleeding in the past 45 days. She says each episode consisted of
light spotting and lasted for 3 days. Currently, she is afebrile and hemodynamically
stable with an unremarkable physical examination. What is the best next step in
evaluation?
1. CT abdomen and pelvis
2. Transvaginal ultrasound
3. Sonohysterography
4. Hysteroscopy - ANSWER2
A 16-year-old girl presents to the clinic with moderately severe vaginal bleeding and
lower abdominal cramping for the past two months. She is not sexually active; her last
menstrual period was 3 weeks ago. Per FIGO terminology, which of the following best
identifies the patient's presentation?
1. Menorrhagia
2. Menometorrhagia
3. Dysfunctional uterine bleeding
4. Abnormal uterine bleeding - ANSWER4
A 65-year-old female complains of vaginal burning, itching, and dyspareunia. She has
no significant past medical history. She takes an aspirin a day and calcium
supplements. Her pelvic exam shows pallor and thinning of the vaginal mucosa. There
is no discharge and the wet mount shows no organisms. What is the best treatment for
this patient?
1. Vaginal lubricants
2. 2.5% hydrocortisone cream intravaginally
3. Estrogen vaginal cream
4. Ospemifene - ANSWER3
An otherwise healthy 14-year-old girl who has never menstruated presents with
recurrent episodes of pelvic pain. She reports 3 episodes, each lasting several days,
though her most recent episode lasted longer than 1 week. During her episodes, the
pain is described as constant cramping that waxes and wanes somewhat in intensity
and radiates to her low back. She denies fever, nausea, vomiting, diarrhea,
constipation, or bloody stools and reports that she has never been sexually active. Her
height and weight are within normal limits for her age. On exam, she is noted to have
Tanner stage IV breast development and pubic hair. A urine pregnancy test is negative.
What is the most appropriate next step in evaluating this patient?
1. Pelvic exam
2. CT scan
3. Ultrasound
4. Serum beta-hCG testing - ANSWER1
,A 30-year-old woman presents with her third episode of painful swelling in the left labia
majora. What is the diagnosis and what is the best treatment to prevent this swelling
from recurring?
1. Skene's gland cyst, laser
2. Bartholin's gland abscess, cryotherapy
3. Bartholin's gland abscess, marsupialization
4. Skene's gland cyst, incision, and drainage - ANSWER3
A 48-year-old woman presents with a swelling on the left side of her vulva. The patient
says she noticed this swelling one week ago. She denies any pain, or history of weight
loss. She reports having regular menstrual cycles and being sexually active with her
husband. She has no past medical history and takes no medications. On examination,
there is no erythema, or purulent discharge. Which of the following is the most
appropriate treatment option?
1. Marsupialization
2. Incision and drainage
3. Antibiotic prescription
4. Observation, no further treatment is required - ANSWER4
A 45-year-old woman presents complaining of a swelling on her left labia that she
discovered it accidentally while bathing. She reports having a regular menstrual cycle
that lasts for about 5 days every month. She is sexually active with her husband for the
last twenty years. She is concerned as her mother died from metastatic breast cancer,
two years ago. What is the most common vulvar mass in a young woman?
1. Lipoma
2. Dermatofibroma
3. Bartholin gland cyst
4. Sebaceous cyst - ANSWER3
A 52-year-old woman with a past medical history of hypertension and hyperlipidemia
presents to her primary care provider after feeling a hard lump in her right breast while
showering. She has a sister with breast cancer diagnosed at 60 years of age. Her blood
pressure is 134/76 mmHg, heart rate 87/min, respiratory rate of 17/min, and
temperature of 98.6 F (37 C). Examination is significant for a palpable, nontender 1.5
cm mass noted in the right breast at 3'o clock position 5 cm from the nipple, with no
associated nipple discharge or axillary adenopathy. A diagnostic mammogram with
ultrasound of the right breast is ordered. Which of the following is included in the "triple
assessment" for this patient's evaluation?
1. Positron emission tomography scan
2. Computed tomography scan
3. Ultrasound-guided core needle biopsy
4. Nuclear medicine bone scan - ANSWER3
A 33-year-old woman presents with a painful and erythematous right breast. Her history
is significant for a normal spontaneous vaginal delivery 4 weeks ago and she is
exclusively breastfeeding her infant. Vital signs are temperature 99.7 F (37.6 C), blood
, pressure 130/70 mmHg, and heart rate 89 bpm. Physical examination reveals an
erythematous area on the right breast covering approximately 2 cm by 3 cm at 7 o'clock.
The area is tender to palpation, fluctuant, and slightly indurated. The nipple of the right
breast is cracked, but milk can be expressed without any difficulty. No visible pus is
observed in breast milk. A breast ultrasound confirms a collection of pus in the
erythematous part of the right breast. The clinician prescribes antibiotics and
recommends fine-needle aspiration of the affected area of the breast. Which is the next
best step if the patient does not improve with the recommended therapy?
1. Incis - ANSWER1
A 24-year-old woman presents to the clinic with breast tenderness, which increases
before menses. Ultrasound reveals a round, well-circumscribed, anechoic structure,
with an imperceptible wall. What is the most likely diagnosis?
1. Simple cyst
2. Complicated cyst
3. Complex cyst
4. Fibroadenoma - ANSWER1
A 37-year-old female presents to the clinic with a painless breast lump. Examination
reveals a mobile, solitary, painless breast mass, felt in the lower outer quadrant of the
right breast. A mammogram reveals a well-circumscribed discrete oval hypodense
breast glandular mass. What is the most likely diagnosis?
1. Lipoma
2. Ductal carcinoma in situ
3. Breast fibrocystic disease
4. Fibroadenoma - ANSWER4
A 25-year-old G0P0 female presents with intermittent abdominal pain. She states that
the pain starts before her period, is "crampy" in nature, and lasts for a few days after,
and has been occurring intermittently since menarche. Her periods have been regular,
with no spotting or pain in between periods. Her last period was a week ago. She has
no other health issues and takes no medications. She has had no previous surgeries in
the past. She is currently sexually active with her husband and is interested in starting a
family shortly. What is the first line of treatment for this patient?
1. Morphine
2. Selective serotonin reuptake inhibitor
3. Oral contraceptives
4. NSAIDs - ANSWER4
A 22-year-old woman presents to the clinic with a history of lower abdominal pain for the
past six months. There is no history of dysuria and dyspareunia. There is no relevant
family history of cancer. The patient noticed that the pain increases during the first two
days of her period. The periods are regular and slightly heavier than usual. She has to
change 6 to 7 pads per day. The patient's blood pressure is 120/80 mmHg, pulse
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