A 46-Year-Old Woman Comes to the Office for Evaluation of a Vaginal

question 186

Multiple Choice

A 46-year-old woman comes to the office for evaluation of a vaginal mass.  The patient has had intermittent vaginal pressure for the past 2 years that is now constant and worse with intercourse.  She now notices a vaginal mass when voiding and sometimes sees light blood on the toilet paper after wiping.  The patient has no chronic medical conditions.  Her only surgery was a cervical conization 4 years ago; repeat Pap testing has since been normal.  The patient had 3 uncomplicated vaginal deliveries in her 20s and a tubal ligation with her last delivery.  She is recently divorced and has had 3 new sexual partners in the past year.  The patient smokes a half pack of cigarettes daily and drinks 1-2 glasses of wine on the weekends.  BMI is 23 kg/m².  Vital signs are normal.  On pelvic examination, there is a small erosion over the anterior vaginal wall but no lesions on the cervix.  The cervix protrudes to the hymenal ring with Valsalva maneuver.  The uterus is mobile and nontender, and there is a 2-cm pedunculated fundal uterine fibroid.  Which of the following is the most likely contributing factor to this patient's clinical presentation?

• A)Chronic tobacco use
• B)Multiple pregnancies
• C)Number of sexual partners
• D)Prior cervical conization
• E)Uterine leiomyomata

---

Definitions:

Training Solution

A strategic approach designed to address and resolve gaps in knowledge, skills, or abilities through tailored training programs.

Creative Techniques

Innovative methods or strategies used to produce new ideas or solve problems.

Mager And Pipe's

Refers to a model developed by Robert F. Mager and Peter Pipe that is used for analyzing performance problems and designing solutions.

Decision Tree

A graphical representation used for decision-making, showing different courses of action and potential outcomes as branches that stem from a central node.