NEW
Font size
WorksheetsGAT and VVC and Anorectal Disorders
Total questions: 60
Worksheet time: 30mins
Which of the following is the preferred terminology when discussing sex classification in a patient?
Biologic sex
Natal sex
Sex assigned at birth
Genetic sex
Gender dysphoria differs from gender incongruence in that gender dysphoria:
Is not considered a psychiatric condition
Requires the presence of psychological distress or impairment
Is determined solely by hormone levels
Must be present since childhood
Which of the following communication approaches aligns with inclusive care?
Always use “sir” or “ma’am” when unsure
Use pronouns based on the patient’s appearance
Ask the patient how they would like to be addressed
Avoid asking about pronouns unless the patient brings it up
Which of the following is a limitation of feminizing hormone therapy?
Breast development typically fully matches cisgender females
Reduction in facial hair growth is usually complete
Voice pitch does NOT change with estrogen therapy
Skeletal structure (pelvis, jaw) significantly changes with therapy
Which estrogen formulation is recommended for feminizing therapy according to guidelines?
Conjugated equine estrogens
Ethinyl estradiol
Estradiol
Estrone
For patients over age 45 or with a history of VTE who desire feminizing therapy, the preferred estradiol route is:
Oral tablets
Transdermal patch
Intramuscular valerate
Subcutaneous cypionate
Which antiandrogen is the most commonly used agent in feminizing therapy?
Finasteride
Bicalutamide
GnRH analogue implants
Spironolactone
Progesterone use in gender-affirming care:
Is strongly recommended for all patients
Has strong evidence supporting improved breast development
Is not recommended due to limited evidence and potential risks
Has no known risks or side effects
Which of the following is an irreversible effect of masculinizing testosterone therapy?
Increased acne
Increased facial/body hair
Deepening of the voice
Increased hemoglobin levels
A patient using testosterone with an intact uterus and ovaries must be counseled that:
Testosterone fully prevents pregnancy
Contraception is unnecessary once menses stop
Testosterone is teratogenic and contraception is required
Fertility is permanently lost immediately after initiation
Which adverse effect is most associated with testosterone therapy?
Hyperkalemia
Polycythemia
Hyperprolactinemia
Severe edema
Puberty suppression with GnRH analogues may be initiated once a child has reached:
Tanner stage 1
Tanner stage 2
Tanner stage 3
Tanner stage 4
Which of the following is a benefit of puberty suppression in adolescents?
Prevents the need for any hormone therapy later
Ensures that gender dysphoria will resolve
Gives time to explore gender identity and prevents unwanted pubertal changes
Makes future fertility preservation unnecessary
Which agent used for puberty suppression is available as an annual implant?
Leuprolide
Triptorelin pamoate
Histrelin acetate
Degarelix
Monitoring during the first year of gender-affirming hormone therapy should occur:
Once every 12 months
Every 3 months until a stable dose is achieved
Weekly for the first 6 months
Only if symptoms worsen
Which laboratory is specifically important to monitor when spironolactone is used?
Hemoglobin and hematocrit
Liver function tests
Potassium and creatinine
LH and FSH levels
Which of the following is NOT considered a reversible effect of feminizing therapy?
Skin softening
Breast development
Decreased libido
Decreased muscle mass
Nonpharmacologic gender-affirming methods such as chest binding or tucking may require counseling because:
They are ineffective
They must be medically supervised
They may cause irritation, pain, or infection if done improperly
They reduce the need for hormone therapy
Which of the following best describes “gender expression”?
A person’s internal sense of their gender
How someone presents their gender outwardly
A person’s sexual orientation
The sex assigned at birth
Which term refers specifically to a person whose gender identity aligns with their sex assigned at birth?
Intersex
Cisgender
Transgender
Nonbinary
Which counseling point is MOST appropriate when discussing estradiol injections?
Estradiol valerate and cypionate doses are interchangeable
Dose should be reduced by ¼–⅓ when switching from valerate to cypionate
Estradiol injections cannot cause infertility
Injectable estradiol has no VTE risk
Which of the following describes the role of spironolactone in gender-affirming therapy?
Provides potent estrogenic activity
Serves as the primary estrogen in feminizing therapy
Blocks androgen receptors and lowers testosterone production
Increases conversion of testosterone to DHT
A patient with liver disease wants to begin feminizing hormone therapy. Which option is preferred?
Oral estradiol
Transdermal estradiol
Ethinyl estradiol
Conjugated equine estrogens
Which statement about puberty suppression with GnRH analogues is TRUE?
It irreversibly stops puberty permanently
It should begin before Tanner stage 2
It prevents irreversible pubertal changes
It guarantees the patient will want hormone therapy later
Which outcome is LEAST likely to be achieved with feminizing hormone therapy?
Reduced spontaneous erections
Breast development
Voice feminization
Softer skin
Which is a rare but documented adverse effect of GnRH analogue therapy in adolescents?
Bone fractures
Intracranial hypertension
Hypoglycemia
Severe hyperkalemia
Which of the following changes should be monitored in a patient receiving testosterone therapy?
Potassium levels
Serum estradiol levels only
Hemoglobin and hematocrit
Prolactin levels
Nonbinary patients should receive gender-affirming hormone therapy that is:
Identical to typical male or female protocols
Determined by provider preference
Tailored to their individual embodiment goals
Avoided due to insufficient evidence
When counseling a patient beginning estradiol therapy, which point is appropriate?
Expect maximal breast development within 1 month
Smoking increases thromboembolic risk
Estradiol prevents all fertility
Dose adjustments are rarely required
Which of the following disparities is commonly experienced by transgender and gender-diverse (TGD) individuals?
Lower rates of depression compared to the general population
Higher employment rates
Increased risk of homelessness and poverty
Lower risk of substance use disorder
Which organism is MOST responsible for maintaining normal vaginal pH through lactic acid and hydrogen peroxide production?
Gardnerella vaginalis
Lactobacillus
Candida albicans
Bacteroides
Which change occurs during menopause that increases the risk of vaginal infections?
Increased vaginal glycogen stores
Increased lactobacillus presence
Thinning of vaginal lining and increased pH
Increased hydrogen peroxide production
Which of the following is the MOST common cause of vulvovaginal candidiasis?
Candida glabrata
Candida tropicalis
Saccharomyces cerevisiae
Candida albicans
Which of the following medications increases vulvovaginal candidiasis risk by reducing normal vaginal flora?
Clomiphene
Broad-spectrum antibiotics
Metoprolol
Loop diuretics
Which symptom is characteristic of vulvovaginal candidiasis and differentiates it from bacterial vaginosis?
Fishy vaginal odor
Thick white “cottage-cheese” discharge without odor
Frothy green discharge
Elevated pH > 4.5
Which patient is appropriate for vulovaginal candidiasis self-treatment with OTC antifungals?
Symptoms returned 1 month after last infection
First-time symptoms never medically diagnosed
Mild symptoms, pH ≤ 4.5, and fewer than 3 infections/year
Taking warfarin
Which of the following is an exclusion for VVC self-treatment?
Mild itching and irritation
Symptoms occurring less than 3 times/year
Pregnancy
History of one medically diagnosed VVC episode
Which statement about OTC imidazole antifungals is TRUE?
7-day products are more effective than 1-day products
1-day regimens provide faster symptom relief than 7-day
Oral therapy is recommended before topical therapy
All OTC products require a prescription
A patient on warfarin wants to use miconazole for vulvovaginal candidiasis. What should you advise?
Safe—no interactions
Avoid miconazole; may increase warfarin effect
Use only 7-day regimens
Take warfarin with food only
Which counseling point is correct regarding vaginal antifungal administration?
Use tampons to prevent leakage
OK to discontinue once symptoms resolve
Insert at bedtime to reduce leakage
Do not use during menstruation
Which is the primary cause of atrophic vaginitis?
Vaginal infection
Elevated estrogen levels
Estrogen deficiency leading to mucosal atrophy
Excessive vaginal moisture
Which symptom MOST strongly suggests atrophic vaginitis?
Cottage-cheese discharge
Thin, watery, or bloody discharge
Frothy green discharge
Strong odor
Which patient should be referred for medical evaluation?
Mild dryness relieved by lubricants
Postmenopausal bleeding
Dyspareunia relieved with lubricant
Occasional itching
Which is a known adverse effect of routine douching?
Decreases risk of pelvic inflammatory disease
Improves natural vaginal flora balance
Increases risk of vaginal infections and ectopic pregnancy
Improves contraceptive efficacy
Which counseling point for douching is correct?
Recommended for routine hygiene
Safe for use during pregnancy
Do not use 48 hours before gynecologic exam
Helps treat vaginal infections
Grade 3 hemorrhoids are described as:
Enlarged but do not prolapse
Prolapse and cannot be reinserted
Prolapse during defecation but retract spontaneously
Prolapse during defecation and require manual reduction
Which symptom requires referral rather than self-treatment?
Itching
Burning
Mild swelling
Pain or bleeding
Which OTC class forms a physical barrier to decrease water loss and protect tissue?
Vasoconstrictors
Protectants
Astringents
Local anesthetics
Which counseling point for vasoconstrictors is correct?
Safe for anyone
Avoid in hypertension and diabetes
First-line therapy
Only effective for internal hemorrhoids
Which factor is LEAST likely to contribute to developing vulvovaginal candidiasis?
High-dose estrogen therapy
Frequent antibiotic use
Wearing tight, non-absorbent clothing
Using water-based vaginal lubricants
Which adverse effect is MOST commonly associated with vaginal antifungal products?
Severe systemic rash
Burning or irritation with first application
Hypertension
Fever and chills
A patient is using a vaginal antifungal. Which behavior decreases product efficacy?
Wearing a sanitary pad
Using a tampon during therapy
Taking the medication at bedtime
Continuing therapy during menses
Which OTC therapy is most appropriate for mild atrophic vaginitis?
Oral estrogen therapy
Water-soluble vaginal lubricants
OTC antifungals
Douching products
Which scenario requires referral instead of self-care?
Dryness during intercourse
Mild itching improved with lubricants
Postmenopausal bleeding
Occasional discomfort during sexual activity
Which counseling point for vaginal lubricants is TRUE?
Petroleum jelly is preferred because it lasts longer
Apply up to 2 teaspoons initially and adjust as needed
Lubricants can damage latex contraception
They should be applied only externally
Which type of douche ingredient poses a risk of fetal thyroid problems if overused during pregnancy?
Witch hazel
Vinegar and water
Povidone-iodine
Calamine
Which lifestyle recommendation helps prevent hemorrhoid symptoms?
Avoid drinking water before meals
Limit dietary fiber to reduce stool volume
Increase daily fiber to 25–40 grams
Delay defecation to strengthen muscles
Which grading description correctly matches Grade 2 hemorrhoids?
Prolapse with defecation, require manual reduction
Permanently prolapsed and cannot be reintroduced
Enlarge but do not prolapse
Prolapse with defecation but retract spontaneously
Which protective ingredient is appropriate for both internal and external hemorrhoids?
Witch hazel
Glycerin
Zinc oxide
Menthol
Which class includes agents that promote desquamation of epidermal cells but should NOT be used intrarectally?
Keratolytics
Astringents
Vasoconstrictors
Protectants
