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WHNP-BC study materials
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WHNP-BC: Gynecologic Disorders and Conditions

WHNP-BC · Work through your exam, one topic at a time.

All guide sections

Gynecologic Disorders and Conditions

What the exam tests

Gynecology items reward a structured approach to three complaints: bleeding, pain, and discharge. Learn one framework for each and apply it consistently.

Core concepts

  • Abnormal uterine bleeding: use PALM-COEIN (structural: polyp, adenomyosis, leiomyoma, malignancy; nonstructural: coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not otherwise classified). With heavy menses, check CBC and ferritin; consider von Willebrand disease in adolescents bleeding heavily since menarche.
  • Postmenopausal bleeding is endometrial cancer until proven otherwise: transvaginal ultrasound with an endometrial thickness threshold, or endometrial biopsy.
  • PCOS: Rotterdam criteria require two of three (oligo-ovulation or anovulation, clinical or biochemical hyperandrogenism, polycystic ovaries), after excluding thyroid disease, hyperprolactinemia, and congenital adrenal hyperplasia.
  • PID: a clinical diagnosis using minimum criteria (cervical motion, uterine, or adnexal tenderness); treat empirically with a low threshold.
  • Vaginitis: Amsel criteria for bacterial vaginosis (three of four); budding pseudohyphae with candidiasis; motile flagellates with trichomoniasis.
  • Endometriosis: dysmenorrhea, dyspareunia, and infertility; laparoscopy is definitive, but empiric therapy is acceptable.

Traps

  • Attributing all discharge to candida; bacterial vaginosis needs metronidazole, and partner treatment is not indicated.
  • Treating unscheduled bleeding in the first 3 months of combined pills as dangerous; it is common.
  • Missing lichen sclerosus (pruritus, white plaques), which carries malignancy risk and needs biopsy if atypical.

Rule of thumb

Any bleeding after menopause, any adnexal mass with a negative pregnancy test and acute pain, and any vulvar lesion that fails treatment require imaging or tissue, not reassurance.

Worked example

A 59-year-old who is 6 years postmenopausal reports a single episode of vaginal bleeding. The next step is transvaginal ultrasound and/or endometrial biopsy to evaluate for endometrial hyperplasia or cancer.