The shift in vaginal pH that occurs during puberty is influenced by            

A 22-year-old female presents to your clinic with the concern of vaginal discharge and malodor. On vaginal exam, you notice a discharge and erythematous irritation. You then check the pH of the vaginal fluid, and it turns the pH paper blue (pH>4.5). What is your assessment based on what you observe on the microscopic exam? (See image below)

At what age should COC’s be discontinued for smokers?

What condition of the reproductive system results in pain, erythema, a perineal mass, and dyspareunia?

All the following suggest vulvar cancer except:  

A 22 year old female presents with a complaint of increased vaginal discharge, no itching, and an unpleasant odor.  On examination a grayish white discharge is noted at the introitus and adhering to the vaginal walls.  There is no erythema. She is sexually active. The most likely finding on a wet mount examination would be:

A mother and her young 12 y.o. daughter come to your office frightened and concerned over the daughter’s irregular menstrual patterns and bleeding.  You explain to them that:

A 30-year old woman with bilateral breast implants is scheduled for her yearly exam. You begin to assess her breast health. She asks if it is necessary to do monthly BSE (breast self exam) because she does not know what to feel for.  The most appropriate response would be?  AND You are preparing for her breast exam, the proper exam technique for this woman  would be:

I have no set office hours. You must contact me via email.

Your patient is a 58yo postmenopausal female who comes in for her annual examination. She reports a feeling of fullness, bloating, and anorexia for the past 5-6 months. Her pelvic exam reveals a firm, fixed left adnexal mass >8cm. What is the most appropriate next step in managing this patient?