APEA Women's Health and Reproductive Medicine 1 — Questions and Answers
Question 1: A 28-year-old woman presents with dysmenorrhea, dyspareunia, and infertility of 2 years. Pelvic exam reveals fixed, tender uterus with nodularity along the uterosacral ligaments. What is the most likely diagnosis?
- Polycystic ovary syndrome
- Endometriosis (Correct answer)
- Uterine fibroids
- Ovarian torsion
Correct answer: Endometriosis
Endometriosis classically presents with the triad of dysmenorrhea, dyspareunia, and infertility, along with uterosacral nodularity and a fixed, retroverted uterus on exam.
Question 2: Which medication is first-line for treatment of bacterial vaginosis in non-pregnant women?
- Fluconazole 150 mg orally once
- Metronidazole 500 mg orally twice daily for 7 days (Correct answer)
- Azithromycin 1 g orally once
- Doxycycline 100 mg twice daily for 7 days
Correct answer: Metronidazole 500 mg orally twice daily for 7 days
CDC guidelines recommend metronidazole 500 mg PO BID for 7 days or metronidazole gel 0.75% intravaginally as first-line treatment for bacterial vaginosis.
Question 3: Which finding on pelvic exam and wet prep is most characteristic of Trichomonas vaginalis infection?
- Thin, gray, homogeneous discharge with positive whiff test
- Thick, white, cottage cheese-like discharge with pseudohyphae
- Frothy, yellow-green discharge with motile trichomonads on wet mount (Correct answer)
- Mucopurulent cervical discharge with polymorphonuclear cells
Correct answer: Frothy, yellow-green discharge with motile trichomonads on wet mount
Trichomonas vaginalis produces frothy, malodorous, yellow-green discharge and the classic 'strawberry cervix'; wet mount reveals motile pear-shaped trichomonads.
Question 4: A 42-year-old woman presents with hot flashes, night sweats, and irregular periods over the past 8 months. FSH is 48 mIU/mL and estradiol is 28 pg/mL. What is the most appropriate diagnosis?
- Primary hypothyroidism
- Perimenopause (Correct answer)
- Premature ovarian insufficiency
- Hyperprolactinemia
Correct answer: Perimenopause
Perimenopause is diagnosed clinically in women over 40 with vasomotor symptoms and irregular periods; elevated FSH confirms the hormonal transition but is not required for diagnosis.
Question 5: Which contraceptive method is most strongly contraindicated in a woman with a history of deep vein thrombosis (DVT)?
- Progestin-only pills (mini-pill)
- Combined oral contraceptives containing estrogen (Correct answer)
- Levonorgestrel-releasing IUD
- Copper intrauterine device
Correct answer: Combined oral contraceptives containing estrogen
Estrogen-containing contraceptives increase the risk of thromboembolic events by activating clotting factors; combined oral contraceptives are a WHO MEC category 4 (unacceptable risk) in women with history of DVT.
Question 6: A 25-year-old woman presents with acute severe pelvic pain, vaginal spotting, and nausea. Her last menstrual period was 7 weeks ago. Urine pregnancy test is positive and transvaginal ultrasound shows no intrauterine gestational sac. What is the priority diagnosis to rule out?
- Ovarian torsion
- Ectopic pregnancy (Correct answer)
- Ruptured hemorrhagic cyst
- Appendicitis
Correct answer: Ectopic pregnancy
A positive pregnancy test with no intrauterine gestational sac on ultrasound is an ectopic pregnancy until proven otherwise, as it is a life-threatening emergency if the tube ruptures.
Question 7: According to the 2024 USPSTF updated recommendations, at what age should routine screening mammography begin for average-risk women?
- 40 years (Correct answer)
- 45 years
- 50 years
- 35 years
Correct answer: 40 years
The 2024 USPSTF update changed the recommendation to begin biennial mammography screening at age 40 for all women at average risk, lowering from the previous 50-year threshold.
APEA Women's Health and Reproductive Medicine 1
A 28-year-old woman presents with dysmenorrhea, dyspareunia, and infertility of 2 years.
Pelvic exam reveals fixed, tender uterus with nodularity along the uterosacral ligaments.
What is the most likely diagnosis?