APEA Women's Health and Reproductive Medicine 2 — Questions and Answers
Question 1: A 26-year-old woman presents with vaginal pruritus, thick white cottage cheese-like discharge, and vulvar erythema. KOH prep shows budding hyphae. What is the most appropriate first-line treatment?
- Metronidazole 500 mg PO BID for 7 days
- Doxycycline 100 mg PO BID for 14 days
- Oral fluconazole 150 mg once or topical azole for 3–7 days (Correct answer)
- Clindamycin vaginal cream for 7 days
Correct answer: Oral fluconazole 150 mg once or topical azole for 3–7 days
Uncomplicated vulvovaginal candidiasis is treated with either a single dose of oral fluconazole 150 mg or a short-course topical azole; both options are equally effective first-line choices.
Question 2: A 29-year-old woman with PCOS who desires pregnancy has failed lifestyle modification for 6 months. Which medication is most appropriate as first-line pharmacotherapy to induce ovulation?
- Metformin alone
- Clomiphene citrate (Correct answer)
- Medroxyprogesterone acetate
- Spironolactone
Correct answer: Clomiphene citrate
Clomiphene citrate (a selective estrogen receptor modulator) is the first-line ovulation induction agent in women with PCOS who desire fertility, working by blocking estrogen feedback to increase FSH release.
Question 3: Which histological type of cervical cancer is most commonly associated with high-risk HPV infection?
- Adenocarcinoma
- Squamous cell carcinoma (Correct answer)
- Small cell neuroendocrine carcinoma
- Clear cell carcinoma
Correct answer: Squamous cell carcinoma
Squamous cell carcinoma accounts for approximately 70–75% of all cervical cancers and is strongly associated with high-risk HPV types 16 and 18.
Question 4: A 55-year-old postmenopausal woman presents with unexpected vaginal bleeding that started 2 weeks ago. She has no prior history of hormone therapy. What is the most critical next step in management?
- Reassure the patient and schedule a follow-up in 6 months
- Prescribe topical estrogen cream and re-evaluate in 3 months
- Order pelvic ultrasound and perform endometrial biopsy (Correct answer)
- Initiate systemic hormone replacement therapy
Correct answer: Order pelvic ultrasound and perform endometrial biopsy
Postmenopausal vaginal bleeding must be evaluated promptly for endometrial cancer with transvaginal ultrasound and endometrial biopsy, as endometrial carcinoma is the most common gynecologic malignancy in developed countries.
Question 5: Which Bethesda System classification corresponds to cervical intraepithelial neoplasia grade 1 (CIN 1) on Pap smear cytology?
- Atypical squamous cells of undetermined significance (ASC-US)
- Low-grade squamous intraepithelial lesion (LSIL) (Correct answer)
- High-grade squamous intraepithelial lesion (HSIL)
- Atypical squamous cells, cannot exclude HSIL (ASC-H)
Correct answer: Low-grade squamous intraepithelial lesion (LSIL)
LSIL on Pap cytology correlates with CIN 1 histologically, representing mild dysplasia and often associated with productive HPV infection that may regress spontaneously.
Question 6: A 24-year-old woman is diagnosed with an unruptured tubal ectopic pregnancy at 6 weeks. She is hemodynamically stable, hCG is 1,800 mIU/mL, and the gestational sac measures 2.5 cm. Which treatment is most appropriate?
- Expectant management only
- Methotrexate 50 mg/m² intramuscularly (Correct answer)
- Mifepristone 600 mg orally
- Emergency salpingectomy
Correct answer: Methotrexate 50 mg/m² intramuscularly
Methotrexate (a folic acid antagonist that inhibits rapidly dividing cells) is the preferred medical treatment for hemodynamically stable ectopic pregnancies meeting criteria such as hCG <5,000 mIU/mL and sac <3.5 cm.
Question 7: A 30-year-old woman with well-controlled hypertension desires reliable contraception. She is a non-smoker with no personal history of thromboembolic disease. Which contraceptive option is most appropriate?
- Combined oral contraceptive pill
- Contraceptive patch (Xulane)
- Levonorgestrel-releasing IUD (Mirena) (Correct answer)
- Combined hormonal vaginal ring (NuvaRing)
Correct answer: Levonorgestrel-releasing IUD (Mirena)
Progestin-only intrauterine devices are WHO MEC category 2 (advantages outweigh risks) for women with hypertension, while estrogen-containing methods are category 3–4 depending on blood pressure control.
APEA Women's Health and Reproductive Medicine 2
A 26-year-old woman presents with vaginal pruritus, thick white cottage cheese-like discharge, and vulvar erythema.
KOH prep shows budding hyphae.
What is the most appropriate first-line treatment?