Family Practice Exam Women Health 2 — Questions and Answers
Question 1: A 55-year-old postmenopausal woman presents with vaginal bleeding. What is the most important initial step in evaluation?
- Reassure that spotting is normal after menopause
- Perform endometrial biopsy to rule out malignancy (Correct answer)
- Start combined HRT to stabilize the endometrium
- Order pelvic ultrasound and defer biopsy
Correct answer: Perform endometrial biopsy to rule out malignancy
Any postmenopausal bleeding must be evaluated with endometrial biopsy (or transvaginal ultrasound with biopsy if endometrium >4 mm) to exclude endometrial cancer.
Question 2: Which of the following is the most appropriate primary prevention strategy for cervical cancer in a 13-year-old girl?
- Annual Pap smear beginning at age 13
- HPV vaccination with the 9-valent vaccine (Correct answer)
- Annual pelvic exam with colposcopy
- Vaginal pH monitoring every 6 months
Correct answer: HPV vaccination with the 9-valent vaccine
The 9-valent HPV vaccine (Gardasil 9) is recommended at age 11–12 and is most effective before sexual debut.
Question 3: A 32-year-old woman with regular cycles presents with cyclic pelvic pain, dyspareunia, and infertility. CA-125 is mildly elevated. What is the most likely diagnosis?
- Ovarian torsion
- Pelvic inflammatory disease
- Endometriosis (Correct answer)
- Interstitial cystitis
Correct answer: Endometriosis
Endometriosis classically presents with cyclic pelvic pain, dyspareunia, and infertility, often with mildly elevated CA-125.
Question 4: What is the recommended screening interval for cervical cancer in a 25-year-old woman with no prior abnormal results?
- Annual Pap smear alone
- Pap smear every 3 years (Correct answer)
- Co-testing every 5 years
- No screening until age 30
Correct answer: Pap smear every 3 years
Women aged 21–29 should have a Pap smear every 3 years; HPV co-testing is not recommended in this age group.
Question 5: A 48-year-old perimenopausal woman reports hot flashes, mood changes, and sleep disturbance. She has no contraindications. What is the most effective treatment?
- SSRIs as first-line therapy
- Low-dose vaginal estrogen alone
- Systemic hormone replacement therapy (Correct answer)
- Black cohosh supplementation
Correct answer: Systemic hormone replacement therapy
Systemic HRT (estrogen ± progestogen) is the most effective treatment for vasomotor symptoms in perimenopausal women without contraindications.
Question 6: A 28-year-old woman presents with recurrent UTIs (>3 per year). All cultures grow E. coli. What is the most appropriate management strategy?
- Long-term suppressive antibiotics or post-coital prophylaxis (Correct answer)
- Imaging to rule out anatomical abnormality immediately
- Switch to macrobid only for treatment episodes
- Refer to nephrology for renal function testing
Correct answer: Long-term suppressive antibiotics or post-coital prophylaxis
Recurrent uncomplicated UTIs in premenopausal women are managed with continuous low-dose prophylaxis or post-coital antibiotics.
Question 7: Which breast cancer risk factor is considered the strongest independent predictor of lifetime risk?
- Nulliparity
- BRCA1 or BRCA2 mutation (Correct answer)
- Combined oral contraceptive use
- First-degree relative with postmenopausal breast cancer
Correct answer: BRCA1 or BRCA2 mutation
BRCA1/2 mutations confer up to 70–85% lifetime risk of breast cancer, making them the strongest independent genetic risk factor.
Family Practice Exam Women Health 2
A 55-year-old postmenopausal woman presents with vaginal bleeding.
What is the most important initial step in evaluation?