Family Practice Exam Women Health 3 — Questions and Answers
Question 1: A 35-year-old woman on combined oral contraceptives presents with sudden severe headache and left-sided weakness. Which OCP-related risk is most concerning?
- Increased risk of ovarian cyst rupture
- Estrogen-related thromboembolic stroke (Correct answer)
- Progesterone-induced hypertensive crisis
- Dopamine suppression from ethinyl estradiol
Correct answer: Estrogen-related thromboembolic stroke
Combined OCPs containing estrogen increase the risk of venous and arterial thromboembolism, including ischemic stroke, particularly in women with migraines with aura.
Question 2: What is the recommended first-line treatment for moderate-to-severe premenstrual dysphoric disorder (PMDD)?
- Cyclic oral contraceptives
- SSRIs (continuous or luteal-phase dosing) (Correct answer)
- Progesterone supplementation in the luteal phase
- Vitamin B6 and magnesium supplementation
Correct answer: SSRIs (continuous or luteal-phase dosing)
SSRIs are first-line for PMDD and can be used continuously or limited to the luteal phase with equivalent efficacy.
Question 3: A 22-year-old woman presents with thick, white, cottage-cheese-like vaginal discharge with vulvar pruritus and no odor. KOH prep shows pseudohyphae. What is the treatment?
- Metronidazole 500 mg PO twice daily for 7 days
- Fluconazole 150 mg PO single dose (Correct answer)
- Clindamycin vaginal cream for 7 days
- Azithromycin 1g PO single dose
Correct answer: Fluconazole 150 mg PO single dose
Vulvovaginal candidiasis is treated with oral fluconazole 150 mg single dose or topical antifungals; pseudohyphae on KOH confirms Candida.
Question 4: A 52-year-old woman is noted to have a BMI of 34, nulliparity, late menopause at age 55, and type 2 diabetes. Which cancer does this cluster of risk factors most increase?
- Cervical cancer
- Ovarian cancer
- Endometrial cancer (Correct answer)
- Breast cancer
Correct answer: Endometrial cancer
Obesity, nulliparity, late menopause, and diabetes are classic risk factors for endometrial cancer due to unopposed estrogen exposure.
Question 5: A 38-year-old G3P3 woman presents with heavy menstrual bleeding and pelvic pressure. Ultrasound shows a 6 cm intramural fibroid. She desires no future pregnancies. What is the definitive treatment?
- Levonorgestrel IUD for symptom control
- Uterine artery embolization
- GnRH agonist therapy
- Hysterectomy (Correct answer)
Correct answer: Hysterectomy
Hysterectomy is the definitive cure for symptomatic uterine fibroids in a woman who has completed childbearing.
Question 6: Which test is recommended for gestational diabetes screening in a low-risk pregnant woman at 24–28 weeks?
- Fasting plasma glucose only
- 1-hour 50 g glucose challenge test (GCT) (Correct answer)
- 2-hour 75 g oral glucose tolerance test (OGTT)
- HbA1c measurement
Correct answer: 1-hour 50 g glucose challenge test (GCT)
The 1-hour 50 g GCT (non-fasting) is the standard initial screening test for GDM at 24–28 weeks in the US.
Question 7: A 29-year-old woman presents with amenorrhea for 3 months, galactorrhea, and headaches. Serum prolactin is 180 ng/mL. What is the most appropriate next step?
- Start bromocriptine empirically
- Order an MRI of the pituitary gland
- Perform pregnancy test and thyroid function tests first (Correct answer)
- Begin combined OCPs to restore cycles
Correct answer: Perform pregnancy test and thyroid function tests first
Before MRI, exclude pregnancy (most common cause of amenorrhea-galactorrhea) and hypothyroidism (causes elevated prolactin) to avoid unnecessary imaging.
Family Practice Exam Women Health 3
A 35-year-old woman on combined oral contraceptives presents with sudden severe headache and left-sided weakness.
Which OCP-related risk is most concerning?