Family Practice Exam Women Health 4 — Questions and Answers
Question 1: A 45-year-old woman presents with a painless, irregular breast mass on self-exam. Mammogram shows an irregular spiculated mass. What is the next step?
- Repeat mammogram in 6 months (BI-RADS 3 follow-up)
- Core needle biopsy (Correct answer)
- Fine-needle aspiration cytology only
- Diagnostic ultrasound and defer biopsy
Correct answer: Core needle biopsy
A spiculated mass on mammogram is BI-RADS 4–5 and requires tissue diagnosis via core needle biopsy.
Question 2: A 16-year-old presents with primary amenorrhea. She has normal breast development but no pubic/axillary hair. Testosterone is in the male range. What is the most likely diagnosis?
- Turner syndrome (45,X)
- Complete androgen insensitivity syndrome (CAIS) (Correct answer)
- Mullerian agenesis (Mayer-Rokitansky syndrome)
- Congenital adrenal hyperplasia
Correct answer: Complete androgen insensitivity syndrome (CAIS)
CAIS presents with female phenotype, normal breast development, absent pubic/axillary hair, and male-range testosterone (46,XY karyotype).
Question 3: Which contraceptive method provides the most reliable protection against both STIs and pregnancy?
- Combined oral contraceptive pill
- Copper IUD
- Male latex condom (Correct answer)
- Depot medroxyprogesterone acetate (DMPA)
Correct answer: Male latex condom
Male latex condoms are the only contraceptive method that provides significant protection against both pregnancy and sexually transmitted infections.
Question 4: A 34-year-old woman with PCOS presents desiring pregnancy. She has anovulatory cycles and a BMI of 32. What is the first-line ovulation induction agent?
- Clomiphene citrate
- Letrozole (aromatase inhibitor) (Correct answer)
- Gonadotropin injections (FSH)
- Metformin alone
Correct answer: Letrozole (aromatase inhibitor)
Letrozole is now preferred over clomiphene for ovulation induction in PCOS as it achieves higher live birth rates with less multiple pregnancy risk.
Question 5: A 60-year-old postmenopausal woman is started on alendronate for osteoporosis. Which instruction is most important to prevent esophageal injury?
- Take with a full glass of milk to protect the esophagus
- Remain upright for at least 30 minutes after taking the tablet (Correct answer)
- Take at bedtime to maximize overnight absorption
- Crush the tablet and dissolve in juice for easier swallowing
Correct answer: Remain upright for at least 30 minutes after taking the tablet
Bisphosphonates must be taken with a full glass of plain water and the patient must remain upright for ≥30 minutes to prevent esophageal ulceration.
Question 6: A 25-year-old woman presents with mucopurulent cervical discharge, cervical motion tenderness, and uterine tenderness. She is afebrile. What is the most appropriate treatment?
- Azithromycin 1g PO single dose only
- Ceftriaxone 500 mg IM plus doxycycline 100 mg PO BID for 14 days (Correct answer)
- Metronidazole 500 mg PO BID for 7 days alone
- Ciprofloxacin 500 mg PO BID for 14 days
Correct answer: Ceftriaxone 500 mg IM plus doxycycline 100 mg PO BID for 14 days
Outpatient PID treatment per CDC guidelines is ceftriaxone 500 mg IM once plus doxycycline 100 mg BID for 14 days (with or without metronidazole).
Question 7: A 31-year-old woman at 10 weeks gestation is found to have a TSH of 6.8 mIU/L and low free T4. She is asymptomatic. What is the appropriate management?
- Recheck thyroid function in the second trimester
- Start levothyroxine to achieve TSH <2.5 mIU/L (Correct answer)
- Start methimazole to suppress TSH
- No treatment needed as TSH rises normally in pregnancy
Correct answer: Start levothyroxine to achieve TSH <2.5 mIU/L
Overt hypothyroidism in pregnancy (elevated TSH + low free T4) requires levothyroxine to maintain TSH <2.5 mIU/L to prevent adverse fetal outcomes.
Family Practice Exam Women Health 4
A 45-year-old woman presents with a painless, irregular breast mass on self-exam.
Mammogram shows an irregular spiculated mass.
What is the next step?