Family Practice Exam Women Health 5 — Questions and Answers
Question 1: A 44-year-old woman presents with irregular periods, a FSH of 45 IU/L, and estradiol of 18 pg/mL. She is experiencing hot flashes. What is the most accurate interpretation?
- She is in the early follicular phase of a normal cycle
- These values confirm perimenopause/ovarian insufficiency (Correct answer)
- Elevated FSH with low estradiol indicates hyperprolactinemia
- FSH of 45 is diagnostic of primary hypothyroidism
Correct answer: These values confirm perimenopause/ovarian insufficiency
Elevated FSH (>25–40 IU/L) with low estradiol and irregular cycles in a woman >40 years confirms perimenopause or premature ovarian insufficiency.
Question 2: Which of the following is the MOST appropriate management for a 30-year-old woman who presents with a 3 cm simple ovarian cyst found incidentally on ultrasound?
- Immediate laparoscopic cystectomy
- CA-125 measurement and repeat ultrasound in 8–12 weeks
- Start combined OCPs to suppress the cyst
- Reassurance and repeat ultrasound in 8–12 weeks (Correct answer)
Correct answer: Reassurance and repeat ultrasound in 8–12 weeks
A simple cyst ≤5 cm in a premenopausal woman is almost always benign; reassurance with follow-up ultrasound in 8–12 weeks is appropriate.
Question 3: A 19-year-old woman presents with sudden onset severe unilateral pelvic pain, nausea, and vomiting. She had a positive pregnancy test 3 weeks ago. Ultrasound shows no intrauterine pregnancy and free fluid in the cul-de-sac. What is the priority diagnosis?
- Ovarian torsion
- Ruptured ectopic pregnancy (Correct answer)
- Appendicitis
- Spontaneous abortion with hemorrhage
Correct answer: Ruptured ectopic pregnancy
The combination of positive pregnancy test, no IUP on ultrasound, and free pelvic fluid is ruptured ectopic pregnancy until proven otherwise — a surgical emergency.
Question 4: A 65-year-old woman with a 40 pack-year smoking history is concerned about lung cancer. Per USPSTF guidelines, which statement about her screening eligibility is correct?
- She qualifies for annual low-dose CT screening if she smoked within the past 15 years (Correct answer)
- She requires annual chest X-ray as first-line screening
- Screening is only recommended if she has a family history of lung cancer
- She is too old to benefit from screening per USPSTF guidelines
Correct answer: She qualifies for annual low-dose CT screening if she smoked within the past 15 years
USPSTF recommends annual LDCT for adults 50–80 years with a 20+ pack-year history who currently smoke or quit within the past 15 years.
Question 5: A 26-year-old woman presents with thin, gray-white vaginal discharge with a fishy odor, especially after intercourse. Wet prep shows clue cells. What is the first-line treatment?
- Fluconazole 150 mg PO single dose
- Metronidazole 500 mg PO twice daily for 7 days (Correct answer)
- Ceftriaxone 500 mg IM single dose
- Clotrimazole vaginal cream for 7 days
Correct answer: Metronidazole 500 mg PO twice daily for 7 days
Bacterial vaginosis is diagnosed by Amsel criteria (clue cells, fishy odor, pH >4.5, gray discharge) and treated with metronidazole 500 mg PO BID for 7 days.
Question 6: A 37-year-old woman with a BRCA1 mutation asks about risk-reducing surgery. At what age is risk-reducing salpingo-oophorectomy (RRSO) generally recommended for BRCA1 carriers?
- After age 50, concurrent with menopause
- Between ages 35–40 years, after childbearing is complete (Correct answer)
- At age 25, regardless of childbearing plans
- Only after a first-degree relative develops ovarian cancer
Correct answer: Between ages 35–40 years, after childbearing is complete
For BRCA1 carriers, RRSO is recommended between ages 35–40 after childbearing is complete due to the earlier onset of ovarian cancer risk.
Question 7: A 58-year-old woman on long-term systemic HRT (estrogen + progestogen) asks about risks. Which cancer risk is most significantly increased with combined HRT use beyond 5 years?
- Ovarian cancer
- Cervical cancer
- Breast cancer (Correct answer)
- Endometrial cancer
Correct answer: Breast cancer
Combined estrogen-progestogen HRT used for more than 5 years is associated with a modest but significant increase in breast cancer risk.
Family Practice Exam Women Health 5
A 44-year-old woman presents with irregular periods, a FSH of 45 IU/L, and estradiol of 18 pg/mL.
She is experiencing hot flashes.
What is the most accurate interpretation?