NCCPA Obstetrics and Gynecology 2

Question 1

A 38-year-old woman presents with irregular periods, hirsutism, acne, and difficulty conceiving. Transvaginal ultrasound shows bilateral enlarged ovaries with 12 or more peripheral follicles each. LH:FSH ratio is elevated. What is the most likely diagnosis?

Accepted Answer

Polycystic ovary syndrome (PCOS)

Answer

PCOS is diagnosed by the Rotterdam criteria (≥2 of 3: oligo/anovulation, hyperandrogenism, polycystic ovaries on ultrasound) and is the most common cause of anovulatory infertility.

Question 2

A 29-year-old woman presents with cyclic pelvic pain that worsens just before and during menstruation, dyspareunia, and dyschezia. She has been trying to conceive for 18 months. The most appropriate initial diagnostic tool is:

Accepted Answer

Diagnostic laparoscopy

Answer

Diagnostic laparoscopy with histologic confirmation is the gold standard for diagnosing endometriosis, as imaging and serum markers are neither sensitive nor specific enough for definitive diagnosis.

Question 3

According to USPSTF guidelines, at what age should average-risk women begin cervical cancer screening with Pap smear alone?

Accepted Answer

21 years

Answer

The USPSTF recommends cervical cancer screening beginning at age 21 with cytology (Pap smear) alone every 3 years for average-risk women, regardless of sexual activity onset.

Question 4

A 55-year-old postmenopausal woman presents with hot flashes, vaginal dryness, and mood changes. She has no personal or family history of breast cancer or VTE. What is the most appropriate management for her vasomotor symptoms?

Accepted Answer

Systemic hormone replacement therapy (HRT)

Answer

Systemic hormone replacement therapy (estrogen ± progestogen) is the most effective treatment for moderate-to-severe vasomotor symptoms of menopause and is appropriate in women without contraindications.

Question 5

A 22-year-old woman presents with lower abdominal pain, fever (38.4°C), cervical motion tenderness, and mucopurulent cervical discharge. The most appropriate treatment regimen for outpatient management is:

Accepted Answer

IM ceftriaxone 500 mg once plus oral doxycycline 100 mg BID × 14 days with metronidazole 500 mg BID × 14 days

Answer

Current CDC guidelines recommend IM ceftriaxone 500 mg once (for gonorrhea) plus doxycycline 100 mg BID × 14 days and metronidazole 500 mg BID × 14 days for outpatient PID treatment.

(NCCPA) National Commission on Certification of Physician Assistants Practice Test

(NCCPA) National Commission on Certification of Physician Assistants Practice Test

NCCPA Obstetrics and Gynecology 2