1
Barkley WHNP Diagnostic Readiness Test (DRT) |
100 Practice Questions and Rationales
SECTION 1 – WELL-WOMAN GYNECOLOGY & PREVENTIVE CARE (Q1–25)
1. A 22-year-old woman presents for her first Pap test. According to current
ASCCP guidelines, cervical cancer screening with cytology alone should begin at
age:
A. 18
B. 21
C. 25
D. 30
Answer: B
Rationale: The American Society for Colposcopy and Cervical Pathology (ASCCP)
and USPSTF recommend initiating cervical cancer screening at age 21, regardless
of sexual history.
2. A 30-year-old woman has a Pap test with HPV co-testing. The result is
negative for intraepithelial lesion or malignancy (NILM) and HPV negative. The
recommended follow-up is:
A. Repeat co-testing in 1 year
B. Repeat co-testing in 3 years
C. Repeat co-testing in 5 years
D. Colposcopy
Answer: C
Rationale: For women aged 30–65 with a negative co-test (NILM and HPV
negative), routine screening is recommended no sooner than every 5 years.
pg. 1
,2
3. Which of the following is a known risk factor for cervical cancer?
A. Multiparity
B. Persistent infection with high-risk HPV types 16 and 18
C. Early menopause
D. Endometriosis
Answer: B
Rationale: Persistent infection with oncogenic (high-risk) HPV types, especially 16
and 18, is the primary cause of cervical cancer.
4. The quadrivalent HPV vaccine (Gardasil) protects against which HPV types?
A. 6, 11, 16, 18
B. 16, 18, 31, 33
C. 31, 33, 45, 52
D. 6, 11, 16, 18, 31, 33, 45, 52, 58
Answer: A
Rationale: The quadrivalent vaccine covers HPV 6, 11 (low-risk, cause 90% of
genital warts) and HPV 16, 18 (high-risk, cause 70% of cervical cancers). The 9-
valent vaccine covers additional types.
5. A 45-year-old woman reports irregular, heavy menses and hot flashes. Her
FSH level is elevated. Which phase of reproductive aging is she most likely
experiencing?
A. Premenopause
B. Perimenopause (menopause transition)
C. Postmenopause
D. Primary ovarian insufficiency
Answer: B
Rationale: The menopause transition (perimenopause) is characterized by
menstrual cycle irregularity, vasomotor symptoms, and elevated FSH levels,
typically occurring in the mid-to-late 40s.
pg. 2
,3
6. The most common cause of secondary amenorrhea in a reproductive-age
woman after pregnancy has been ruled out is:
A. Asherman’s syndrome
B. Polycystic ovary syndrome (PCOS)
C. Hypothalamic amenorrhea
D. Premature ovarian failure
Answer: B
Rationale: PCOS is the most common endocrine cause of secondary amenorrhea.
Hypothalamic amenorrhea (functional) is also common, but PCOS is the leading
overall cause.
7. A 27-year-old woman with PCOS is seeking contraception. Which method also
addresses her underlying hyperandrogenism and menstrual irregularity?
A. Copper IUD
B. Combined oral contraceptives (COCs)
C. Progestin-only pill
D. Condoms
Answer: B
Rationale: COCs suppress ovarian androgen production and increase SHBG,
reducing free testosterone. They also regulate menstrual cycles.
8. A 52-year-old woman complains of vulvovaginal dryness, dyspareunia, and
urinary urgency. She is not interested in systemic hormone therapy. What is the
most appropriate first-line treatment for her genitourinary syndrome of
menopause?
A. Oral ospemifene
B. Vaginal estrogen therapy
C. Systemic estrogen-progestin therapy
D. Testosterone gel
Answer: B
Rationale: Low-dose vaginal estrogen is the most effective treatment for
pg. 3
, 4
moderate-to-severe genitourinary syndrome of menopause (GSM). It has minimal
systemic absorption.
9. A 24-year-old woman presents with a 2-day history of dysuria, frequency, and
suprapubic pressure. Urine dipstick shows nitrites and leukocyte esterase. She is
8 weeks pregnant. Which antibiotic is safest in this trimester?
A. Nitrofurantoin
B. Ciprofloxacin
C. Trimethoprim-sulfamethoxazole
D. Doxycycline
Answer: A
Rationale: Nitrofurantoin can be used in the second trimester but is generally
avoided near term (38–42 weeks) and in the first trimester unless necessary.
Penicillins and cephalosporins are preferred. Here, in the first trimester,
amoxicillin or cephalexin would be safer. Nitrofurantoin is a common answer for
UTI in pregnancy but with caution. However, many guidelines list nitrofurantoin
as acceptable in the second trimester and after the first trimester. I'll adjust: The
question might expect cephalexin or amoxicillin as first line in early pregnancy. I'll
change the antibiotic to "amoxicillin" as answer and adjust options. Let's set the
correct answer as amoxicillin, which is Category B. I'll rephrase the question with
options including amoxicillin.
Revised Question 9: A 24-year-old at 8 weeks gestation has a UTI. Which
antibiotic is considered safe in early pregnancy?
A. Nitrofurantoin
B. Ciprofloxacin
C. Amoxicillin
D. Doxycycline
Answer: C
Rationale: Penicillins (amoxicillin) and cephalosporins are considered safe
throughout pregnancy. Nitrofurantoin can be used in the second trimester but is
often avoided in the first trimester if alternatives exist. Fluoroquinolones and
tetracyclines are contraindicated.
pg. 4
Barkley WHNP Diagnostic Readiness Test (DRT) |
100 Practice Questions and Rationales
SECTION 1 – WELL-WOMAN GYNECOLOGY & PREVENTIVE CARE (Q1–25)
1. A 22-year-old woman presents for her first Pap test. According to current
ASCCP guidelines, cervical cancer screening with cytology alone should begin at
age:
A. 18
B. 21
C. 25
D. 30
Answer: B
Rationale: The American Society for Colposcopy and Cervical Pathology (ASCCP)
and USPSTF recommend initiating cervical cancer screening at age 21, regardless
of sexual history.
2. A 30-year-old woman has a Pap test with HPV co-testing. The result is
negative for intraepithelial lesion or malignancy (NILM) and HPV negative. The
recommended follow-up is:
A. Repeat co-testing in 1 year
B. Repeat co-testing in 3 years
C. Repeat co-testing in 5 years
D. Colposcopy
Answer: C
Rationale: For women aged 30–65 with a negative co-test (NILM and HPV
negative), routine screening is recommended no sooner than every 5 years.
pg. 1
,2
3. Which of the following is a known risk factor for cervical cancer?
A. Multiparity
B. Persistent infection with high-risk HPV types 16 and 18
C. Early menopause
D. Endometriosis
Answer: B
Rationale: Persistent infection with oncogenic (high-risk) HPV types, especially 16
and 18, is the primary cause of cervical cancer.
4. The quadrivalent HPV vaccine (Gardasil) protects against which HPV types?
A. 6, 11, 16, 18
B. 16, 18, 31, 33
C. 31, 33, 45, 52
D. 6, 11, 16, 18, 31, 33, 45, 52, 58
Answer: A
Rationale: The quadrivalent vaccine covers HPV 6, 11 (low-risk, cause 90% of
genital warts) and HPV 16, 18 (high-risk, cause 70% of cervical cancers). The 9-
valent vaccine covers additional types.
5. A 45-year-old woman reports irregular, heavy menses and hot flashes. Her
FSH level is elevated. Which phase of reproductive aging is she most likely
experiencing?
A. Premenopause
B. Perimenopause (menopause transition)
C. Postmenopause
D. Primary ovarian insufficiency
Answer: B
Rationale: The menopause transition (perimenopause) is characterized by
menstrual cycle irregularity, vasomotor symptoms, and elevated FSH levels,
typically occurring in the mid-to-late 40s.
pg. 2
,3
6. The most common cause of secondary amenorrhea in a reproductive-age
woman after pregnancy has been ruled out is:
A. Asherman’s syndrome
B. Polycystic ovary syndrome (PCOS)
C. Hypothalamic amenorrhea
D. Premature ovarian failure
Answer: B
Rationale: PCOS is the most common endocrine cause of secondary amenorrhea.
Hypothalamic amenorrhea (functional) is also common, but PCOS is the leading
overall cause.
7. A 27-year-old woman with PCOS is seeking contraception. Which method also
addresses her underlying hyperandrogenism and menstrual irregularity?
A. Copper IUD
B. Combined oral contraceptives (COCs)
C. Progestin-only pill
D. Condoms
Answer: B
Rationale: COCs suppress ovarian androgen production and increase SHBG,
reducing free testosterone. They also regulate menstrual cycles.
8. A 52-year-old woman complains of vulvovaginal dryness, dyspareunia, and
urinary urgency. She is not interested in systemic hormone therapy. What is the
most appropriate first-line treatment for her genitourinary syndrome of
menopause?
A. Oral ospemifene
B. Vaginal estrogen therapy
C. Systemic estrogen-progestin therapy
D. Testosterone gel
Answer: B
Rationale: Low-dose vaginal estrogen is the most effective treatment for
pg. 3
, 4
moderate-to-severe genitourinary syndrome of menopause (GSM). It has minimal
systemic absorption.
9. A 24-year-old woman presents with a 2-day history of dysuria, frequency, and
suprapubic pressure. Urine dipstick shows nitrites and leukocyte esterase. She is
8 weeks pregnant. Which antibiotic is safest in this trimester?
A. Nitrofurantoin
B. Ciprofloxacin
C. Trimethoprim-sulfamethoxazole
D. Doxycycline
Answer: A
Rationale: Nitrofurantoin can be used in the second trimester but is generally
avoided near term (38–42 weeks) and in the first trimester unless necessary.
Penicillins and cephalosporins are preferred. Here, in the first trimester,
amoxicillin or cephalexin would be safer. Nitrofurantoin is a common answer for
UTI in pregnancy but with caution. However, many guidelines list nitrofurantoin
as acceptable in the second trimester and after the first trimester. I'll adjust: The
question might expect cephalexin or amoxicillin as first line in early pregnancy. I'll
change the antibiotic to "amoxicillin" as answer and adjust options. Let's set the
correct answer as amoxicillin, which is Category B. I'll rephrase the question with
options including amoxicillin.
Revised Question 9: A 24-year-old at 8 weeks gestation has a UTI. Which
antibiotic is considered safe in early pregnancy?
A. Nitrofurantoin
B. Ciprofloxacin
C. Amoxicillin
D. Doxycycline
Answer: C
Rationale: Penicillins (amoxicillin) and cephalosporins are considered safe
throughout pregnancy. Nitrofurantoin can be used in the second trimester but is
often avoided in the first trimester if alternatives exist. Fluoroquinolones and
tetracyclines are contraindicated.
pg. 4
