ABFM & KSA Care of Women Certification
Exam Actual Questions with Answers &
Rationales
Page 1 of 121
,Question 1: A 28-year-old woman presents for her annual well-woman
examination. She reports regular menses every 28 days lasting 5 days with
moderate flow. She is sexually active with one male partner and uses
combined oral contraceptives. Her BMI is 24 kg/m², blood pressure is 118/76
mmHg, and she has no family history of breast or ovarian cancer. According to
current guidelines, which screening test is recommended at this visit?
A. Pap smear with HPV co-testing
B. Mammogram
C. Lipid profile
D. Bone mineral density scan
CORRECT ANSWER: A. Pap smear with HPV co-testing
Rationale: For women aged 21-29 years, cervical cancer screening with cytology
(Pap smear) every 3 years is recommended. At age 28, if she has not had recent
screening, a Pap smear is appropriate. HPV co-testing is typically for ages 30+, but
combined screening aligns with initiating routine care. Mammography starts at age
40-50, lipid screening is not annual for low-risk young adults, and bone density is
for older postmenopausal women.
Question 2: A 32-year-old primigravida at 8 weeks gestation presents with
nausea and vomiting. She has lost 2 kg since her last visit. Vital signs are
stable, and ultrasound confirms a singleton intrauterine pregnancy with fetal
heartbeat. What is the first-line pharmacologic treatment for her nausea and
vomiting of pregnancy?
A. Ondansetron
B. Doxylamine-pyridoxine
C. Metoclopramide
D. Promethazine
CORRECT ANSWER: B. Doxylamine-pyridoxine
Rationale: Doxylamine-pyridoxine (Diclegis) is the first-line pharmacologic therapy
for nausea and vomiting in pregnancy due to its established safety profile (FDA
Category A equivalent) and efficacy in randomized trials. Ondansetron is second-
line due to potential cardiac risks, while metoclopramide and promethazine carry
higher side effect profiles. Nonpharmacologic measures like ginger or acupressure
should precede but are insufficient here.
Question 3: A 45-year-old perimenopausal woman reports irregular heavy
menses, hot flashes, and mood changes. Her FSH level is elevated. She has no
contraindications to hormone therapy. What is the most appropriate initial
management for her vasomotor symptoms?
A. Low-dose combined oral contraceptive
B. Systemic menopausal hormone therapy with estrogen plus progestin
Page 2 of 121
,C. SSRI such as paroxetine
D. Black cohosh herbal supplement
CORRECT ANSWER: B. Systemic menopausal hormone therapy with estrogen
plus progestin
Rationale: For perimenopausal women with bothersome vasomotor symptoms and
an intact uterus, systemic MHT with estrogen plus progestin is the most effective
treatment. It also helps regulate bleeding. Combined OCPs are an option but less
preferred in this age group due to higher thrombotic risk. SSRIs are non-hormonal
alternatives for those unable to use MHT. Herbal supplements like black cohosh
have limited evidence.
Question 4: A 24-year-old woman requests emergency contraception after
unprotected intercourse 48 hours ago. She has no contraindications. Which
option provides the highest efficacy?
A. Levonorgestrel 1.5 mg oral
B. Ulipristal acetate 30 mg oral
C. Copper intrauterine device
D. Combined estrogen-progestin pills (Yuzpe method)
CORRECT ANSWER: C. Copper intrauterine device
Rationale: The copper IUD is the most effective form of emergency contraception
(failure rate <1%) when inserted within 5 days of unprotected intercourse and
provides ongoing contraception. Ulipristal is more effective than levonorgestrel,
especially after 72 hours, but copper IUD remains superior. The Yuzpe method has
higher failure rates and more side effects.
Question 5: During a routine prenatal visit at 28 weeks gestation, a patient's
blood pressure is 142/88 mmHg on two occasions. She has no proteinuria or
symptoms. What is the diagnosis and initial management?
A. Chronic hypertension; continue monitoring
B. Gestational hypertension; start labetalol
C. Preeclampsia; admit for delivery
D. White coat hypertension; repeat in 1 week
CORRECT ANSWER: B. Gestational hypertension; start labetalol
Rationale: New-onset hypertension after 20 weeks without proteinuria defines
gestational hypertension. At 142/88 mmHg, treatment with labetalol (first-line
antihypertensive in pregnancy) is indicated to prevent progression. Severe features
would warrant magnesium and delivery planning, but this is mild. Chronic
hypertension is pre-existing, and white coat requires confirmation.
Question 6: A 55-year-old postmenopausal woman presents with urinary
urgency, frequency, and occasional leakage. Pelvic exam shows atrophic
vaginal changes. Urinalysis is negative. What is the most appropriate initial
treatment?
Page 3 of 121
, A. Oral oxybutynin
B. Topical vaginal estrogen
C. Pelvic floor physical therapy
D. Mirabegron
CORRECT ANSWER: B. Topical vaginal estrogen
Rationale: Genitourinary syndrome of menopause (GSM) commonly causes
overactive bladder symptoms in postmenopausal women. Low-dose topical vaginal
estrogen is first-line as it directly addresses atrophy with minimal systemic
absorption. Anticholinergics like oxybutynin have more side effects; mirabegron is
second-line; pelvic floor therapy is adjunctive.
Question 7: A 19-year-old nulliparous woman requests contraception. She has
heavy menses and dysmenorrhea. Which method is most suitable?
A. Combined oral contraceptive pills
B. Levonorgestrel intrauterine device (Mirena)
C. Depot medroxyprogesterone acetate injection
D. Condoms with spermicide
CORRECT ANSWER: B. Levonorgestrel intrauterine device (Mirena)
Rationale: LNG-IUD is highly effective, reduces menstrual bleeding by up to 90%,
and alleviates dysmenorrhea, making it ideal for young women with heavy periods.
It has a low failure rate (<1%) and is safe in nulliparous patients. OCPs also help but
require daily compliance. DMPA may cause irregular bleeding initially.
Question 8: A 38-year-old woman with a history of two cesarean deliveries
presents at 39 weeks gestation in early labor. Fetal heart tracing is category I.
What is the recommended mode of delivery?
A. Repeat cesarean section
B. Trial of labor after cesarean (TOLAC)
C. Immediate cesarean for suspected scar dehiscence
D. Augmentation with oxytocin
CORRECT ANSWER: B. Trial of labor after cesarean (TOLAC)
Rationale: Women with one or two prior low transverse cesareans are candidates for
TOLAC if no contraindications exist. Success rates are 60-80%. At 39 weeks with
good tracing, vaginal delivery is encouraged per ACOG guidelines. Routine repeat
cesarean is not mandatory unless patient prefers or risks outweigh benefits.
Question 9: A 62-year-old woman is diagnosed with osteoporosis (T-score -2.7
at hip). She has no history of fractures. What is the first-line pharmacologic
treatment?
A. Raloxifene
B. Alendronate (bisphosphonate)
C. Teriparatide
D. Denosumab
Page 4 of 121
Exam Actual Questions with Answers &
Rationales
Page 1 of 121
,Question 1: A 28-year-old woman presents for her annual well-woman
examination. She reports regular menses every 28 days lasting 5 days with
moderate flow. She is sexually active with one male partner and uses
combined oral contraceptives. Her BMI is 24 kg/m², blood pressure is 118/76
mmHg, and she has no family history of breast or ovarian cancer. According to
current guidelines, which screening test is recommended at this visit?
A. Pap smear with HPV co-testing
B. Mammogram
C. Lipid profile
D. Bone mineral density scan
CORRECT ANSWER: A. Pap smear with HPV co-testing
Rationale: For women aged 21-29 years, cervical cancer screening with cytology
(Pap smear) every 3 years is recommended. At age 28, if she has not had recent
screening, a Pap smear is appropriate. HPV co-testing is typically for ages 30+, but
combined screening aligns with initiating routine care. Mammography starts at age
40-50, lipid screening is not annual for low-risk young adults, and bone density is
for older postmenopausal women.
Question 2: A 32-year-old primigravida at 8 weeks gestation presents with
nausea and vomiting. She has lost 2 kg since her last visit. Vital signs are
stable, and ultrasound confirms a singleton intrauterine pregnancy with fetal
heartbeat. What is the first-line pharmacologic treatment for her nausea and
vomiting of pregnancy?
A. Ondansetron
B. Doxylamine-pyridoxine
C. Metoclopramide
D. Promethazine
CORRECT ANSWER: B. Doxylamine-pyridoxine
Rationale: Doxylamine-pyridoxine (Diclegis) is the first-line pharmacologic therapy
for nausea and vomiting in pregnancy due to its established safety profile (FDA
Category A equivalent) and efficacy in randomized trials. Ondansetron is second-
line due to potential cardiac risks, while metoclopramide and promethazine carry
higher side effect profiles. Nonpharmacologic measures like ginger or acupressure
should precede but are insufficient here.
Question 3: A 45-year-old perimenopausal woman reports irregular heavy
menses, hot flashes, and mood changes. Her FSH level is elevated. She has no
contraindications to hormone therapy. What is the most appropriate initial
management for her vasomotor symptoms?
A. Low-dose combined oral contraceptive
B. Systemic menopausal hormone therapy with estrogen plus progestin
Page 2 of 121
,C. SSRI such as paroxetine
D. Black cohosh herbal supplement
CORRECT ANSWER: B. Systemic menopausal hormone therapy with estrogen
plus progestin
Rationale: For perimenopausal women with bothersome vasomotor symptoms and
an intact uterus, systemic MHT with estrogen plus progestin is the most effective
treatment. It also helps regulate bleeding. Combined OCPs are an option but less
preferred in this age group due to higher thrombotic risk. SSRIs are non-hormonal
alternatives for those unable to use MHT. Herbal supplements like black cohosh
have limited evidence.
Question 4: A 24-year-old woman requests emergency contraception after
unprotected intercourse 48 hours ago. She has no contraindications. Which
option provides the highest efficacy?
A. Levonorgestrel 1.5 mg oral
B. Ulipristal acetate 30 mg oral
C. Copper intrauterine device
D. Combined estrogen-progestin pills (Yuzpe method)
CORRECT ANSWER: C. Copper intrauterine device
Rationale: The copper IUD is the most effective form of emergency contraception
(failure rate <1%) when inserted within 5 days of unprotected intercourse and
provides ongoing contraception. Ulipristal is more effective than levonorgestrel,
especially after 72 hours, but copper IUD remains superior. The Yuzpe method has
higher failure rates and more side effects.
Question 5: During a routine prenatal visit at 28 weeks gestation, a patient's
blood pressure is 142/88 mmHg on two occasions. She has no proteinuria or
symptoms. What is the diagnosis and initial management?
A. Chronic hypertension; continue monitoring
B. Gestational hypertension; start labetalol
C. Preeclampsia; admit for delivery
D. White coat hypertension; repeat in 1 week
CORRECT ANSWER: B. Gestational hypertension; start labetalol
Rationale: New-onset hypertension after 20 weeks without proteinuria defines
gestational hypertension. At 142/88 mmHg, treatment with labetalol (first-line
antihypertensive in pregnancy) is indicated to prevent progression. Severe features
would warrant magnesium and delivery planning, but this is mild. Chronic
hypertension is pre-existing, and white coat requires confirmation.
Question 6: A 55-year-old postmenopausal woman presents with urinary
urgency, frequency, and occasional leakage. Pelvic exam shows atrophic
vaginal changes. Urinalysis is negative. What is the most appropriate initial
treatment?
Page 3 of 121
, A. Oral oxybutynin
B. Topical vaginal estrogen
C. Pelvic floor physical therapy
D. Mirabegron
CORRECT ANSWER: B. Topical vaginal estrogen
Rationale: Genitourinary syndrome of menopause (GSM) commonly causes
overactive bladder symptoms in postmenopausal women. Low-dose topical vaginal
estrogen is first-line as it directly addresses atrophy with minimal systemic
absorption. Anticholinergics like oxybutynin have more side effects; mirabegron is
second-line; pelvic floor therapy is adjunctive.
Question 7: A 19-year-old nulliparous woman requests contraception. She has
heavy menses and dysmenorrhea. Which method is most suitable?
A. Combined oral contraceptive pills
B. Levonorgestrel intrauterine device (Mirena)
C. Depot medroxyprogesterone acetate injection
D. Condoms with spermicide
CORRECT ANSWER: B. Levonorgestrel intrauterine device (Mirena)
Rationale: LNG-IUD is highly effective, reduces menstrual bleeding by up to 90%,
and alleviates dysmenorrhea, making it ideal for young women with heavy periods.
It has a low failure rate (<1%) and is safe in nulliparous patients. OCPs also help but
require daily compliance. DMPA may cause irregular bleeding initially.
Question 8: A 38-year-old woman with a history of two cesarean deliveries
presents at 39 weeks gestation in early labor. Fetal heart tracing is category I.
What is the recommended mode of delivery?
A. Repeat cesarean section
B. Trial of labor after cesarean (TOLAC)
C. Immediate cesarean for suspected scar dehiscence
D. Augmentation with oxytocin
CORRECT ANSWER: B. Trial of labor after cesarean (TOLAC)
Rationale: Women with one or two prior low transverse cesareans are candidates for
TOLAC if no contraindications exist. Success rates are 60-80%. At 39 weeks with
good tracing, vaginal delivery is encouraged per ACOG guidelines. Routine repeat
cesarean is not mandatory unless patient prefers or risks outweigh benefits.
Question 9: A 62-year-old woman is diagnosed with osteoporosis (T-score -2.7
at hip). She has no history of fractures. What is the first-line pharmacologic
treatment?
A. Raloxifene
B. Alendronate (bisphosphonate)
C. Teriparatide
D. Denosumab
Page 4 of 121
