The Ultimate APEA Women's Health
Exam Cram: 200 Board-Style
Questions with Verified Answers &
Clinical Rationales
SECTION 1: GYNECOLOGIC CONDITIONS & MENSTRUAL
DISORDERS (Questions 1–40)
Q1. A 28-year-old woman reports heavy, regular menses
every 28 days lasting 8 days with clots and soaking through a
pad every 2 hours. Which term best describes this?
A) Menorrhagia
B) Metrorrhagia
C) Menometrorrhagia
D) Oligomenorrhea
Answer: A) Menorrhagia
Rationale: Menorrhagia is heavy but regular menstrual bleeding
(duration >7 days or >80 mL blood loss). Metrorrhagia is irregular
bleeding between periods; menometrorrhagia is heavy irregular
bleeding; oligomenorrhea is infrequent menses (>35 days). This
patient has regular cycles, so menorrhagia is correct.
,Q2. A 42-year-old with menorrhagia and dysmenorrhea has a
diffusely enlarged, globular, nontender uterus on bimanual
exam. The most likely diagnosis is:
A) Uterine fibroids (leiomyomas)
B) Adenomyosis
C) Endometrial polyp
D) Endometrial cancer
Answer: B) Adenomyosis
Rationale: Adenomyosis (endometrial glands within myometrium)
causes diffuse symmetric uterine enlargement, menorrhagia, and
painful menses. Fibroids cause irregularly enlarged uterus; polyps
do not enlarge uterus globally; cancer rarely presents with this
exam in absence of risk factors.
Q3. A 35-year-old has intermenstrual spotting and pelvic
pressure. Ultrasound shows a 2 cm intracavitary mass. Next
best step is:
A) Endometrial biopsy
B) Hysteroscopy with polypectomy
C) Observation for 3 months
D) Dilation and curettage (D&C)
Answer: B) Hysteroscopy with polypectomy
,Rationale: Suspected endometrial polyp: hysteroscopy allows
visualization and removal. Endometrial biopsy can miss polyps.
Observation is not indicated for a symptomatic polyp. D&C is less
accurate than hysteroscopy for focal lesions.
Q4. A 45-year-old woman with menorrhagia has a bimanual
exam showing a symmetrically enlarged, globular uterus.
Which diagnostic test is most appropriate?
A) Endometrial biopsy
B) Pelvic ultrasound
C) Hysteroscopy
D) CA-125
Answer: B) Pelvic ultrasound
Rationale: Pelvic ultrasound is the initial imaging study for
evaluating uterine enlargement and can differentiate between
adenomyosis (diffuse enlargement) and fibroids (irregular
enlargement). Endometrial biopsy may be needed if endometrial
thickening is present.
Q5. A 30-year-old woman presents with complaints of
abnormal uterine bleeding. If the patient has leiomyomas, the
NP will likely find which of the following when performing
the bimanual exam?
, A) An irregularly enlarged, firm uterus
B) A symmetrically enlarged, globular uterus
C) A tender, fixed uterus
D) A normal-sized uterus
Answer: A) An irregularly enlarged, firm uterus
Rationale: Leiomyomas (fibroids) cause an irregularly enlarged,
firm uterus on bimanual examination due to the presence of
multiple discrete tumors. Adenomyosis causes diffuse symmetric
enlargement.
Q6. Which of the following is NOT a manifestation seen in
women with polycystic ovarian syndrome?
A) Hirsutism
B) Oligomenorrhea
C) Pelvic pain
D) Obesity
Answer: C) Pelvic pain
Rationale: Pelvic pain is NOT a classic manifestation of PCOS.
PCOS is characterized by hyperandrogenism (hirsutism, acne),
ovulatory dysfunction (oligomenorrhea or amenorrhea), and
polycystic ovaries on ultrasound. Obesity and insulin resistance
are common associated features.
Exam Cram: 200 Board-Style
Questions with Verified Answers &
Clinical Rationales
SECTION 1: GYNECOLOGIC CONDITIONS & MENSTRUAL
DISORDERS (Questions 1–40)
Q1. A 28-year-old woman reports heavy, regular menses
every 28 days lasting 8 days with clots and soaking through a
pad every 2 hours. Which term best describes this?
A) Menorrhagia
B) Metrorrhagia
C) Menometrorrhagia
D) Oligomenorrhea
Answer: A) Menorrhagia
Rationale: Menorrhagia is heavy but regular menstrual bleeding
(duration >7 days or >80 mL blood loss). Metrorrhagia is irregular
bleeding between periods; menometrorrhagia is heavy irregular
bleeding; oligomenorrhea is infrequent menses (>35 days). This
patient has regular cycles, so menorrhagia is correct.
,Q2. A 42-year-old with menorrhagia and dysmenorrhea has a
diffusely enlarged, globular, nontender uterus on bimanual
exam. The most likely diagnosis is:
A) Uterine fibroids (leiomyomas)
B) Adenomyosis
C) Endometrial polyp
D) Endometrial cancer
Answer: B) Adenomyosis
Rationale: Adenomyosis (endometrial glands within myometrium)
causes diffuse symmetric uterine enlargement, menorrhagia, and
painful menses. Fibroids cause irregularly enlarged uterus; polyps
do not enlarge uterus globally; cancer rarely presents with this
exam in absence of risk factors.
Q3. A 35-year-old has intermenstrual spotting and pelvic
pressure. Ultrasound shows a 2 cm intracavitary mass. Next
best step is:
A) Endometrial biopsy
B) Hysteroscopy with polypectomy
C) Observation for 3 months
D) Dilation and curettage (D&C)
Answer: B) Hysteroscopy with polypectomy
,Rationale: Suspected endometrial polyp: hysteroscopy allows
visualization and removal. Endometrial biopsy can miss polyps.
Observation is not indicated for a symptomatic polyp. D&C is less
accurate than hysteroscopy for focal lesions.
Q4. A 45-year-old woman with menorrhagia has a bimanual
exam showing a symmetrically enlarged, globular uterus.
Which diagnostic test is most appropriate?
A) Endometrial biopsy
B) Pelvic ultrasound
C) Hysteroscopy
D) CA-125
Answer: B) Pelvic ultrasound
Rationale: Pelvic ultrasound is the initial imaging study for
evaluating uterine enlargement and can differentiate between
adenomyosis (diffuse enlargement) and fibroids (irregular
enlargement). Endometrial biopsy may be needed if endometrial
thickening is present.
Q5. A 30-year-old woman presents with complaints of
abnormal uterine bleeding. If the patient has leiomyomas, the
NP will likely find which of the following when performing
the bimanual exam?
, A) An irregularly enlarged, firm uterus
B) A symmetrically enlarged, globular uterus
C) A tender, fixed uterus
D) A normal-sized uterus
Answer: A) An irregularly enlarged, firm uterus
Rationale: Leiomyomas (fibroids) cause an irregularly enlarged,
firm uterus on bimanual examination due to the presence of
multiple discrete tumors. Adenomyosis causes diffuse symmetric
enlargement.
Q6. Which of the following is NOT a manifestation seen in
women with polycystic ovarian syndrome?
A) Hirsutism
B) Oligomenorrhea
C) Pelvic pain
D) Obesity
Answer: C) Pelvic pain
Rationale: Pelvic pain is NOT a classic manifestation of PCOS.
PCOS is characterized by hyperandrogenism (hirsutism, acne),
ovulatory dysfunction (oligomenorrhea or amenorrhea), and
polycystic ovaries on ultrasound. Obesity and insulin resistance
are common associated features.
