Women's Health APEA Final Exam Prep
Complete Questions and Verified Answers
Question 1
During a clinical breast exam, a 35-year-old woman presents with a small, firm, mobile
mass in the Axillary Tail of Spence. There are no skin changes or nipple discharge.
What is the most appropriate next step?
A) Order a diagnostic mammogram and ultrasound
B) Reassure the patient and recommend a follow-up in 6 months
C) Perform a fine-needle aspiration in the clinic
D) Start empirical antibiotics for a possible breast infection
Correct Answer
Answer: A) Order a diagnostic mammogram and ultrasound
Explanation: The Axillary Tail of Spence is a common location for breast tumors,
including fibroadenomas, cysts, and malignancies. Imaging (mammogram +
ultrasound) is the first step in evaluating any breast mass, especially in women over
30 years old.
Question 2
(Moderate to High Difficulty) A patient with severe premenstrual dysphoric disorder
(PMDD) is prescribed fluoxetine. How should this medication be administered for
optimal symptom relief?
A) Taken continuously throughout the menstrual cycle
B) Taken only during the follicular phase (days 1-14)
C) Taken only during the luteal phase (days 14-28)
D) Used as needed when symptoms begin
Correct Answer
: C) Taken only during the luteal phase (days 14-28)
Explanation: SSRIs (e.g., fluoxetine, sertraline) are first-line for moderate to severe
PMS/PMDD and can be used continuously or only during the luteal phase to
minimize side effects.
Page 1 of 112
,Question 3
(High Difficulty) A patient with HER2-positive breast cancer is prescribed trastuzumab
(Herceptin). Which of the following adverse effects should be closely monitored?
A) Nephrotoxicity
B) Cardiotoxicity
C) Hepatotoxicity
D) Pulmonary fibrosis
Correct Answer
B) Cardiotoxicity
Explanation: Trastuzumab can cause cardiomyopathy, leading to reduced left
ventricular ejection fraction (LVEF). Baseline and follow-up echocardiograms are
recommended.
Question 4
What are the main risks and benefits associated with hormone replacement therapy
(HRT) in the management of menopausal symptoms, and how does it impact
cardiovascular health?
Correct Answer
The benefits of HRT include relief from vasomotor symptoms (hot flashes, night
sweats), improved mood, and prevention of osteoporosis. However, it also carries
risks such as an increased risk of breast cancer, deep vein thrombosis (DVT), and
stroke, especially in women who start HRT after age 60 or have a history of
cardiovascular disease. HRT may have a protective effect on heart health when
started early (around the time of menopause) but can increase cardiovascular risks
later in life.
Page 2 of 112
,Question 5
Which of the following medications is often prescribed for patients with polycystic
ovary syndrome (PCOS) who experience secondary amenorrhea due to anovulation?
A) Levothyroxine
B) Metformin
C) Clomiphene citrate
D) Bromocriptine
Correct Answer
C) Clomiphene citrate
Explanation: Clomiphene citrate is commonly used to induce ovulation in women
with PCOS. It works by blocking estrogen receptors in the hypothalamus, leading to
increased secretion of gonadotropins (FSH and LH), which stimulates ovulation.
Question 6
Which of the following is a contraindication for prescribing combined oral
contraceptives (COCs)?
A) A history of venous thromboembolism
B) A history of mild acne
C) A history of seasonal allergies
D) A family history of hypertension
Correct Answer
Answer: A) A history of venous thromboembolism
Question 7
What is the primary mechanism of action of progestin-only contraceptives, and how
do they differ from combined hormonal contraceptives in terms of side effects and
indications?
Correct Answer
Progestin-only contraceptives primarily work by thickening cervical mucus to
prevent sperm from entering the uterus and thinning the endometrial lining to
prevent implantation. Unlike combined hormonal contraceptives, they do not inhibit
ovulation in all users. These are particularly indicated in women who are
breastfeeding or have contraindications to estrogen. Common side effects include
irregular bleeding and amenorrhea, and they have a lower risk of venous
thromboembolism compared to combined methods.
Page 3 of 112
, Question 8
A 40-year-old woman has PMS symptoms refractory to SSRIs and lifestyle changes.
She does not wish to conceive. Which of the following would be the next best
treatment?
A) Spironolactone
B) Gonadotropin-releasing hormone (GnRH) agonists
C) NSAIDs
D) Combined oral contraceptives (OCPs)
Correct Answer
Answer: D) Combined oral contraceptives (OCPs)🔎 Explanation: OCPs suppress
ovulation, reducing hormonal fluctuations that contribute to PMS. Drospirenone-
containing OCPs (e.g., Yaz) are particularly effective.
Question 9
A patient with severe PMS is prescribed fluoxetine during the luteal phase only. What
is the primary reason for this dosing strategy?
A) To avoid long-term side effects of SSRIs
B) To target symptoms only when they occur
C) To reduce the risk of serotonin syndrome
D) To improve the patient's response to oral contraceptives
Correct Answer
B) To target symptoms only when they occur
🔎 Explanation: For PMS/PMDD, SSRIs like fluoxetine can be given continuously or
just during the luteal phase to target symptoms only when needed while minimizing
unnecessary medication exposure.
Question 10
Assessment of Menopausal Symptoms
Which diagnostic test is commonly used to confirm the onset of menopause in
women experiencing symptoms, and what is the significance of the test result?
Correct Answer
Answer: The Follicle Stimulating Hormone (FSH) level is commonly used. An FSH
level higher than 30 mIU/mL is indicative of menopause, as it reflects a lack of
ovarian response and the cessation of estrogen production.
Page 4 of 112
Complete Questions and Verified Answers
Question 1
During a clinical breast exam, a 35-year-old woman presents with a small, firm, mobile
mass in the Axillary Tail of Spence. There are no skin changes or nipple discharge.
What is the most appropriate next step?
A) Order a diagnostic mammogram and ultrasound
B) Reassure the patient and recommend a follow-up in 6 months
C) Perform a fine-needle aspiration in the clinic
D) Start empirical antibiotics for a possible breast infection
Correct Answer
Answer: A) Order a diagnostic mammogram and ultrasound
Explanation: The Axillary Tail of Spence is a common location for breast tumors,
including fibroadenomas, cysts, and malignancies. Imaging (mammogram +
ultrasound) is the first step in evaluating any breast mass, especially in women over
30 years old.
Question 2
(Moderate to High Difficulty) A patient with severe premenstrual dysphoric disorder
(PMDD) is prescribed fluoxetine. How should this medication be administered for
optimal symptom relief?
A) Taken continuously throughout the menstrual cycle
B) Taken only during the follicular phase (days 1-14)
C) Taken only during the luteal phase (days 14-28)
D) Used as needed when symptoms begin
Correct Answer
: C) Taken only during the luteal phase (days 14-28)
Explanation: SSRIs (e.g., fluoxetine, sertraline) are first-line for moderate to severe
PMS/PMDD and can be used continuously or only during the luteal phase to
minimize side effects.
Page 1 of 112
,Question 3
(High Difficulty) A patient with HER2-positive breast cancer is prescribed trastuzumab
(Herceptin). Which of the following adverse effects should be closely monitored?
A) Nephrotoxicity
B) Cardiotoxicity
C) Hepatotoxicity
D) Pulmonary fibrosis
Correct Answer
B) Cardiotoxicity
Explanation: Trastuzumab can cause cardiomyopathy, leading to reduced left
ventricular ejection fraction (LVEF). Baseline and follow-up echocardiograms are
recommended.
Question 4
What are the main risks and benefits associated with hormone replacement therapy
(HRT) in the management of menopausal symptoms, and how does it impact
cardiovascular health?
Correct Answer
The benefits of HRT include relief from vasomotor symptoms (hot flashes, night
sweats), improved mood, and prevention of osteoporosis. However, it also carries
risks such as an increased risk of breast cancer, deep vein thrombosis (DVT), and
stroke, especially in women who start HRT after age 60 or have a history of
cardiovascular disease. HRT may have a protective effect on heart health when
started early (around the time of menopause) but can increase cardiovascular risks
later in life.
Page 2 of 112
,Question 5
Which of the following medications is often prescribed for patients with polycystic
ovary syndrome (PCOS) who experience secondary amenorrhea due to anovulation?
A) Levothyroxine
B) Metformin
C) Clomiphene citrate
D) Bromocriptine
Correct Answer
C) Clomiphene citrate
Explanation: Clomiphene citrate is commonly used to induce ovulation in women
with PCOS. It works by blocking estrogen receptors in the hypothalamus, leading to
increased secretion of gonadotropins (FSH and LH), which stimulates ovulation.
Question 6
Which of the following is a contraindication for prescribing combined oral
contraceptives (COCs)?
A) A history of venous thromboembolism
B) A history of mild acne
C) A history of seasonal allergies
D) A family history of hypertension
Correct Answer
Answer: A) A history of venous thromboembolism
Question 7
What is the primary mechanism of action of progestin-only contraceptives, and how
do they differ from combined hormonal contraceptives in terms of side effects and
indications?
Correct Answer
Progestin-only contraceptives primarily work by thickening cervical mucus to
prevent sperm from entering the uterus and thinning the endometrial lining to
prevent implantation. Unlike combined hormonal contraceptives, they do not inhibit
ovulation in all users. These are particularly indicated in women who are
breastfeeding or have contraindications to estrogen. Common side effects include
irregular bleeding and amenorrhea, and they have a lower risk of venous
thromboembolism compared to combined methods.
Page 3 of 112
, Question 8
A 40-year-old woman has PMS symptoms refractory to SSRIs and lifestyle changes.
She does not wish to conceive. Which of the following would be the next best
treatment?
A) Spironolactone
B) Gonadotropin-releasing hormone (GnRH) agonists
C) NSAIDs
D) Combined oral contraceptives (OCPs)
Correct Answer
Answer: D) Combined oral contraceptives (OCPs)🔎 Explanation: OCPs suppress
ovulation, reducing hormonal fluctuations that contribute to PMS. Drospirenone-
containing OCPs (e.g., Yaz) are particularly effective.
Question 9
A patient with severe PMS is prescribed fluoxetine during the luteal phase only. What
is the primary reason for this dosing strategy?
A) To avoid long-term side effects of SSRIs
B) To target symptoms only when they occur
C) To reduce the risk of serotonin syndrome
D) To improve the patient's response to oral contraceptives
Correct Answer
B) To target symptoms only when they occur
🔎 Explanation: For PMS/PMDD, SSRIs like fluoxetine can be given continuously or
just during the luteal phase to target symptoms only when needed while minimizing
unnecessary medication exposure.
Question 10
Assessment of Menopausal Symptoms
Which diagnostic test is commonly used to confirm the onset of menopause in
women experiencing symptoms, and what is the significance of the test result?
Correct Answer
Answer: The Follicle Stimulating Hormone (FSH) level is commonly used. An FSH
level higher than 30 mIU/mL is indicative of menopause, as it reflects a lack of
ovarian response and the cessation of estrogen production.
Page 4 of 112
