Comprehensive Women's Health Examination: Clinical
Practice and Evidence-Based Management FINAL EXAM
2026 EDITION WITH QUESTIONS AND CORRECT
ANSWERS ALREADY GRADED A
Question 1
A 28-year-old nulliparous woman at 34 weeks gestation presents with a 3-day history of
worsening headache, visual disturbances described as "flashing lights," and epigastric pain rated
7/10. Her blood pressure is 168/104 mmHg, and urine dipstick reveals 3+ protein. Deep tendon
reflexes are 3+ with 1 beat of clonus. Which of the following represents the MOST appropriate
immediate management strategy for this patient?
A. Administer oral nifedipine 10 mg, obtain a complete metabolic panel, and schedule
outpatient blood pressure monitoring for tomorrow morning
B. Initiate magnesium sulfate intravenous bolus followed by continuous infusion, administer
intravenous labetalol for blood pressure control, and prepare for urgent delivery after
corticosteroid administration
C. Prescribe bed rest at home with daily blood pressure monitoring, instruct the patient to
return if headache worsens, and schedule a biophysical profile in 48 hours
D. Administer intravenous hydralazine 5 mg, obtain an urgent obstetric ultrasound, and transfer
to the labor and delivery unit for continuous fetal monitoring without magnesium sulfate
ANSWER: B
Explanation: This patient presents with severe preeclampsia with features of impending
eclampsia (severe hypertension, headache, visual changes, epigastric pain, hyperreflexia with
clonus). The standard of care requires immediate seizure prophylaxis with magnesium sulfate
(loading dose of 4-6 g IV followed by 1-2 g/hour continuous infusion) and blood pressure
control with agents such as labetalol or hydralazine to maintain systolic BP below 160 mmHg
and diastolic below 105 mmHg. Corticosteroids should be administered to promote fetal lung
maturity if delivery is anticipated within 7 days, and delivery is indicated once the patient is
stabilized. Option A is incorrect because outpatient management is contraindicated with severe
features. Option C is incorrect because home management with severe preeclampsia is
,dangerous and could lead to eclampsia. Option D is incorrect because it omits magnesium
sulfate, which is the standard of care for seizure prophylaxis in this scenario.
Question 2
A 45-year-old woman with a body mass index of 32 kg/m² presents with irregular menstrual
bleeding for the past 6 months, describing cycles ranging from 21 to 45 days with heavy flow
requiring pad changes every 1-2 hours. Transvaginal ultrasound reveals an endometrial stripe
thickness of 14 mm. Endometrial biopsy demonstrates complex hyperplasia with atypia. Which
of the following is the MOST appropriate management recommendation for this patient?
A. Initiate continuous combined oral contraceptive pills for 6 months and repeat endometrial
biopsy
B. Prescribe medroxyprogesterone acetate 10 mg daily for 3 months followed by repeat biopsy
C. Recommend hysterectomy given the presence of atypia and the patient's age and BMI
D. Place a levonorgestrel-releasing intrauterine device and perform endometrial biopsy in 6
months
ANSWER: C
Explanation: Complex endometrial hyperplasia with atypia is a premalignant condition that
progresses to endometrial carcinoma in approximately 25-30% of cases if left untreated. In a
perimenopausal patient with obesity (a significant risk factor for endometrial cancer),
hysterectomy is the standard and most definitive treatment. While progestin therapy (oral or
intrauterine) can be considered in women who desire fertility preservation, this patient is 45
years old with completed childbearing, making hysterectomy the preferred approach. Option A
is incorrect because oral contraceptives are not sufficient for treating atypical hyperplasia.
Option B is incorrect because while progestin therapy may be attempted in select cases, the
high risk of progression and the patient's age make hysterectomy more appropriate. Option D is
incorrect because an LNG-IUS is a treatment option for women desiring fertility preservation,
not the standard recommendation for a perimenopausal woman with atypia.
Question 3
A 32-year-old woman at 28 weeks gestation with a twin pregnancy presents with a blood
pressure of 145/92 mmHg on two occasions 4 hours apart. Urine protein is 450 mg per 24-hour
collection. She denies headache, visual changes, or epigastric pain. Fetal heart tones are
,reassuring for both twins, with appropriate growth on ultrasound. Which of the following is the
MOST appropriate next step in the management of this patient?
A. Initiate oral labetalol 100 mg twice daily and schedule weekly blood pressure checks
B. Admit to the hospital for blood pressure monitoring and administer antenatal corticosteroids
C. Prescribe low-dose aspirin 81 mg daily and recommend modified bed rest at home
D. Obtain baseline laboratory studies including complete blood count, liver function tests, and
serum creatinine, and admit for close maternal-fetal monitoring
ANSWER: D
Explanation: This patient meets criteria for preeclampsia without severe features (gestational
age ≥20 weeks, systolic BP ≥140 or diastolic BP ≥90 on two occasions, and proteinuria ≥300
mg/24 hours). In a twin gestation at 28 weeks, the appropriate management includes hospital
admission for close monitoring, baseline laboratory evaluation (CBC to assess for
thrombocytopenia, liver function tests to evaluate for HELLP syndrome, and renal function
studies), and fetal surveillance. Antihypertensive therapy is indicated when BP is persistently
≥160/105, which is not the case here. Option A is incorrect because outpatient management is
not appropriate for new-onset preeclampsia, especially with a twin gestation. Option B is
incorrect because corticosteroids are indicated when delivery is anticipated within 7 days, not
as a routine admission measure. Option C is incorrect because aspirin is used for prevention in
high-risk patients, not treatment of established preeclampsia, and home bed rest is insufficient.
Question 4
A 55-year-old postmenopausal woman presents for routine health maintenance. She has a
history of hypertension controlled with lisinopril and hyperlipidemia managed with atorvastatin.
She reports no vaginal bleeding or pelvic pain. She had her last menstrual period at age 51 and
has never used hormone therapy. Her BMI is 28 kg/m². A screening mammogram is performed
and shows no abnormalities. According to the United States Preventive Services Task Force
(USPSTF) guidelines, which of the following is the MOST appropriate recommendation regarding
her bone health screening?
A. No bone density screening is needed because she has no risk factors for osteoporosis
B. Begin bone mineral density screening now using dual-energy X-ray absorptiometry because
she is postmenopausal and over age 50
, C. Screen for osteoporosis using DXA starting at age 60, which is the recommended age for all
women
D. Screen with DXA now only if she has a parental history of hip fracture or uses corticosteroid
therapy
ANSWER: D
Explanation: The USPSTF recommends screening for osteoporosis with DXA in women aged 65
years and older, and in younger women aged 50-64 years who have risk factors that increase
their fracture risk equivalent to that of a 65-year-old woman. This patient's risk factors include
postmenopausal status, BMI 28 (which is not low; low BMI <20 is a risk factor), hypertension,
and hyperlipidemia. However, she does not have the major risk factors that would prompt early
screening (parental hip fracture, current smoking, alcohol use >3 drinks/day, low body weight
<58 kg, or chronic corticosteroid use). Therefore, routine screening is not recommended at this
time. Option A is incorrect because all postmenopausal women have some risk, but screening is
not universal before age 65. Option B is incorrect because age 50 alone is not the USPSTF
threshold for screening. Option C is incorrect because the recommended age for routine
screening is 65, not 60, for women without risk factors.
Question 5
A 24-year-old woman presents with a 6-month history of secondary amenorrhea. She reports
that her menstrual cycles were regular since menarche at age 13, but she has had no menses
for 6 months. She is not pregnant (confirmed by urine HCG), and she has no history of
galactorrhea or headaches. Her BMI is 19.2 kg/m², and she reports running 10 miles daily and
restricting her caloric intake to approximately 1,200 calories per day. Serum laboratory
evaluation reveals estradiol 28 pg/mL, FSH 6 mIU/mL, LH 3 mIU/mL, and prolactin 8 ng/mL.
Which of the following is the MOST likely diagnosis and appropriate initial management?
A. Polycystic ovary syndrome; initiate metformin and lifestyle modification
B. Hyperprolactinemia; order pituitary MRI and consider bromocriptine therapy
C. Premature ovarian insufficiency; begin hormone replacement therapy and counsel on fertility
options
D. Functional hypothalamic amenorrhea; recommend increased caloric intake, reduction in
exercise intensity, and weight restoration
ANSWER: D
Practice and Evidence-Based Management FINAL EXAM
2026 EDITION WITH QUESTIONS AND CORRECT
ANSWERS ALREADY GRADED A
Question 1
A 28-year-old nulliparous woman at 34 weeks gestation presents with a 3-day history of
worsening headache, visual disturbances described as "flashing lights," and epigastric pain rated
7/10. Her blood pressure is 168/104 mmHg, and urine dipstick reveals 3+ protein. Deep tendon
reflexes are 3+ with 1 beat of clonus. Which of the following represents the MOST appropriate
immediate management strategy for this patient?
A. Administer oral nifedipine 10 mg, obtain a complete metabolic panel, and schedule
outpatient blood pressure monitoring for tomorrow morning
B. Initiate magnesium sulfate intravenous bolus followed by continuous infusion, administer
intravenous labetalol for blood pressure control, and prepare for urgent delivery after
corticosteroid administration
C. Prescribe bed rest at home with daily blood pressure monitoring, instruct the patient to
return if headache worsens, and schedule a biophysical profile in 48 hours
D. Administer intravenous hydralazine 5 mg, obtain an urgent obstetric ultrasound, and transfer
to the labor and delivery unit for continuous fetal monitoring without magnesium sulfate
ANSWER: B
Explanation: This patient presents with severe preeclampsia with features of impending
eclampsia (severe hypertension, headache, visual changes, epigastric pain, hyperreflexia with
clonus). The standard of care requires immediate seizure prophylaxis with magnesium sulfate
(loading dose of 4-6 g IV followed by 1-2 g/hour continuous infusion) and blood pressure
control with agents such as labetalol or hydralazine to maintain systolic BP below 160 mmHg
and diastolic below 105 mmHg. Corticosteroids should be administered to promote fetal lung
maturity if delivery is anticipated within 7 days, and delivery is indicated once the patient is
stabilized. Option A is incorrect because outpatient management is contraindicated with severe
features. Option C is incorrect because home management with severe preeclampsia is
,dangerous and could lead to eclampsia. Option D is incorrect because it omits magnesium
sulfate, which is the standard of care for seizure prophylaxis in this scenario.
Question 2
A 45-year-old woman with a body mass index of 32 kg/m² presents with irregular menstrual
bleeding for the past 6 months, describing cycles ranging from 21 to 45 days with heavy flow
requiring pad changes every 1-2 hours. Transvaginal ultrasound reveals an endometrial stripe
thickness of 14 mm. Endometrial biopsy demonstrates complex hyperplasia with atypia. Which
of the following is the MOST appropriate management recommendation for this patient?
A. Initiate continuous combined oral contraceptive pills for 6 months and repeat endometrial
biopsy
B. Prescribe medroxyprogesterone acetate 10 mg daily for 3 months followed by repeat biopsy
C. Recommend hysterectomy given the presence of atypia and the patient's age and BMI
D. Place a levonorgestrel-releasing intrauterine device and perform endometrial biopsy in 6
months
ANSWER: C
Explanation: Complex endometrial hyperplasia with atypia is a premalignant condition that
progresses to endometrial carcinoma in approximately 25-30% of cases if left untreated. In a
perimenopausal patient with obesity (a significant risk factor for endometrial cancer),
hysterectomy is the standard and most definitive treatment. While progestin therapy (oral or
intrauterine) can be considered in women who desire fertility preservation, this patient is 45
years old with completed childbearing, making hysterectomy the preferred approach. Option A
is incorrect because oral contraceptives are not sufficient for treating atypical hyperplasia.
Option B is incorrect because while progestin therapy may be attempted in select cases, the
high risk of progression and the patient's age make hysterectomy more appropriate. Option D is
incorrect because an LNG-IUS is a treatment option for women desiring fertility preservation,
not the standard recommendation for a perimenopausal woman with atypia.
Question 3
A 32-year-old woman at 28 weeks gestation with a twin pregnancy presents with a blood
pressure of 145/92 mmHg on two occasions 4 hours apart. Urine protein is 450 mg per 24-hour
collection. She denies headache, visual changes, or epigastric pain. Fetal heart tones are
,reassuring for both twins, with appropriate growth on ultrasound. Which of the following is the
MOST appropriate next step in the management of this patient?
A. Initiate oral labetalol 100 mg twice daily and schedule weekly blood pressure checks
B. Admit to the hospital for blood pressure monitoring and administer antenatal corticosteroids
C. Prescribe low-dose aspirin 81 mg daily and recommend modified bed rest at home
D. Obtain baseline laboratory studies including complete blood count, liver function tests, and
serum creatinine, and admit for close maternal-fetal monitoring
ANSWER: D
Explanation: This patient meets criteria for preeclampsia without severe features (gestational
age ≥20 weeks, systolic BP ≥140 or diastolic BP ≥90 on two occasions, and proteinuria ≥300
mg/24 hours). In a twin gestation at 28 weeks, the appropriate management includes hospital
admission for close monitoring, baseline laboratory evaluation (CBC to assess for
thrombocytopenia, liver function tests to evaluate for HELLP syndrome, and renal function
studies), and fetal surveillance. Antihypertensive therapy is indicated when BP is persistently
≥160/105, which is not the case here. Option A is incorrect because outpatient management is
not appropriate for new-onset preeclampsia, especially with a twin gestation. Option B is
incorrect because corticosteroids are indicated when delivery is anticipated within 7 days, not
as a routine admission measure. Option C is incorrect because aspirin is used for prevention in
high-risk patients, not treatment of established preeclampsia, and home bed rest is insufficient.
Question 4
A 55-year-old postmenopausal woman presents for routine health maintenance. She has a
history of hypertension controlled with lisinopril and hyperlipidemia managed with atorvastatin.
She reports no vaginal bleeding or pelvic pain. She had her last menstrual period at age 51 and
has never used hormone therapy. Her BMI is 28 kg/m². A screening mammogram is performed
and shows no abnormalities. According to the United States Preventive Services Task Force
(USPSTF) guidelines, which of the following is the MOST appropriate recommendation regarding
her bone health screening?
A. No bone density screening is needed because she has no risk factors for osteoporosis
B. Begin bone mineral density screening now using dual-energy X-ray absorptiometry because
she is postmenopausal and over age 50
, C. Screen for osteoporosis using DXA starting at age 60, which is the recommended age for all
women
D. Screen with DXA now only if she has a parental history of hip fracture or uses corticosteroid
therapy
ANSWER: D
Explanation: The USPSTF recommends screening for osteoporosis with DXA in women aged 65
years and older, and in younger women aged 50-64 years who have risk factors that increase
their fracture risk equivalent to that of a 65-year-old woman. This patient's risk factors include
postmenopausal status, BMI 28 (which is not low; low BMI <20 is a risk factor), hypertension,
and hyperlipidemia. However, she does not have the major risk factors that would prompt early
screening (parental hip fracture, current smoking, alcohol use >3 drinks/day, low body weight
<58 kg, or chronic corticosteroid use). Therefore, routine screening is not recommended at this
time. Option A is incorrect because all postmenopausal women have some risk, but screening is
not universal before age 65. Option B is incorrect because age 50 alone is not the USPSTF
threshold for screening. Option C is incorrect because the recommended age for routine
screening is 65, not 60, for women without risk factors.
Question 5
A 24-year-old woman presents with a 6-month history of secondary amenorrhea. She reports
that her menstrual cycles were regular since menarche at age 13, but she has had no menses
for 6 months. She is not pregnant (confirmed by urine HCG), and she has no history of
galactorrhea or headaches. Her BMI is 19.2 kg/m², and she reports running 10 miles daily and
restricting her caloric intake to approximately 1,200 calories per day. Serum laboratory
evaluation reveals estradiol 28 pg/mL, FSH 6 mIU/mL, LH 3 mIU/mL, and prolactin 8 ng/mL.
Which of the following is the MOST likely diagnosis and appropriate initial management?
A. Polycystic ovary syndrome; initiate metformin and lifestyle modification
B. Hyperprolactinemia; order pituitary MRI and consider bromocriptine therapy
C. Premature ovarian insufficiency; begin hormone replacement therapy and counsel on fertility
options
D. Functional hypothalamic amenorrhea; recommend increased caloric intake, reduction in
exercise intensity, and weight restoration
ANSWER: D
