Barkley Women's Reproductive Health Practice
Exam 200 Original Practice Questions with
Detailed Rationale
Section 1: Well-Woman Gynecology and Preventive Care
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
Correct 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. Screening
before age 21 is not recommended because cervical cancer is rare
in this age group and HPV infections are typically transient.
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
Correct 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. This interval is supported by multiple guidelines due
to the low risk of high-grade lesions in this population.
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
Correct Answer: B
Rationale: Persistent infection with oncogenic (high-risk) HPV types,
especially 16 and 18, is the primary cause of cervical cancer. Other
risk factors include smoking, immunosuppression, and multiple
sexual partners.
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
,Correct Answer: A
Rationale: The quadrivalent vaccine covers HPV 6 and 11 (low-risk,
cause 90% of genital warts) and HPV 16 and 18 (high-risk, cause
70% of cervical cancers). The 9-valent vaccine covers additional
types including 31, 33, 45, 52, and 58.
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
Correct 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. Postmenopause is defined as 12 months of amenorrhea
without a pathologic cause.
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
, Correct 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. Pregnancy must always be
ruled out first in any reproductive-age woman with amenorrhea.
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
Correct Answer: B
Rationale: COCs suppress ovarian androgen production and increase
SHBG, reducing free testosterone. They also regulate menstrual
cycles, making them an ideal choice for women with PCOS who need
contraception.
8. A 52-year-old woman complains of vulvovaginal dryness and
dyspareunia. What is the most appropriate first-line treatment?
A. Oral hormone therapy
B. Vaginal moisturizers and lubricants
C. Topical testosterone
D. Antibiotics
Exam 200 Original Practice Questions with
Detailed Rationale
Section 1: Well-Woman Gynecology and Preventive Care
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
Correct 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. Screening
before age 21 is not recommended because cervical cancer is rare
in this age group and HPV infections are typically transient.
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
Correct 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. This interval is supported by multiple guidelines due
to the low risk of high-grade lesions in this population.
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
Correct Answer: B
Rationale: Persistent infection with oncogenic (high-risk) HPV types,
especially 16 and 18, is the primary cause of cervical cancer. Other
risk factors include smoking, immunosuppression, and multiple
sexual partners.
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
,Correct Answer: A
Rationale: The quadrivalent vaccine covers HPV 6 and 11 (low-risk,
cause 90% of genital warts) and HPV 16 and 18 (high-risk, cause
70% of cervical cancers). The 9-valent vaccine covers additional
types including 31, 33, 45, 52, and 58.
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
Correct 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. Postmenopause is defined as 12 months of amenorrhea
without a pathologic cause.
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
, Correct 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. Pregnancy must always be
ruled out first in any reproductive-age woman with amenorrhea.
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
Correct Answer: B
Rationale: COCs suppress ovarian androgen production and increase
SHBG, reducing free testosterone. They also regulate menstrual
cycles, making them an ideal choice for women with PCOS who need
contraception.
8. A 52-year-old woman complains of vulvovaginal dryness and
dyspareunia. What is the most appropriate first-line treatment?
A. Oral hormone therapy
B. Vaginal moisturizers and lubricants
C. Topical testosterone
D. Antibiotics
