NUNP 6551 Primary Care of Women
Midterm Exam Review
(Questions & Solutions)
2025
©2025
, 1. Case: A 38-year-old woman presents with a history of irregular,
heavy menstrual bleeding and obesity. She has not yet undergone any
evaluation for her abnormal bleeding.
Question: What is the most appropriate initial diagnostic step?
a) Reassurance and symptomatic treatment
b) Pelvic ultrasound combined with laboratory studies (CBC and
coagulation profile)
c) Immediate referral for endometrial biopsy
d) Empirical hormone therapy initiation
Correct ANS: b) Pelvic ultrasound combined with laboratory studies
(CBC and coagulation profile)
Rationale: In reproductive‐aged women with abnormal uterine
bleeding, initial evaluation should include noninvasive tests. Pelvic
ultrasound assesses uterine anatomy, while laboratory studies detect
anemia or coagulation abnormalities. Endometrial biopsy is generally
reserved for women with risk factors or above age 45.
---
2. Case: A 45-year-old patient with a history of a previous abnormal
Pap smear comes for her routine well-woman exam.
Question: Which screening strategy is most appropriate under current
guidelines?
a) Annual Pap smear only
b) Co-testing with Pap smear and high-risk HPV testing every 5 years
c) Pap smear alone every 3 years
d) No further screening is needed since a previous abnormal result was
treated
Correct ANS: b) Co-testing with Pap smear and high-risk HPV testing
every 5 years
Rationale: For women 30–65 years old, current guidelines favor co-
testing every 5 years as it increases sensitivity for detecting cervical
dysplasia. This approach is particularly important in patients with a
©2025
, history of abnormal findings.
---
3. Case: A 28-year-old woman presents with irregular menstrual cycles,
hirsutism, and acne. Her body mass index is 32.
Question: Which initial diagnostic approach is most appropriate for
suspected polycystic ovary syndrome (PCOS)?
a) Serum thyroid-stimulating hormone (TSH) measurement alone
b) Pelvic ultrasound only
c) Clinical evaluation supplemented by hormonal assays (LH, FSH, total
testosterone) and pelvic ultrasound
d) Empirical use of combined oral contraceptives
Correct ANS: c) Clinical evaluation supplemented by hormonal assays
(LH, FSH, total testosterone) and pelvic ultrasound
Rationale: PCOS is diagnosed based on clinical criteria (irregular cycles,
hyperandrogenism) and confirmed with laboratory testing (LH:FSH ratio,
testosterone levels) plus ultrasound evidence of polycystic ovaries. This
comprehensive evaluation ensures an accurate diagnosis.
---
4. Case: A 52-year-old perimenopausal woman complains of vasomotor
symptoms, including hot flashes and night sweats, and is also at risk for
osteoporosis.
Question: When considering hormone replacement therapy (HRT) for
symptom relief, which factor must be carefully assessed first?
a) The patient’s lipid profile only
b) A detailed personal and family history of breast cancer and
thromboembolic events
c) The patient’s blood pressure reading
d) Previous Pap smear abnormalities
Correct ANS: b) A detailed personal and family history of breast
©2025
Midterm Exam Review
(Questions & Solutions)
2025
©2025
, 1. Case: A 38-year-old woman presents with a history of irregular,
heavy menstrual bleeding and obesity. She has not yet undergone any
evaluation for her abnormal bleeding.
Question: What is the most appropriate initial diagnostic step?
a) Reassurance and symptomatic treatment
b) Pelvic ultrasound combined with laboratory studies (CBC and
coagulation profile)
c) Immediate referral for endometrial biopsy
d) Empirical hormone therapy initiation
Correct ANS: b) Pelvic ultrasound combined with laboratory studies
(CBC and coagulation profile)
Rationale: In reproductive‐aged women with abnormal uterine
bleeding, initial evaluation should include noninvasive tests. Pelvic
ultrasound assesses uterine anatomy, while laboratory studies detect
anemia or coagulation abnormalities. Endometrial biopsy is generally
reserved for women with risk factors or above age 45.
---
2. Case: A 45-year-old patient with a history of a previous abnormal
Pap smear comes for her routine well-woman exam.
Question: Which screening strategy is most appropriate under current
guidelines?
a) Annual Pap smear only
b) Co-testing with Pap smear and high-risk HPV testing every 5 years
c) Pap smear alone every 3 years
d) No further screening is needed since a previous abnormal result was
treated
Correct ANS: b) Co-testing with Pap smear and high-risk HPV testing
every 5 years
Rationale: For women 30–65 years old, current guidelines favor co-
testing every 5 years as it increases sensitivity for detecting cervical
dysplasia. This approach is particularly important in patients with a
©2025
, history of abnormal findings.
---
3. Case: A 28-year-old woman presents with irregular menstrual cycles,
hirsutism, and acne. Her body mass index is 32.
Question: Which initial diagnostic approach is most appropriate for
suspected polycystic ovary syndrome (PCOS)?
a) Serum thyroid-stimulating hormone (TSH) measurement alone
b) Pelvic ultrasound only
c) Clinical evaluation supplemented by hormonal assays (LH, FSH, total
testosterone) and pelvic ultrasound
d) Empirical use of combined oral contraceptives
Correct ANS: c) Clinical evaluation supplemented by hormonal assays
(LH, FSH, total testosterone) and pelvic ultrasound
Rationale: PCOS is diagnosed based on clinical criteria (irregular cycles,
hyperandrogenism) and confirmed with laboratory testing (LH:FSH ratio,
testosterone levels) plus ultrasound evidence of polycystic ovaries. This
comprehensive evaluation ensures an accurate diagnosis.
---
4. Case: A 52-year-old perimenopausal woman complains of vasomotor
symptoms, including hot flashes and night sweats, and is also at risk for
osteoporosis.
Question: When considering hormone replacement therapy (HRT) for
symptom relief, which factor must be carefully assessed first?
a) The patient’s lipid profile only
b) A detailed personal and family history of breast cancer and
thromboembolic events
c) The patient’s blood pressure reading
d) Previous Pap smear abnormalities
Correct ANS: b) A detailed personal and family history of breast
©2025
