NU 631
Healthcare of Women Across the
Lifespan
Proctored Midterm Exam
2026
(With Solutions)
Multiple Choice Questions (MCQ)
A 35-year-old woman presents with heavy menstrual bleeding and pelvic pressure.
Imaging reveals multiple uterine leiomyomas. Which treatment option is considered first-
line for symptom management in this patient wishing to preserve fertility?
A) Hysterectomy
B) Myomectomy
C) Uterine artery embolization
D) Hormonal therapy with GnRH agonists
Answer: B) Myomectomy
Rationale: Myomectomy is preferred for women desiring future fertility as it removes
fibroids while preserving the uterus. Hysterectomy is definitive but not fertility-
preserving; uterine artery embolization can impair fertility; GnRH agonists are temporary
and mainly preoperative adjuncts.
In managing menopause symptoms, which of the following statements about hormone
replacement therapy (HRT) is MOST accurate?
A) Estrogen-only HRT is safe for women with a uterus.
B) Combined estrogen-progestin therapy reduces the risk of endometrial cancer.
C) HRT should be started regardless of time since last menstrual period.
D) HRT increases the risk of venous thromboembolism in all women equally.
Answer: B) Combined estrogen-progestin therapy reduces the risk of endometrial
cancer.
Rationale: Estrogen alone stimulates the endometrium and increases cancer risk in
women with a uterus; adding progestin mitigates this. Timing of initiation affects benefit-
risk; VTE risk varies with patient-specific factors (e.g., age, obesity).
Which of the following is the most appropriate initial pharmacologic treatment for a 28-
year-old woman newly diagnosed with Polycystic Ovary Syndrome (PCOS) presenting
,with oligomenorrhea and hirsutism?
A) Metformin alone
B) Oral contraceptive pills
C) Spironolactone
D) Clomiphene citrate
Answer: B) Oral contraceptive pills
Rationale: Combined oral contraceptives regulate menstrual cycles and reduce
androgen levels, addressing hirsutism and oligomenorrhea. Metformin is adjunctive,
spironolactone is used after contraception for hirsutism, and clomiphene is for infertility.
In a 60-year-old postmenopausal woman, which bone mineral density (BMD) T-score is
diagnostic of osteoporosis?
A) -1.0
B) -1.5
C) -2.5
D) -3.5
Answer: C) -2.5
Rationale: Osteoporosis is diagnosed when BMD T-score is -2.5 or lower. Scores
between -1.0 and -2.5 indicate osteopenia.
Regarding the human papillomavirus (HPV) vaccination, which is TRUE for women
aged 27–45?
A) Vaccination is recommended routinely for all women in this age group.
B) Vaccine efficacy is reduced but still beneficial in this age group.
C) Vaccination should be avoided due to safety concerns.
D) Screening can replace vaccination in this age group.
Answer: B) Vaccine efficacy is reduced but still beneficial in this age group.
Rationale: Though HPV vaccination is most effective before sexual debut, it can still
protect against strains not yet encountered, so benefit exists beyond age 26.
True/False
The use of levonorgestrel intrauterine devices (IUDs) can reduce menorrhagia and
dysmenorrhea in reproductive-aged women.
True
Rationale: Levonorgestrel IUDs thin endometrial lining, reducing heavy bleeding and
cramps.
Postpartum depression typically resolves within 2 weeks without intervention.
False
Rationale: Postpartum depression often lasts months and requires treatment; early
support and sometimes pharmacotherapy are needed.
,Pregnant women with pre-existing Type 1 diabetes are at increased risk for fetal
macrosomia and congenital anomalies.
True
Rationale: Poor glucose control impacts fetal growth and development, increasing
adverse outcomes.
Screening mammography is not recommended for women under 40 years old at
average risk.
True
Rationale: Breast cancer incidence is low under 40; screening typically starts at 40 or
individualized based on risk.
Endometriosis can only be definitively diagnosed with invasive laparoscopy.
True
Rationale: Visualization and biopsy during laparoscopy remain the gold standard for
definitive diagnosis.
Short Answer
List three common clinical symptoms of endometriosis in women of reproductive age.
Answer: Dysmenorrhea, chronic pelvic pain, dyspareunia, infertility.
Rationale: These symptoms correlate with ectopic endometrial tissue.
Outline the key differences in breast cancer screening recommendations for average-
risk women versus those with BRCA mutations.
Answer: Average-risk women start routine mammograms at 40-50 annually or
biennially; BRCA carriers begin earlier (often 25-30), add MRI, and have more frequent
screening.
Rationale: BRCA mutations confer high risk requiring intensified surveillance.
Identify two non-hormonal treatment options for vasomotor symptoms of menopause.
Answer: SSRIs/SNRIs (e.g., paroxetine), gabapentin, lifestyle modifications (cool
environment, layered clothing).
Rationale: For women contraindicated to HRT or preferring alternatives, these mitigate
hot flashes.
Explain the rationale for screening women for intimate partner violence (IPV) during
well-woman visits.
Answer: Early identification allows intervention and referral; IPV affects physical, mental
health and pregnancy outcomes.
Rationale: IPV is underreported but prevalent; screening can save lives.
, Describe the mechanism of action of clomiphene citrate in treating infertility due to
anovulation.
Answer: Clomiphene blocks estrogen receptors at the hypothalamus, increasing GnRH
pulse frequency and stimulating FSH/LH release to induce ovulation.
Rationale: Understanding mechanism aids in identifying indications and
contraindications.
Matching (Match condition to key characteristic)
16-20. Match the following conditions to their hallmark clinical features:
Conditions Features
A) PCOS 1) "Ground glass" appearance on ultrasound
B) Endometriosis 2) Anovulation, hyperandrogenism, polycystic ovaries
C) Premenstrual Dysphoric Disorder (PMDD) 3) Cyclical mood and somatic symptoms
preceding menses
D) Adenomyosis 4) Diffuse uterine enlargement with heavy bleeding
E) Pelvic Inflammatory Disease (PID) 5) Lower abdominal pain, cervical motion
tenderness
Answers:
A-2, B-1, C-3, D-4, E-5
Rationale: Each feature aligns with these defining traits: PCOS (anovulation +
hyperandrogenism), endometriosis (characteristic ultrasound or surgical findings),
PMDD (mood symptoms pre-menses), adenomyosis (uterine enlargement, bleeding),
PID (pain and infection signs).
Fill in the Blank
The recommended daily intake of folic acid for women of childbearing age to prevent
neural tube defects is ______ micrograms.
Answer: 400
Rationale: This is the standard dose before and during early pregnancy.
The pelvic organ prolapse stage is determined based on measurements obtained during
a __________ examination.
Answer: Pelvic (specifically POP-Q)
Rationale: The Pelvic Organ Prolapse Quantification system is clinical assessment
during pelvic exam.
In the context of breastfeeding, the hormone _________________ stimulates milk
letdown in response to infant suckling.
Answer: Oxytocin
Rationale: Oxytocin causes myoepithelial cell contraction to eject milk.
Healthcare of Women Across the
Lifespan
Proctored Midterm Exam
2026
(With Solutions)
Multiple Choice Questions (MCQ)
A 35-year-old woman presents with heavy menstrual bleeding and pelvic pressure.
Imaging reveals multiple uterine leiomyomas. Which treatment option is considered first-
line for symptom management in this patient wishing to preserve fertility?
A) Hysterectomy
B) Myomectomy
C) Uterine artery embolization
D) Hormonal therapy with GnRH agonists
Answer: B) Myomectomy
Rationale: Myomectomy is preferred for women desiring future fertility as it removes
fibroids while preserving the uterus. Hysterectomy is definitive but not fertility-
preserving; uterine artery embolization can impair fertility; GnRH agonists are temporary
and mainly preoperative adjuncts.
In managing menopause symptoms, which of the following statements about hormone
replacement therapy (HRT) is MOST accurate?
A) Estrogen-only HRT is safe for women with a uterus.
B) Combined estrogen-progestin therapy reduces the risk of endometrial cancer.
C) HRT should be started regardless of time since last menstrual period.
D) HRT increases the risk of venous thromboembolism in all women equally.
Answer: B) Combined estrogen-progestin therapy reduces the risk of endometrial
cancer.
Rationale: Estrogen alone stimulates the endometrium and increases cancer risk in
women with a uterus; adding progestin mitigates this. Timing of initiation affects benefit-
risk; VTE risk varies with patient-specific factors (e.g., age, obesity).
Which of the following is the most appropriate initial pharmacologic treatment for a 28-
year-old woman newly diagnosed with Polycystic Ovary Syndrome (PCOS) presenting
,with oligomenorrhea and hirsutism?
A) Metformin alone
B) Oral contraceptive pills
C) Spironolactone
D) Clomiphene citrate
Answer: B) Oral contraceptive pills
Rationale: Combined oral contraceptives regulate menstrual cycles and reduce
androgen levels, addressing hirsutism and oligomenorrhea. Metformin is adjunctive,
spironolactone is used after contraception for hirsutism, and clomiphene is for infertility.
In a 60-year-old postmenopausal woman, which bone mineral density (BMD) T-score is
diagnostic of osteoporosis?
A) -1.0
B) -1.5
C) -2.5
D) -3.5
Answer: C) -2.5
Rationale: Osteoporosis is diagnosed when BMD T-score is -2.5 or lower. Scores
between -1.0 and -2.5 indicate osteopenia.
Regarding the human papillomavirus (HPV) vaccination, which is TRUE for women
aged 27–45?
A) Vaccination is recommended routinely for all women in this age group.
B) Vaccine efficacy is reduced but still beneficial in this age group.
C) Vaccination should be avoided due to safety concerns.
D) Screening can replace vaccination in this age group.
Answer: B) Vaccine efficacy is reduced but still beneficial in this age group.
Rationale: Though HPV vaccination is most effective before sexual debut, it can still
protect against strains not yet encountered, so benefit exists beyond age 26.
True/False
The use of levonorgestrel intrauterine devices (IUDs) can reduce menorrhagia and
dysmenorrhea in reproductive-aged women.
True
Rationale: Levonorgestrel IUDs thin endometrial lining, reducing heavy bleeding and
cramps.
Postpartum depression typically resolves within 2 weeks without intervention.
False
Rationale: Postpartum depression often lasts months and requires treatment; early
support and sometimes pharmacotherapy are needed.
,Pregnant women with pre-existing Type 1 diabetes are at increased risk for fetal
macrosomia and congenital anomalies.
True
Rationale: Poor glucose control impacts fetal growth and development, increasing
adverse outcomes.
Screening mammography is not recommended for women under 40 years old at
average risk.
True
Rationale: Breast cancer incidence is low under 40; screening typically starts at 40 or
individualized based on risk.
Endometriosis can only be definitively diagnosed with invasive laparoscopy.
True
Rationale: Visualization and biopsy during laparoscopy remain the gold standard for
definitive diagnosis.
Short Answer
List three common clinical symptoms of endometriosis in women of reproductive age.
Answer: Dysmenorrhea, chronic pelvic pain, dyspareunia, infertility.
Rationale: These symptoms correlate with ectopic endometrial tissue.
Outline the key differences in breast cancer screening recommendations for average-
risk women versus those with BRCA mutations.
Answer: Average-risk women start routine mammograms at 40-50 annually or
biennially; BRCA carriers begin earlier (often 25-30), add MRI, and have more frequent
screening.
Rationale: BRCA mutations confer high risk requiring intensified surveillance.
Identify two non-hormonal treatment options for vasomotor symptoms of menopause.
Answer: SSRIs/SNRIs (e.g., paroxetine), gabapentin, lifestyle modifications (cool
environment, layered clothing).
Rationale: For women contraindicated to HRT or preferring alternatives, these mitigate
hot flashes.
Explain the rationale for screening women for intimate partner violence (IPV) during
well-woman visits.
Answer: Early identification allows intervention and referral; IPV affects physical, mental
health and pregnancy outcomes.
Rationale: IPV is underreported but prevalent; screening can save lives.
, Describe the mechanism of action of clomiphene citrate in treating infertility due to
anovulation.
Answer: Clomiphene blocks estrogen receptors at the hypothalamus, increasing GnRH
pulse frequency and stimulating FSH/LH release to induce ovulation.
Rationale: Understanding mechanism aids in identifying indications and
contraindications.
Matching (Match condition to key characteristic)
16-20. Match the following conditions to their hallmark clinical features:
Conditions Features
A) PCOS 1) "Ground glass" appearance on ultrasound
B) Endometriosis 2) Anovulation, hyperandrogenism, polycystic ovaries
C) Premenstrual Dysphoric Disorder (PMDD) 3) Cyclical mood and somatic symptoms
preceding menses
D) Adenomyosis 4) Diffuse uterine enlargement with heavy bleeding
E) Pelvic Inflammatory Disease (PID) 5) Lower abdominal pain, cervical motion
tenderness
Answers:
A-2, B-1, C-3, D-4, E-5
Rationale: Each feature aligns with these defining traits: PCOS (anovulation +
hyperandrogenism), endometriosis (characteristic ultrasound or surgical findings),
PMDD (mood symptoms pre-menses), adenomyosis (uterine enlargement, bleeding),
PID (pain and infection signs).
Fill in the Blank
The recommended daily intake of folic acid for women of childbearing age to prevent
neural tube defects is ______ micrograms.
Answer: 400
Rationale: This is the standard dose before and during early pregnancy.
The pelvic organ prolapse stage is determined based on measurements obtained during
a __________ examination.
Answer: Pelvic (specifically POP-Q)
Rationale: The Pelvic Organ Prolapse Quantification system is clinical assessment
during pelvic exam.
In the context of breastfeeding, the hormone _________________ stimulates milk
letdown in response to infant suckling.
Answer: Oxytocin
Rationale: Oxytocin causes myoepithelial cell contraction to eject milk.
