NR60 NR602 Women's Health & Pediatrics — Final Exam Practice • 75 Questions with
Answers & Rationales
2
Question 1 of 75
A 28-year-old female presents with cyclic pelvic pain beginning 2-3 days before menses and
relieved within 1-2 days of onset. She has no prior history of pelvic pathology. Pelvic exam is
normal. What is the most likely diagnosis and first-line treatment?
A. Secondary dysmenorrhea - oral contraceptives
B. Primary dysmenorrhea - NSAIDs
C. Endometriosis - GnRH agonist
D. Pelvic inflammatory disease - antibiotics
Correct Answer
B. Primary dysmenorrhea - NSAIDs
Rationale
Primary dysmenorrhea is painful menstruation without underlying pelvic pathology,
caused by excess prostaglandins causing uterine contractions. NSAIDs (ibuprofen,
naproxen) are first-line by inhibiting prostaglandin synthesis. Secondary dysmenorrhea
has an identifiable cause (endometriosis, fibroids); endometriosis is diagnosed
laparoscopically; PID presents with fever and cervical motion tenderness.
,Question 2 of 75
A 32-year-old female presents with dysmenorrhea, deep dyspareunia, dysuria with menses,
and infertility. Pelvic exam reveals uterosacral nodularity and a fixed, retroverted uterus.
CA-125 is mildly elevated. What is the most likely diagnosis?
A. Uterine fibroids
B. Endometriosis
C. Adenomyosis
D. Pelvic inflammatory disease
Correct Answer
B. Endometriosis
Rationale
Endometriosis is characterized by the triad of dysmenorrhea, dyspareunia, and
infertility. Uterosacral nodularity and a fixed retroverted uterus are classic physical
findings. Definitive diagnosis requires laparoscopy. Fibroids cause heavy bleeding and
bulk symptoms; adenomyosis causes a globular uterus with heavy bleeding; PID
presents acutely with fever.
,Question 3 of 75
A 45-year-old female presents with heavy menstrual bleeding, pelvic pressure, urinary
frequency, and constipation. Bimanual exam reveals an irregularly enlarged uterus. Ultrasound
shows multiple intramural masses. What is the most likely diagnosis?
A. Endometrial cancer
B. Uterine leiomyomas (fibroids)
C. Ovarian cysts
D. Adenomyosis
Correct Answer
B. Uterine leiomyomas (fibroids)
Rationale
Uterine fibroids (leiomyomas) are the most common benign uterine tumors, presenting
with heavy menstrual bleeding, pelvic pressure, and an irregularly enlarged uterus.
Intramural fibroids are confirmed by ultrasound. Endometrial cancer presents with
postmenopausal bleeding; adenomyosis causes a uniformly enlarged uterus; ovarian
cysts are adnexal, not uterine.
, Question 4 of 75
A 25-year-old female reports premenstrual irritability, mood swings, breast tenderness,
bloating, and fatigue that begin 7-10 days before menses and resolve within 2 days of onset.
Symptoms significantly impact her daily functioning. What is the diagnosis?
A. Premenstrual syndrome (PMS)
B. Premenstrual dysphoric disorder (PMDD)
C. Major depressive disorder
D. Generalized anxiety disorder
Correct Answer
B. Premenstrual dysphoric disorder (PMDD)
Rationale
PMDD is a severe form of PMS where affective symptoms (irritability, mood swings,
depression) are prominent and significantly impair daily functioning. It requires
symptoms in the luteal phase that resolve after menses, confirmed prospectively over 2
cycles. PMS is less severe; MDD and GAD are not cycle-dependent.
Answers & Rationales
2
Question 1 of 75
A 28-year-old female presents with cyclic pelvic pain beginning 2-3 days before menses and
relieved within 1-2 days of onset. She has no prior history of pelvic pathology. Pelvic exam is
normal. What is the most likely diagnosis and first-line treatment?
A. Secondary dysmenorrhea - oral contraceptives
B. Primary dysmenorrhea - NSAIDs
C. Endometriosis - GnRH agonist
D. Pelvic inflammatory disease - antibiotics
Correct Answer
B. Primary dysmenorrhea - NSAIDs
Rationale
Primary dysmenorrhea is painful menstruation without underlying pelvic pathology,
caused by excess prostaglandins causing uterine contractions. NSAIDs (ibuprofen,
naproxen) are first-line by inhibiting prostaglandin synthesis. Secondary dysmenorrhea
has an identifiable cause (endometriosis, fibroids); endometriosis is diagnosed
laparoscopically; PID presents with fever and cervical motion tenderness.
,Question 2 of 75
A 32-year-old female presents with dysmenorrhea, deep dyspareunia, dysuria with menses,
and infertility. Pelvic exam reveals uterosacral nodularity and a fixed, retroverted uterus.
CA-125 is mildly elevated. What is the most likely diagnosis?
A. Uterine fibroids
B. Endometriosis
C. Adenomyosis
D. Pelvic inflammatory disease
Correct Answer
B. Endometriosis
Rationale
Endometriosis is characterized by the triad of dysmenorrhea, dyspareunia, and
infertility. Uterosacral nodularity and a fixed retroverted uterus are classic physical
findings. Definitive diagnosis requires laparoscopy. Fibroids cause heavy bleeding and
bulk symptoms; adenomyosis causes a globular uterus with heavy bleeding; PID
presents acutely with fever.
,Question 3 of 75
A 45-year-old female presents with heavy menstrual bleeding, pelvic pressure, urinary
frequency, and constipation. Bimanual exam reveals an irregularly enlarged uterus. Ultrasound
shows multiple intramural masses. What is the most likely diagnosis?
A. Endometrial cancer
B. Uterine leiomyomas (fibroids)
C. Ovarian cysts
D. Adenomyosis
Correct Answer
B. Uterine leiomyomas (fibroids)
Rationale
Uterine fibroids (leiomyomas) are the most common benign uterine tumors, presenting
with heavy menstrual bleeding, pelvic pressure, and an irregularly enlarged uterus.
Intramural fibroids are confirmed by ultrasound. Endometrial cancer presents with
postmenopausal bleeding; adenomyosis causes a uniformly enlarged uterus; ovarian
cysts are adnexal, not uterine.
, Question 4 of 75
A 25-year-old female reports premenstrual irritability, mood swings, breast tenderness,
bloating, and fatigue that begin 7-10 days before menses and resolve within 2 days of onset.
Symptoms significantly impact her daily functioning. What is the diagnosis?
A. Premenstrual syndrome (PMS)
B. Premenstrual dysphoric disorder (PMDD)
C. Major depressive disorder
D. Generalized anxiety disorder
Correct Answer
B. Premenstrual dysphoric disorder (PMDD)
Rationale
PMDD is a severe form of PMS where affective symptoms (irritability, mood swings,
depression) are prominent and significantly impair daily functioning. It requires
symptoms in the luteal phase that resolve after menses, confirmed prospectively over 2
cycles. PMS is less severe; MDD and GAD are not cycle-dependent.
