MN 576 UNIT 10 FINAL EXAM CoMprEhENsIvE QUEsTIoN BANk wITh
ANswErs ANd dETAILEd rATIoNALEs /grAdEd A+/2026
UpdATE/100% CorrECT /INsTANT dowNLoAd
SECTION 1: WOMEN'S HEALTH ACROSS THE LIFESPAN (Questions 1-15)
**Question 1**
A 16-year-old female presents with primary amenorrhea. She has normal breast development
(Tanner stage 4) and pubic hair (Tanner stage 4) but has never experienced menstrual bleeding.
What is the most likely anatomical finding?
A) Imperforate hymen
B) Müllerian agenesis
C) Androgen insensitivity syndrome
D) Turner syndrome
**Answer:** A) Imperforate hymen
**Rationale:** With normal secondary sexual characteristics (breast and pubic hair
development), the hypothalamic-pituitary-ovarian axis is functional. The most common cause of
primary amenorrhea with normal secondary sex characteristics is an outflow tract obstruction,
most commonly imperforate hymen. Patients typically present with cyclic abdominal pain and a
bulging, bluish hymenal membrane on examination.
---
**Question 2**
A 28-year-old G0P0 presents with hirsutism, acne, and irregular menses since menarche. BMI is
32. Labs show elevated free testosterone and LH:FSH ratio of 3:1. Transvaginal ultrasound
,demonstrates polycystic ovaries. Which medication is first-line for inducing ovulation when she
desires pregnancy?
A) Metformin
B) Spironolactone
C) Clomiphene citrate
D) Oral contraceptives
**Answer:** C) Clomiphene citrate
**Rationale:** This patient has Polycystic Ovary Syndrome (PCOS) based on Rotterdam criteria
(oligomenorrhea, hyperandrogenism, polycystic ovaries). For ovulation induction in PCOS
patients desiring pregnancy, clomiphene citrate is first-line. Metformin may be used as an
adjunct but is not first-line for ovulation induction. Oral contraceptives are used for cycle control
and hyperandrogenism when pregnancy is not desired.
---
**Question 3**
A 45-year-old woman reports hot flashes, night sweats, and vaginal dryness that are
significantly affecting her quality of life. She has a history of estrogen receptor-positive breast
cancer treated 3 years ago. Which statement regarding menopausal hormone therapy is
correct?
A) Systemic estrogen is safe and can be prescribed
B) Low-dose vaginal estrogen is contraindicated
C) Non-hormonal options should be tried first
D) Progestin-only therapy is first-line
**Answer:** C) Non-hormonal options should be tried first
**Rationale:** In women with a history of estrogen receptor-positive breast cancer, systemic
hormone therapy is contraindicated due to risk of recurrence. While low-dose vaginal estrogen
has lower systemic absorption, it is generally avoided in this population. Non-hormonal options
, such as SSRIs/SNRIs (paroxetine, venlafaxine), gabapentin, or lifestyle modifications should be
tried first.
---
**Question 4**
A 32-year-old G1P1 at 8 weeks gestation presents with lower abdominal pain and spotting.
Transvaginal ultrasound shows an empty uterine cavity, adnexal mass, and free fluid in the cul-
de-sac. Beta-hCG is 2,500 mIU/mL. What is the most appropriate next step?
A) Repeat beta-hCG in 48 hours
B) Methotrexate administration
C) Immediate surgical consultation
D) Progesterone supplementation
**Answer:** C) Immediate surgical consultation
**Rationale:** This presentation is consistent with ruptured ectopic pregnancy (empty uterus,
adnexal mass, free fluid, pain, and bleeding). Hemoperitoneum from ruptured ectopic pregnancy
is a surgical emergency requiring immediate consultation. Methotrexate is used for unruptured
ectopic pregnancy with beta-hCG <5,000 and no cardiac activity.
---
**Question 5**
A 55-year-old postmenopausal woman presents with sudden onset of heavy vaginal bleeding.
She has not had a period for 4 years. What is the most concerning potential diagnosis?
A) Atrophic vaginitis
B) Endometrial polyp
C) Endometrial hyperplasia
D) Endometrial cancer
ANswErs ANd dETAILEd rATIoNALEs /grAdEd A+/2026
UpdATE/100% CorrECT /INsTANT dowNLoAd
SECTION 1: WOMEN'S HEALTH ACROSS THE LIFESPAN (Questions 1-15)
**Question 1**
A 16-year-old female presents with primary amenorrhea. She has normal breast development
(Tanner stage 4) and pubic hair (Tanner stage 4) but has never experienced menstrual bleeding.
What is the most likely anatomical finding?
A) Imperforate hymen
B) Müllerian agenesis
C) Androgen insensitivity syndrome
D) Turner syndrome
**Answer:** A) Imperforate hymen
**Rationale:** With normal secondary sexual characteristics (breast and pubic hair
development), the hypothalamic-pituitary-ovarian axis is functional. The most common cause of
primary amenorrhea with normal secondary sex characteristics is an outflow tract obstruction,
most commonly imperforate hymen. Patients typically present with cyclic abdominal pain and a
bulging, bluish hymenal membrane on examination.
---
**Question 2**
A 28-year-old G0P0 presents with hirsutism, acne, and irregular menses since menarche. BMI is
32. Labs show elevated free testosterone and LH:FSH ratio of 3:1. Transvaginal ultrasound
,demonstrates polycystic ovaries. Which medication is first-line for inducing ovulation when she
desires pregnancy?
A) Metformin
B) Spironolactone
C) Clomiphene citrate
D) Oral contraceptives
**Answer:** C) Clomiphene citrate
**Rationale:** This patient has Polycystic Ovary Syndrome (PCOS) based on Rotterdam criteria
(oligomenorrhea, hyperandrogenism, polycystic ovaries). For ovulation induction in PCOS
patients desiring pregnancy, clomiphene citrate is first-line. Metformin may be used as an
adjunct but is not first-line for ovulation induction. Oral contraceptives are used for cycle control
and hyperandrogenism when pregnancy is not desired.
---
**Question 3**
A 45-year-old woman reports hot flashes, night sweats, and vaginal dryness that are
significantly affecting her quality of life. She has a history of estrogen receptor-positive breast
cancer treated 3 years ago. Which statement regarding menopausal hormone therapy is
correct?
A) Systemic estrogen is safe and can be prescribed
B) Low-dose vaginal estrogen is contraindicated
C) Non-hormonal options should be tried first
D) Progestin-only therapy is first-line
**Answer:** C) Non-hormonal options should be tried first
**Rationale:** In women with a history of estrogen receptor-positive breast cancer, systemic
hormone therapy is contraindicated due to risk of recurrence. While low-dose vaginal estrogen
has lower systemic absorption, it is generally avoided in this population. Non-hormonal options
, such as SSRIs/SNRIs (paroxetine, venlafaxine), gabapentin, or lifestyle modifications should be
tried first.
---
**Question 4**
A 32-year-old G1P1 at 8 weeks gestation presents with lower abdominal pain and spotting.
Transvaginal ultrasound shows an empty uterine cavity, adnexal mass, and free fluid in the cul-
de-sac. Beta-hCG is 2,500 mIU/mL. What is the most appropriate next step?
A) Repeat beta-hCG in 48 hours
B) Methotrexate administration
C) Immediate surgical consultation
D) Progesterone supplementation
**Answer:** C) Immediate surgical consultation
**Rationale:** This presentation is consistent with ruptured ectopic pregnancy (empty uterus,
adnexal mass, free fluid, pain, and bleeding). Hemoperitoneum from ruptured ectopic pregnancy
is a surgical emergency requiring immediate consultation. Methotrexate is used for unruptured
ectopic pregnancy with beta-hCG <5,000 and no cardiac activity.
---
**Question 5**
A 55-year-old postmenopausal woman presents with sudden onset of heavy vaginal bleeding.
She has not had a period for 4 years. What is the most concerning potential diagnosis?
A) Atrophic vaginitis
B) Endometrial polyp
C) Endometrial hyperplasia
D) Endometrial cancer
