NR 603 – Primary Care of Women | Final Exam
NR 603 – Primary Care of Women
Final Exam
Latest 2026/2027 Edition
Question 1
A 34-year-old woman presents for a routine well-woman exam. She reports regular 28-day
cycles and no complaints. Her last Pap smear with HPV co-testing 3 years ago was normal, and
she has no history of abnormal results. According to current cervical cancer screening
guidelines for average-risk women in this age group, when should her next screening be
performed?
A. In 1 year with Pap alone
B. In 3 years with Pap alone or in 5 years with Pap/HPV co-testing
C. In 6 months due to age
D. Screening can be discontinued since her last result was normal
Correct Answer: B
Rationale: For average-risk women aged 30-65 with a normal prior co-test, guidelines support
re-screening every 5 years with co-testing or every 3 years with cytology alone. Annual
screening is not recommended for average-risk women, and discontinuation is only appropriate
after age 65 with adequate prior negative screening.
Question 2
A 22-year-old presents with a 3-day history of thick, white, curd-like vaginal discharge and
vulvar itching. Vaginal pH is 4.0, and microscopy shows pseudohyphae. Which of the following
is the most appropriate first-line treatment?
A. Oral metronidazole 2g single dose
B. Fluconazole 150mg oral single dose
C. Doxycycline 100mg twice daily for 7 days
D. Clindamycin vaginal cream for 7 days
Correct Answer: B
Rationale: Findings are consistent with vulvovaginal candidiasis, for which a single oral dose of
fluconazole is a first-line, evidence-based treatment. Metronidazole treats bacterial vaginosis or
trichomoniasis, and doxycycline/clindamycin are not indicated for candidal infections.
Question 3
A 45-year-old woman reports irregular menses over the past year, with cycles now occurring
every 45-60 days, along with occasional hot flashes and sleep disturbance. FSH is mildly
elevated. Which stage of the menopausal transition does this presentation most likely reflect?
A. Premenopause
Page 1 of 34
, NR 603 – Primary Care of Women | Final Exam
B. Early perimenopause
C. Late perimenopause
D. Postmenopause
Correct Answer: C
Rationale: Late perimenopause is characterized by cycle intervals of 60 days or more or
skipped cycles, along with vasomotor symptoms and rising FSH, distinguishing it from early
perimenopause where cycle variability is less pronounced. Postmenopause is defined only after
12 consecutive months of amenorrhea.
Question 4
Which of the following patient counseling points is most important when initiating a combined
oral contraceptive pill in a healthy 28-year-old nonsmoker?
A. Barrier contraception is required for the first 3 months
B. Missed pills carry no risk if taken within 5 days
C. Report calf pain, chest pain, or severe headache immediately
D. Blood pressure monitoring is unnecessary once therapy begins
Correct Answer: C
Rationale: Combined hormonal contraceptives carry a small but important risk of venous
thromboembolism and cardiovascular events; patients must be counseled to report warning
symptoms promptly. Ongoing blood pressure monitoring is recommended, and missed-pill risk
depends on timing within the cycle.
Question 5
A 19-year-old nulligravid woman presents with severe cramping pain beginning 1-2 days before
menses and lasting through the first days of bleeding, with no identifiable pelvic pathology on
exam. Which diagnosis is most consistent with this presentation?
A. Primary dysmenorrhea
B. Secondary dysmenorrhea
C. Endometriosis
D. Adenomyosis
Correct Answer: A
Rationale: Primary dysmenorrhea occurs in the absence of pelvic pathology and typically
begins shortly before or with menses in younger women. Secondary dysmenorrhea,
endometriosis, and adenomyosis are associated with underlying structural or inflammatory
pelvic disease.
Question 6
A 40-year-old woman with a BMI of 32 and a history of migraine with aura requests
contraception. Which method should be avoided due to increased stroke risk?
A. Copper intrauterine device
Page 2 of 34
, NR 603 – Primary Care of Women | Final Exam
B. Progestin-only pill
C. Combined estrogen-containing contraceptive
D. Levonorgestrel intrauterine system
Correct Answer: C
Rationale: Migraine with aura is a contraindication to estrogen-containing contraceptives due to
increased ischemic stroke risk. Progestin-only and non-hormonal methods do not carry this
same risk and remain appropriate options.
Question 7
A patient calls reporting unprotected intercourse 60 hours ago and requests emergency
contraception. Her BMI is 24. Which option provides the most effective postcoital protection at
this time interval?
A. Levonorgestrel oral tablet
B. Ulipristal acetate
C. Combined estrogen-progestin regimen (Yuzpe method)
D. Progestin-only pill taken daily
Correct Answer: B
Rationale: Ulipristal acetate maintains efficacy up to 120 hours after intercourse and is more
effective than levonorgestrel at later time points. The copper IUD is actually the most effective
option overall, but among oral options ulipristal is superior at this interval.
Question 8
A 55-year-old woman 3 years postmenopausal reports vaginal dryness and dyspareunia without
significant vasomotor symptoms. Which treatment is most appropriate as first-line therapy?
A. Systemic oral estrogen
B. Low-dose vaginal estrogen
C. Selective serotonin reuptake inhibitor
D. Transdermal testosterone
Correct Answer: B
Rationale: Low-dose vaginal estrogen effectively treats genitourinary syndrome of menopause
with minimal systemic absorption, making it preferred when vasomotor symptoms are absent.
Systemic estrogen is reserved for women with additional bothersome vasomotor symptoms.
Question 9
A 30-year-old woman presents with irregular menses, hirsutism, and acne. Pelvic ultrasound
shows multiple small peripheral ovarian follicles. Labs show an elevated LH:FSH ratio. Which
additional finding would support a diagnosis of PCOS according to Rotterdam criteria?
A. Elevated prolactin only
B. Clinical or biochemical hyperandrogenism
Page 3 of 34
, NR 603 – Primary Care of Women | Final Exam
C. Isolated elevated TSH
D. Normal ovarian volume
Correct Answer: B
Rationale: Rotterdam criteria require two of three features: oligo/anovulation, clinical or
biochemical hyperandrogenism, and polycystic ovarian morphology. Thyroid and prolactin
abnormalities should be excluded as alternative causes rather than used to confirm PCOS.
Question 10
A 26-year-old woman using a combined oral contraceptive presents with new onset severe
unilateral leg swelling and calf pain. What is the most appropriate immediate action?
A. Reassure and continue the medication
B. Discontinue the pill and refer for urgent evaluation of possible DVT
C. Switch to a progestin-only pill and monitor
D. Prescribe compression stockings and recheck in 1 week
Correct Answer: B
Rationale: Unilateral leg swelling and pain in a patient on estrogen-containing contraception
raises concern for deep vein thrombosis, a known serious adverse effect requiring urgent
evaluation. Continuing the medication or delaying care could allow progression to pulmonary
embolism.
Question 11
Which vaccine is recommended for all adolescents and young adults up to age 26 to prevent
HPV-related cervical, vulvar, and vaginal cancers?
A. Hepatitis B vaccine
B. Quadrivalent meningococcal vaccine
C. HPV vaccine
D. Tdap vaccine
Correct Answer: C
Rationale: The HPV vaccine is specifically recommended to prevent infection with high-risk
HPV strains associated with cervical and other anogenital cancers. It is routinely recommended
starting at age 11-12 and catch-up through age 26.
Question 12
A 60-year-old woman with a T-score of -2.7 on DEXA scan is being considered for
pharmacologic therapy. Which class of medication is considered first-line for osteoporosis
treatment?
A. Bisphosphonates
B. Selective estrogen receptor modulators
C. Calcitonin
Page 4 of 34
NR 603 – Primary Care of Women
Final Exam
Latest 2026/2027 Edition
Question 1
A 34-year-old woman presents for a routine well-woman exam. She reports regular 28-day
cycles and no complaints. Her last Pap smear with HPV co-testing 3 years ago was normal, and
she has no history of abnormal results. According to current cervical cancer screening
guidelines for average-risk women in this age group, when should her next screening be
performed?
A. In 1 year with Pap alone
B. In 3 years with Pap alone or in 5 years with Pap/HPV co-testing
C. In 6 months due to age
D. Screening can be discontinued since her last result was normal
Correct Answer: B
Rationale: For average-risk women aged 30-65 with a normal prior co-test, guidelines support
re-screening every 5 years with co-testing or every 3 years with cytology alone. Annual
screening is not recommended for average-risk women, and discontinuation is only appropriate
after age 65 with adequate prior negative screening.
Question 2
A 22-year-old presents with a 3-day history of thick, white, curd-like vaginal discharge and
vulvar itching. Vaginal pH is 4.0, and microscopy shows pseudohyphae. Which of the following
is the most appropriate first-line treatment?
A. Oral metronidazole 2g single dose
B. Fluconazole 150mg oral single dose
C. Doxycycline 100mg twice daily for 7 days
D. Clindamycin vaginal cream for 7 days
Correct Answer: B
Rationale: Findings are consistent with vulvovaginal candidiasis, for which a single oral dose of
fluconazole is a first-line, evidence-based treatment. Metronidazole treats bacterial vaginosis or
trichomoniasis, and doxycycline/clindamycin are not indicated for candidal infections.
Question 3
A 45-year-old woman reports irregular menses over the past year, with cycles now occurring
every 45-60 days, along with occasional hot flashes and sleep disturbance. FSH is mildly
elevated. Which stage of the menopausal transition does this presentation most likely reflect?
A. Premenopause
Page 1 of 34
, NR 603 – Primary Care of Women | Final Exam
B. Early perimenopause
C. Late perimenopause
D. Postmenopause
Correct Answer: C
Rationale: Late perimenopause is characterized by cycle intervals of 60 days or more or
skipped cycles, along with vasomotor symptoms and rising FSH, distinguishing it from early
perimenopause where cycle variability is less pronounced. Postmenopause is defined only after
12 consecutive months of amenorrhea.
Question 4
Which of the following patient counseling points is most important when initiating a combined
oral contraceptive pill in a healthy 28-year-old nonsmoker?
A. Barrier contraception is required for the first 3 months
B. Missed pills carry no risk if taken within 5 days
C. Report calf pain, chest pain, or severe headache immediately
D. Blood pressure monitoring is unnecessary once therapy begins
Correct Answer: C
Rationale: Combined hormonal contraceptives carry a small but important risk of venous
thromboembolism and cardiovascular events; patients must be counseled to report warning
symptoms promptly. Ongoing blood pressure monitoring is recommended, and missed-pill risk
depends on timing within the cycle.
Question 5
A 19-year-old nulligravid woman presents with severe cramping pain beginning 1-2 days before
menses and lasting through the first days of bleeding, with no identifiable pelvic pathology on
exam. Which diagnosis is most consistent with this presentation?
A. Primary dysmenorrhea
B. Secondary dysmenorrhea
C. Endometriosis
D. Adenomyosis
Correct Answer: A
Rationale: Primary dysmenorrhea occurs in the absence of pelvic pathology and typically
begins shortly before or with menses in younger women. Secondary dysmenorrhea,
endometriosis, and adenomyosis are associated with underlying structural or inflammatory
pelvic disease.
Question 6
A 40-year-old woman with a BMI of 32 and a history of migraine with aura requests
contraception. Which method should be avoided due to increased stroke risk?
A. Copper intrauterine device
Page 2 of 34
, NR 603 – Primary Care of Women | Final Exam
B. Progestin-only pill
C. Combined estrogen-containing contraceptive
D. Levonorgestrel intrauterine system
Correct Answer: C
Rationale: Migraine with aura is a contraindication to estrogen-containing contraceptives due to
increased ischemic stroke risk. Progestin-only and non-hormonal methods do not carry this
same risk and remain appropriate options.
Question 7
A patient calls reporting unprotected intercourse 60 hours ago and requests emergency
contraception. Her BMI is 24. Which option provides the most effective postcoital protection at
this time interval?
A. Levonorgestrel oral tablet
B. Ulipristal acetate
C. Combined estrogen-progestin regimen (Yuzpe method)
D. Progestin-only pill taken daily
Correct Answer: B
Rationale: Ulipristal acetate maintains efficacy up to 120 hours after intercourse and is more
effective than levonorgestrel at later time points. The copper IUD is actually the most effective
option overall, but among oral options ulipristal is superior at this interval.
Question 8
A 55-year-old woman 3 years postmenopausal reports vaginal dryness and dyspareunia without
significant vasomotor symptoms. Which treatment is most appropriate as first-line therapy?
A. Systemic oral estrogen
B. Low-dose vaginal estrogen
C. Selective serotonin reuptake inhibitor
D. Transdermal testosterone
Correct Answer: B
Rationale: Low-dose vaginal estrogen effectively treats genitourinary syndrome of menopause
with minimal systemic absorption, making it preferred when vasomotor symptoms are absent.
Systemic estrogen is reserved for women with additional bothersome vasomotor symptoms.
Question 9
A 30-year-old woman presents with irregular menses, hirsutism, and acne. Pelvic ultrasound
shows multiple small peripheral ovarian follicles. Labs show an elevated LH:FSH ratio. Which
additional finding would support a diagnosis of PCOS according to Rotterdam criteria?
A. Elevated prolactin only
B. Clinical or biochemical hyperandrogenism
Page 3 of 34
, NR 603 – Primary Care of Women | Final Exam
C. Isolated elevated TSH
D. Normal ovarian volume
Correct Answer: B
Rationale: Rotterdam criteria require two of three features: oligo/anovulation, clinical or
biochemical hyperandrogenism, and polycystic ovarian morphology. Thyroid and prolactin
abnormalities should be excluded as alternative causes rather than used to confirm PCOS.
Question 10
A 26-year-old woman using a combined oral contraceptive presents with new onset severe
unilateral leg swelling and calf pain. What is the most appropriate immediate action?
A. Reassure and continue the medication
B. Discontinue the pill and refer for urgent evaluation of possible DVT
C. Switch to a progestin-only pill and monitor
D. Prescribe compression stockings and recheck in 1 week
Correct Answer: B
Rationale: Unilateral leg swelling and pain in a patient on estrogen-containing contraception
raises concern for deep vein thrombosis, a known serious adverse effect requiring urgent
evaluation. Continuing the medication or delaying care could allow progression to pulmonary
embolism.
Question 11
Which vaccine is recommended for all adolescents and young adults up to age 26 to prevent
HPV-related cervical, vulvar, and vaginal cancers?
A. Hepatitis B vaccine
B. Quadrivalent meningococcal vaccine
C. HPV vaccine
D. Tdap vaccine
Correct Answer: C
Rationale: The HPV vaccine is specifically recommended to prevent infection with high-risk
HPV strains associated with cervical and other anogenital cancers. It is routinely recommended
starting at age 11-12 and catch-up through age 26.
Question 12
A 60-year-old woman with a T-score of -2.7 on DEXA scan is being considered for
pharmacologic therapy. Which class of medication is considered first-line for osteoporosis
treatment?
A. Bisphosphonates
B. Selective estrogen receptor modulators
C. Calcitonin
Page 4 of 34
