APEA Women’s Health Final Exam
2026 Test Bank: Practice Questions
with Verified Answers and Detailed
Rationales/Instant Download pdf
Q1. A woman reports heavy, regular menses every 28 days lasting 8 days
with clots and soaking through a pad every 2 hours. Which term best
describes this?
A. Menorrhagia
B. Metrorrhagia
C. Menometrorrhagia
D. Oligomenorrhea
Answer: A. Menorrhagia
Rationale: Menorrhagia is heavy but regular menstrual bleeding (duration
>7 days or >80 mL blood loss). Metrorrhagia is irregular bleeding between
periods; menometrorrhagia is heavy irregular bleeding; oligomenorrhea is
infrequent menses (>35 days). This patient has regular cycles, so
menorrhagia is correct.
Q2. A 42-year-old with menorrhagia and dysmenorrhea has a diffusely
enlarged, globular, nontender uterus on bimanual exam. The most likely
diagnosis is:
, A. Uterine fibroids (leiomyomas)
B. Adenomyosis
C. Endometrial polyp
D. Endometrial cancer
Answer: B. Adenomyosis
Rationale: Adenomyosis (endometrial glands within myometrium) causes
diffuse symmetric uterine enlargement, menorrhagia, and painful menses.
Fibroids cause irregularly enlarged uterus; polyps do not enlarge uterus
globally; cancer rarely presents with this exam in absence of risk factors.
Q3. A woman has intermenstrual spotting and pelvic pressure. Ultrasound
shows a 2 cm intracavitary mass. Next best step is:
A. Endometrial biopsy
B. Hysteroscopy with polypectomy
C. Observation for 3 months
D. Dilation and curettage (D&C)
Answer: B. Hysteroscopy with polypectomy
Rationale: Suspected endometrial polyp: hysteroscopy allows visualization
and removal. Endometrial biopsy can miss polyps. Observation not
indicated for symptomatic polyp. D&C less accurate than hysteroscopy for
focal lesions.
,Q4. A woman with normal menses has a 4-week history of daily spotting.
Pregnancy test negative. TSH, prolactin normal. Next step:
A. Oral contraceptive pills
B. Pelvic ultrasound
C. Endometrial biopsy
D. Reassurance
Answer: B. Pelvic ultrasound
Rationale: Spotting with negative pregnancy test and normal labs requires
evaluation for structural causes (polyp, fibroid, ovarian cyst). Ultrasound is
first-line. Endometrial biopsy rarely needed in young low-risk women.
Q5. A 48-year-old with irregular heavy bleeding and endometrial stripe of
14 mm on ultrasound. What is the appropriate next step?
A. Repeat ultrasound in 6 months
B. Endometrial biopsy
C. Hysteroscopy
D. Observation
Answer: B. Endometrial biopsy
Rationale: In a perimenopausal woman with abnormal uterine bleeding
and endometrial thickness >11 mm (perimenopausal), endometrial biopsy
is indicated to rule out hyperplasia or malignancy.
, Q6. Which of the following is NOT a cause of abnormal uterine bleeding in
the PALM-COEIN classification?
A. Polyp
B. Adenomyosis
C. Coagulopathy
D. Ovarian cancer
Answer: D. Ovarian cancer
Rationale: PALM-COEIN classification includes Polyp, Adenomyosis,
Leiomyoma, Malignancy/Hyperplasia, Coagulopathy, Ovulatory dysfunction,
Endometrial, Iatrogenic, and Not otherwise classified. Ovarian cancer is not
a primary cause of AUB.
Q7. A woman reports severe menstrual cramps that began with menarche
and have worsened. She has tried ibuprofen with minimal relief. What is the
most effective treatment?
A. Higher-dose NSAIDs
B. Combined oral contraceptives
C. Heat therapy
D. Acetaminophen
Answer: B. Combined oral contraceptives
Rationale: Combined oral contraceptives are highly effective for primary
dysmenorrhea by suppressing ovulation and reducing prostaglandin
production. NSAIDs are first-line but if inadequate, OCPs are the next step.
2026 Test Bank: Practice Questions
with Verified Answers and Detailed
Rationales/Instant Download pdf
Q1. A woman reports heavy, regular menses every 28 days lasting 8 days
with clots and soaking through a pad every 2 hours. Which term best
describes this?
A. Menorrhagia
B. Metrorrhagia
C. Menometrorrhagia
D. Oligomenorrhea
Answer: A. Menorrhagia
Rationale: Menorrhagia is heavy but regular menstrual bleeding (duration
>7 days or >80 mL blood loss). Metrorrhagia is irregular bleeding between
periods; menometrorrhagia is heavy irregular bleeding; oligomenorrhea is
infrequent menses (>35 days). This patient has regular cycles, so
menorrhagia is correct.
Q2. A 42-year-old with menorrhagia and dysmenorrhea has a diffusely
enlarged, globular, nontender uterus on bimanual exam. The most likely
diagnosis is:
, A. Uterine fibroids (leiomyomas)
B. Adenomyosis
C. Endometrial polyp
D. Endometrial cancer
Answer: B. Adenomyosis
Rationale: Adenomyosis (endometrial glands within myometrium) causes
diffuse symmetric uterine enlargement, menorrhagia, and painful menses.
Fibroids cause irregularly enlarged uterus; polyps do not enlarge uterus
globally; cancer rarely presents with this exam in absence of risk factors.
Q3. A woman has intermenstrual spotting and pelvic pressure. Ultrasound
shows a 2 cm intracavitary mass. Next best step is:
A. Endometrial biopsy
B. Hysteroscopy with polypectomy
C. Observation for 3 months
D. Dilation and curettage (D&C)
Answer: B. Hysteroscopy with polypectomy
Rationale: Suspected endometrial polyp: hysteroscopy allows visualization
and removal. Endometrial biopsy can miss polyps. Observation not
indicated for symptomatic polyp. D&C less accurate than hysteroscopy for
focal lesions.
,Q4. A woman with normal menses has a 4-week history of daily spotting.
Pregnancy test negative. TSH, prolactin normal. Next step:
A. Oral contraceptive pills
B. Pelvic ultrasound
C. Endometrial biopsy
D. Reassurance
Answer: B. Pelvic ultrasound
Rationale: Spotting with negative pregnancy test and normal labs requires
evaluation for structural causes (polyp, fibroid, ovarian cyst). Ultrasound is
first-line. Endometrial biopsy rarely needed in young low-risk women.
Q5. A 48-year-old with irregular heavy bleeding and endometrial stripe of
14 mm on ultrasound. What is the appropriate next step?
A. Repeat ultrasound in 6 months
B. Endometrial biopsy
C. Hysteroscopy
D. Observation
Answer: B. Endometrial biopsy
Rationale: In a perimenopausal woman with abnormal uterine bleeding
and endometrial thickness >11 mm (perimenopausal), endometrial biopsy
is indicated to rule out hyperplasia or malignancy.
, Q6. Which of the following is NOT a cause of abnormal uterine bleeding in
the PALM-COEIN classification?
A. Polyp
B. Adenomyosis
C. Coagulopathy
D. Ovarian cancer
Answer: D. Ovarian cancer
Rationale: PALM-COEIN classification includes Polyp, Adenomyosis,
Leiomyoma, Malignancy/Hyperplasia, Coagulopathy, Ovulatory dysfunction,
Endometrial, Iatrogenic, and Not otherwise classified. Ovarian cancer is not
a primary cause of AUB.
Q7. A woman reports severe menstrual cramps that began with menarche
and have worsened. She has tried ibuprofen with minimal relief. What is the
most effective treatment?
A. Higher-dose NSAIDs
B. Combined oral contraceptives
C. Heat therapy
D. Acetaminophen
Answer: B. Combined oral contraceptives
Rationale: Combined oral contraceptives are highly effective for primary
dysmenorrhea by suppressing ovulation and reducing prostaglandin
production. NSAIDs are first-line but if inadequate, OCPs are the next step.
