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WOMENS HEALTH APEA Final Exam Newest
Exam Preparation With Complete Questions And
Correct Answers With Rationales | Already Graded
A+||Brand New Version!!
Question 1
A 28-year-old G2P1 woman at 16 weeks gestation presents with a 3-day
history of painless vaginal bleeding. She reports no abdominal pain, no
fever, and no passage of tissue. Her vital signs are stable.
Transabdominal ultrasound reveals a placenta that is covering the
internal cervical os. What is the most appropriate next step in
management?
A) Immediate cesarean delivery
B) Digital cervical examination to assess dilation
C) Pelvic rest and outpatient follow-up with serial ultrasounds
D) Administer betamethasone for fetal lung maturity
Answer: C) Pelvic rest and outpatient follow-up with serial ultrasounds
Explanation: This patient has placenta previa, a condition in which the
placenta partially or completely covers the internal cervical os. The
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classic presentation is painless vaginal bleeding in the second or third
trimester. Digital cervical examination is strictly contraindicated
because it can provoke massive hemorrhage. Immediate delivery is not
indicated in a stable patient at 16 weeks, as fetal viability is not yet
achievable. Betamethasone is not administered until 24 to 34 weeks
when preterm delivery is anticipated. The standard management for an
asymptomatic or mildly symptomatic patient with placenta previa
includes pelvic rest, avoidance of coitus and vaginal examinations, and
close outpatient follow-up with serial ultrasound monitoring to assess
placental migration.
Question 2
A 45-year-old woman presents with a 6-month history of heavy
menstrual bleeding occurring every 21 to 24 days. She reports passing
clots and soaking through a pad every 1 to 2 hours during the first two
days of menses. Her hemoglobin is 10.2 g/dL, and her hematocrit is
31%. Pelvic ultrasound reveals a 4 cm intramural fibroid. Endometrial
biopsy is benign. What is the most appropriate first-line medical
therapy for this patient?
A) Oral contraceptive pills
B) Tranexamic acid
C) Levonorgestrel-releasing intrauterine device (LNG-IUD)
D) GnRH agonists
Answer: C) Levonorgestrel-releasing intrauterine device (LNG-IUD)
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Explanation: The LNG-IUD is considered first-line therapy for heavy
menstrual bleeding in women who have completed childbearing or who
desire long-term contraception, as it reduces menstrual blood loss by
approximately 90% within 12 months of use. Oral contraceptive pills are
effective but require daily adherence and carry a higher risk of
thromboembolic events in women over 35, especially if they smoke.
Tranexamic acid is a reasonable option for acute bleeding but is
typically used as adjunctive therapy rather than first-line for chronic
heavy menstrual bleeding. GnRH agonists induce a medical menopause
and are effective but are reserved for short-term use (3 to 6 months)
due to significant hypoestrogenic side effects, including bone density
loss, and are not appropriate as first-line therapy.
Question 3
A 32-year-old G1P0 woman at 28 weeks gestation presents for a
routine prenatal visit. Her blood pressure is 145/92 mmHg, and she has
1+ protein on urine dipstick. She denies headaches, visual changes, or
epigastric pain. Which of the following is the most important next step
in management?
A) Start labetalol 200 mg twice daily
B) Obtain a 24-hour urine protein collection
C) Admit to labor and delivery for immediate induction of labor
D) Schedule a return visit in 1 week for blood pressure recheck
Answer: B) Obtain a 24-hour urine protein collection
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Explanation: This patient has new-onset hypertension (blood pressure
≥140/90 mmHg) and proteinuria (1+ on dipstick) at 28 weeks gestation,
raising concern for preeclampsia. The diagnostic criteria for
preeclampsia include hypertension and proteinuria (≥300 mg per 24-
hour urine collection or protein/creatinine ratio ≥0.3) or, in the absence
of proteinuria, hypertension with end-organ dysfunction. A 24-hour
urine protein collection is the gold standard for quantifying proteinuria
and confirming the diagnosis. While labetalol is an appropriate
antihypertensive for acute severe hypertension, this patient's blood
pressure is not in the severe range (≥160/110 mmHg) and does not
require immediate pharmacologic intervention. Admission and
induction are not indicated in the absence of severe features (severe
hypertension, neurologic symptoms, hepatic dysfunction,
thrombocytopenia, or fetal compromise). Returning in 1 week without
further evaluation is unsafe given the potential for rapid progression to
severe preeclampsia.
Question 4
A 52-year-old postmenopausal woman presents with a 2-month history
of vulvar pruritus, burning, and dyspareunia. On examination, the
vulvar mucosa appears thin, pale, and atrophic with fissures at the
introitus. A KOH preparation is negative for hyphae. What is the most
likely diagnosis and appropriate treatment?
A) Lichen sclerosus; treat with topical clobetasol propionate
B) Vulvovaginal candidiasis; treat with oral fluconazole
C) Atrophic vaginitis; treat with vaginal estrogen cream
D) Lichen planus; treat with topical tacrolimus
WOMENS HEALTH APEA Final Exam Newest
Exam Preparation With Complete Questions And
Correct Answers With Rationales | Already Graded
A+||Brand New Version!!
Question 1
A 28-year-old G2P1 woman at 16 weeks gestation presents with a 3-day
history of painless vaginal bleeding. She reports no abdominal pain, no
fever, and no passage of tissue. Her vital signs are stable.
Transabdominal ultrasound reveals a placenta that is covering the
internal cervical os. What is the most appropriate next step in
management?
A) Immediate cesarean delivery
B) Digital cervical examination to assess dilation
C) Pelvic rest and outpatient follow-up with serial ultrasounds
D) Administer betamethasone for fetal lung maturity
Answer: C) Pelvic rest and outpatient follow-up with serial ultrasounds
Explanation: This patient has placenta previa, a condition in which the
placenta partially or completely covers the internal cervical os. The
,2|Page
classic presentation is painless vaginal bleeding in the second or third
trimester. Digital cervical examination is strictly contraindicated
because it can provoke massive hemorrhage. Immediate delivery is not
indicated in a stable patient at 16 weeks, as fetal viability is not yet
achievable. Betamethasone is not administered until 24 to 34 weeks
when preterm delivery is anticipated. The standard management for an
asymptomatic or mildly symptomatic patient with placenta previa
includes pelvic rest, avoidance of coitus and vaginal examinations, and
close outpatient follow-up with serial ultrasound monitoring to assess
placental migration.
Question 2
A 45-year-old woman presents with a 6-month history of heavy
menstrual bleeding occurring every 21 to 24 days. She reports passing
clots and soaking through a pad every 1 to 2 hours during the first two
days of menses. Her hemoglobin is 10.2 g/dL, and her hematocrit is
31%. Pelvic ultrasound reveals a 4 cm intramural fibroid. Endometrial
biopsy is benign. What is the most appropriate first-line medical
therapy for this patient?
A) Oral contraceptive pills
B) Tranexamic acid
C) Levonorgestrel-releasing intrauterine device (LNG-IUD)
D) GnRH agonists
Answer: C) Levonorgestrel-releasing intrauterine device (LNG-IUD)
,3|Page
Explanation: The LNG-IUD is considered first-line therapy for heavy
menstrual bleeding in women who have completed childbearing or who
desire long-term contraception, as it reduces menstrual blood loss by
approximately 90% within 12 months of use. Oral contraceptive pills are
effective but require daily adherence and carry a higher risk of
thromboembolic events in women over 35, especially if they smoke.
Tranexamic acid is a reasonable option for acute bleeding but is
typically used as adjunctive therapy rather than first-line for chronic
heavy menstrual bleeding. GnRH agonists induce a medical menopause
and are effective but are reserved for short-term use (3 to 6 months)
due to significant hypoestrogenic side effects, including bone density
loss, and are not appropriate as first-line therapy.
Question 3
A 32-year-old G1P0 woman at 28 weeks gestation presents for a
routine prenatal visit. Her blood pressure is 145/92 mmHg, and she has
1+ protein on urine dipstick. She denies headaches, visual changes, or
epigastric pain. Which of the following is the most important next step
in management?
A) Start labetalol 200 mg twice daily
B) Obtain a 24-hour urine protein collection
C) Admit to labor and delivery for immediate induction of labor
D) Schedule a return visit in 1 week for blood pressure recheck
Answer: B) Obtain a 24-hour urine protein collection
, 4|Page
Explanation: This patient has new-onset hypertension (blood pressure
≥140/90 mmHg) and proteinuria (1+ on dipstick) at 28 weeks gestation,
raising concern for preeclampsia. The diagnostic criteria for
preeclampsia include hypertension and proteinuria (≥300 mg per 24-
hour urine collection or protein/creatinine ratio ≥0.3) or, in the absence
of proteinuria, hypertension with end-organ dysfunction. A 24-hour
urine protein collection is the gold standard for quantifying proteinuria
and confirming the diagnosis. While labetalol is an appropriate
antihypertensive for acute severe hypertension, this patient's blood
pressure is not in the severe range (≥160/110 mmHg) and does not
require immediate pharmacologic intervention. Admission and
induction are not indicated in the absence of severe features (severe
hypertension, neurologic symptoms, hepatic dysfunction,
thrombocytopenia, or fetal compromise). Returning in 1 week without
further evaluation is unsafe given the potential for rapid progression to
severe preeclampsia.
Question 4
A 52-year-old postmenopausal woman presents with a 2-month history
of vulvar pruritus, burning, and dyspareunia. On examination, the
vulvar mucosa appears thin, pale, and atrophic with fissures at the
introitus. A KOH preparation is negative for hyphae. What is the most
likely diagnosis and appropriate treatment?
A) Lichen sclerosus; treat with topical clobetasol propionate
B) Vulvovaginal candidiasis; treat with oral fluconazole
C) Atrophic vaginitis; treat with vaginal estrogen cream
D) Lichen planus; treat with topical tacrolimus
