APEA Women’s Health Final Exam 2025–2026: 150
High-Yield Practice Questions with Four Multiple-
Choice Options and Correct Answers
Section 1: Reproductive Anatomy, Physiology & Contraception (Questions 1-30)
1. A 24-year-old patient asks about the timing of ovulation in her menstrual cycle.
Which hormone surge triggers the release of the mature oocyte from the dominant
follicle?
A. Estrogen surge on day 7
B. Luteinizing hormone (LH) surge approximately 24-36 hours before ovulation
C. Progesterone surge during the luteal phase
D. Follicle-stimulating hormone (FSH) surge at menstruation
Correct Answer: B. Luteinizing hormone (LH) surge approximately 24-36 hours before
ovulation
2. A patient with primary amenorrhea has normal breast development but no pubic or
axillary hair. Which enzyme deficiency should be suspected?
A. 21-hydroxylase deficiency
B. 5-alpha reductase deficiency
C. Androgen insensitivity syndrome (46,XY karyotype with absent androgen receptor
function)
D. Aromatase deficiency
Correct Answer: C. Androgen insensitivity syndrome (46,XY karyotype with absent
androgen receptor function)
3. During a pelvic examination, the provider palpates a firm, muscular structure
between the bladder and rectum. This structure is:
A. The broad ligament
B. The cardinal ligament
C. The uterus
D. The uterosacral ligament
Correct Answer: C. The uterus
,4. A patient asks about the function of the fallopian tubes. Which description is most
accurate?
A. Production of progesterone
B. Site of fertilization and early embryo transport to the uterus
C. Storage of mature oocytes
D. Production of cervical mucus
Correct Answer: B. Site of fertilization and early embryo transport to the uterus
5. Which layer of the uterus is responsible for cyclic shedding during menstruation?
A. Myometrium
B. Perimetrium
C. Endometrium (functional layer)
D. Basalis layer
Correct Answer: C. Endometrium (functional layer)
6. A patient with cyclic breast tenderness asks about the hormonal cause. Which
hormone combination is primarily responsible for breast changes during the luteal
phase?
A. Estrogen alone
B. Progesterone alone
C. Estrogen and progesterone stimulation causing lobular-alveolar proliferation
D. Prolactin and oxytocin
Correct Answer: C. Estrogen and progesterone stimulation causing lobular-alveolar
proliferation
7. Which structure produces the majority of circulating estrogen in premenopausal
women?
A. Adrenal cortex
B. Ovarian theca and granulosa cells (through two-cell theory of estrogen synthesis)
C. Adipose tissue
D. Pituitary gland
Correct Answer: B. Ovarian theca and granulosa cells (through two-cell theory of estrogen
synthesis)
8. A patient asks about cervical mucus changes during the menstrual cycle. Which
description characterizes ovulatory cervical mucus?
A. Thick, opaque, and sticky
B. Clear, stretchy, and watery with spinnbarkeit (ferning pattern)
C. Absent or scant
D. Bloody or brown-tinged
Correct Answer: B. Clear, stretchy, and watery with spinnbarkeit (ferning pattern)
,9. A 28-year-old woman is diagnosed with polycystic ovary syndrome (PCOS). Which
of the following is the most appropriate first-line pharmacologic treatment for her
hirsutism?
A. Spironolactone 100 mg daily
B. Combined oral contraceptive pills
C. Metformin 500 mg twice daily
D. Eflornithine cream twice daily
Correct Answer: B. Combined oral contraceptive pills
10. A 45-year-old woman with a history of venous thromboembolism (VTE) requests
hormonal contraception. Which method is absolutely contraindicated?
A. Levonorgestrel intrauterine device
B. Etonogestrel implant
C. Combined oral contraceptive pill
D. Medroxyprogesterone acetate injection
Correct Answer: C. Combined oral contraceptive pill
11. A patient on combined oral contraceptives (COCs) reports new-onset migraine
with aura. According to the US Medical Eligibility Criteria (MEC), what is the
appropriate recommendation?
A. Continue COCs and prescribe a triptan for acute migraine treatment
B. Switch to a progestin-only pill to reduce stroke risk
C. Discontinue COCs and consider non-hormonal contraception
D. Reduce the estrogen dose to 20 mcg to mitigate risk
Correct Answer: C. Discontinue COCs and consider non-hormonal contraception
12. A 28-year-old woman is considering a progestin-only pill (POP) for contraception.
Which of the following is the most critical counseling point regarding the mechanism
of action and typical use effectiveness?
A. POPs consistently suppress ovulation in most cycles, providing near-perfect efficacy.
B. The main contraceptive effect is thickening of cervical mucus, and ovulation is not
consistently suppressed.
C. POPs are less effective than combined oral contraceptives because they do not inhibit
ovulation.
D. POPs require a placebo week to maintain a regular withdrawal bleed.
Correct Answer: B. The main contraceptive effect is thickening of cervical mucus, and
ovulation is not consistently suppressed.
13. A 21-year-old female requests emergency contraception after a barrier method
failure occurred approximately 48 hours ago. She has a body mass index (BMI) of 32.
Which emergency contraceptive option provides the highest efficacy for this patient?
, A. Oral levonorgestrel (Plan B One-Step)
B. High-dose combined oral contraceptives (Yuzpe method)
C. Copper intrauterine device (Paragard) or Ulipristal acetate (Ella)
D. Oral medroxyprogesterone acetate
Correct Answer: C. Copper intrauterine device (Paragard) or Ulipristal acetate (Ella)
14. Which of the following best explains the mechanism of action of ulipristal acetate
for emergency contraception?
A. Inhibits ovulation by antagonizing progesterone receptors in the pituitary
B. Prevents implantation by altering endometrial receptivity
C. Thickens cervical mucus to impede sperm transport
D. Induces luteolysis of the corpus luteum
Correct Answer: A. Inhibits ovulation by antagonizing progesterone receptors in the pituitary
15. Emergency contraception (e.g., Plan B) is most effective when taken:
A. Within 72 hours after unprotected intercourse
B. Within 5 days after unprotected intercourse
C. 2 weeks after unprotected intercourse
D. Immediately before intercourse
Correct Answer: A. Within 72 hours after unprotected intercourse
16. The vaginal ring for contraception must be removed:
A. Every week
B. Every 2 weeks
C. Every 3 weeks
D. Every month
Correct Answer: C. Every 3 weeks
17. What is the only form of non-hormonal contraception other than barrier methods
such as condoms?
A. IUD
B. Depo-Provera
C. Implant
D. Vaginal ring
Correct Answer: A. IUD
18. If a patient is on birth control and is currently having breakthrough bleeding, what
is the appropriate management?
A. Decrease the estrogen
B. Increase the progesterone
C. Discontinue the pill
High-Yield Practice Questions with Four Multiple-
Choice Options and Correct Answers
Section 1: Reproductive Anatomy, Physiology & Contraception (Questions 1-30)
1. A 24-year-old patient asks about the timing of ovulation in her menstrual cycle.
Which hormone surge triggers the release of the mature oocyte from the dominant
follicle?
A. Estrogen surge on day 7
B. Luteinizing hormone (LH) surge approximately 24-36 hours before ovulation
C. Progesterone surge during the luteal phase
D. Follicle-stimulating hormone (FSH) surge at menstruation
Correct Answer: B. Luteinizing hormone (LH) surge approximately 24-36 hours before
ovulation
2. A patient with primary amenorrhea has normal breast development but no pubic or
axillary hair. Which enzyme deficiency should be suspected?
A. 21-hydroxylase deficiency
B. 5-alpha reductase deficiency
C. Androgen insensitivity syndrome (46,XY karyotype with absent androgen receptor
function)
D. Aromatase deficiency
Correct Answer: C. Androgen insensitivity syndrome (46,XY karyotype with absent
androgen receptor function)
3. During a pelvic examination, the provider palpates a firm, muscular structure
between the bladder and rectum. This structure is:
A. The broad ligament
B. The cardinal ligament
C. The uterus
D. The uterosacral ligament
Correct Answer: C. The uterus
,4. A patient asks about the function of the fallopian tubes. Which description is most
accurate?
A. Production of progesterone
B. Site of fertilization and early embryo transport to the uterus
C. Storage of mature oocytes
D. Production of cervical mucus
Correct Answer: B. Site of fertilization and early embryo transport to the uterus
5. Which layer of the uterus is responsible for cyclic shedding during menstruation?
A. Myometrium
B. Perimetrium
C. Endometrium (functional layer)
D. Basalis layer
Correct Answer: C. Endometrium (functional layer)
6. A patient with cyclic breast tenderness asks about the hormonal cause. Which
hormone combination is primarily responsible for breast changes during the luteal
phase?
A. Estrogen alone
B. Progesterone alone
C. Estrogen and progesterone stimulation causing lobular-alveolar proliferation
D. Prolactin and oxytocin
Correct Answer: C. Estrogen and progesterone stimulation causing lobular-alveolar
proliferation
7. Which structure produces the majority of circulating estrogen in premenopausal
women?
A. Adrenal cortex
B. Ovarian theca and granulosa cells (through two-cell theory of estrogen synthesis)
C. Adipose tissue
D. Pituitary gland
Correct Answer: B. Ovarian theca and granulosa cells (through two-cell theory of estrogen
synthesis)
8. A patient asks about cervical mucus changes during the menstrual cycle. Which
description characterizes ovulatory cervical mucus?
A. Thick, opaque, and sticky
B. Clear, stretchy, and watery with spinnbarkeit (ferning pattern)
C. Absent or scant
D. Bloody or brown-tinged
Correct Answer: B. Clear, stretchy, and watery with spinnbarkeit (ferning pattern)
,9. A 28-year-old woman is diagnosed with polycystic ovary syndrome (PCOS). Which
of the following is the most appropriate first-line pharmacologic treatment for her
hirsutism?
A. Spironolactone 100 mg daily
B. Combined oral contraceptive pills
C. Metformin 500 mg twice daily
D. Eflornithine cream twice daily
Correct Answer: B. Combined oral contraceptive pills
10. A 45-year-old woman with a history of venous thromboembolism (VTE) requests
hormonal contraception. Which method is absolutely contraindicated?
A. Levonorgestrel intrauterine device
B. Etonogestrel implant
C. Combined oral contraceptive pill
D. Medroxyprogesterone acetate injection
Correct Answer: C. Combined oral contraceptive pill
11. A patient on combined oral contraceptives (COCs) reports new-onset migraine
with aura. According to the US Medical Eligibility Criteria (MEC), what is the
appropriate recommendation?
A. Continue COCs and prescribe a triptan for acute migraine treatment
B. Switch to a progestin-only pill to reduce stroke risk
C. Discontinue COCs and consider non-hormonal contraception
D. Reduce the estrogen dose to 20 mcg to mitigate risk
Correct Answer: C. Discontinue COCs and consider non-hormonal contraception
12. A 28-year-old woman is considering a progestin-only pill (POP) for contraception.
Which of the following is the most critical counseling point regarding the mechanism
of action and typical use effectiveness?
A. POPs consistently suppress ovulation in most cycles, providing near-perfect efficacy.
B. The main contraceptive effect is thickening of cervical mucus, and ovulation is not
consistently suppressed.
C. POPs are less effective than combined oral contraceptives because they do not inhibit
ovulation.
D. POPs require a placebo week to maintain a regular withdrawal bleed.
Correct Answer: B. The main contraceptive effect is thickening of cervical mucus, and
ovulation is not consistently suppressed.
13. A 21-year-old female requests emergency contraception after a barrier method
failure occurred approximately 48 hours ago. She has a body mass index (BMI) of 32.
Which emergency contraceptive option provides the highest efficacy for this patient?
, A. Oral levonorgestrel (Plan B One-Step)
B. High-dose combined oral contraceptives (Yuzpe method)
C. Copper intrauterine device (Paragard) or Ulipristal acetate (Ella)
D. Oral medroxyprogesterone acetate
Correct Answer: C. Copper intrauterine device (Paragard) or Ulipristal acetate (Ella)
14. Which of the following best explains the mechanism of action of ulipristal acetate
for emergency contraception?
A. Inhibits ovulation by antagonizing progesterone receptors in the pituitary
B. Prevents implantation by altering endometrial receptivity
C. Thickens cervical mucus to impede sperm transport
D. Induces luteolysis of the corpus luteum
Correct Answer: A. Inhibits ovulation by antagonizing progesterone receptors in the pituitary
15. Emergency contraception (e.g., Plan B) is most effective when taken:
A. Within 72 hours after unprotected intercourse
B. Within 5 days after unprotected intercourse
C. 2 weeks after unprotected intercourse
D. Immediately before intercourse
Correct Answer: A. Within 72 hours after unprotected intercourse
16. The vaginal ring for contraception must be removed:
A. Every week
B. Every 2 weeks
C. Every 3 weeks
D. Every month
Correct Answer: C. Every 3 weeks
17. What is the only form of non-hormonal contraception other than barrier methods
such as condoms?
A. IUD
B. Depo-Provera
C. Implant
D. Vaginal ring
Correct Answer: A. IUD
18. If a patient is on birth control and is currently having breakthrough bleeding, what
is the appropriate management?
A. Decrease the estrogen
B. Increase the progesterone
C. Discontinue the pill
