, Question 1
A 52-year-old woman presents with 8 months of amenorrhea, severe
vasomotor symptoms, and a history of breast cancer treated with tamoxifen.
Which of the following is the most appropriate first-line pharmacologic
therapy for her vasomotor symptoms?
A. Conjugated equine estrogen 0.625 mg daily
B. Paroxetine 7.5 mg daily
C. Venlafaxine XR 75 mg daily
D. Gabapentin 300 mg three times daily
Correct Answer: C - Venlafaxine XR 75 mg daily
RATIONALE
Venlafaxine is a first-line non-hormonal option for vasomotor
symptoms in breast cancer survivors and is preferred over paroxetine
due to CYP2D6 inhibition affecting tamoxifen efficacy. Estrogen is
contraindicated post-breast cancer, and gabapentin is second-line with
less efficacy.
Question 2
A 28-year-old woman reports a 3-day history of dysuria, purulent cervical
discharge, and lower abdominal pain. NAAT testing is positive for Chlamydia
trachomatis and Neisseria gonorrhoeae. She has a severe penicillin allergy.
Which treatment regimen is most appropriate per CDC 2021 guidelines?
A. Ceftriaxone 500 mg IM single dose plus doxycycline 100 mg BID x 7
days
B. Azithromycin 1 g PO single dose plus doxycycline 100 mg BID x 7
days
C. Cefixime 800 mg PO single dose plus azithromycin 1 g PO single dose
D. Gentamicin 240 mg IM single dose plus azithromycin 2 g PO single
dose
Correct Answer: D - Gentamicin 240 mg IM single dose plus
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,azithromycin 2 g PO single dose
RATIONALE
For severe penicillin allergy, CDC recommends gentamicin 240 mg
IM plus azithromycin 2 g PO as an alternative for gonorrhea.
Ceftriaxone and cefixime are contraindicated due to cross-reactivity
risk; azithromycin monotherapy is no longer recommended due to
resistance.
Question 3
A 45-year-old woman with heavy menstrual bleeding has a PALM-COEIN
evaluation. Her ultrasound shows a 3 cm submucosal fibroid. Which of the
following is the most definitive and fertility-sparing treatment option?
A. Levonorgestrel-releasing intrauterine system (LNG-IUS)
B. Hysteroscopic myomectomy
C. Uterine artery embolization
D. Tranexamic acid 1300 mg TID during menses
Correct Answer: B - Hysteroscopic myomectomy
RATIONALE
Hysteroscopic myomectomy is the definitive, fertility-sparing surgical
treatment for submucosal fibroids. LNG-IUS and tranexamic acid
reduce bleeding but do not treat the fibroid; uterine artery
embolization is not first-line for fertility preservation.
Question 4
A 60-year-old postmenopausal woman presents with vulvar pruritus and a 2 cm
ulcerated lesion on the labia majora. Biopsy reveals squamous cell carcinoma.
Which of the following is the most important prognostic factor for survival?
A. Tumor size
B. Inguinal lymph node status
C. Depth of invasion
Page 3
, D. HPV status
Correct Answer: B - Inguinal lymph node status
RATIONALE
Inguinal lymph node status is the strongest prognostic factor for
vulvar squamous cell carcinoma survival. Tumor size and depth of
invasion are important but less predictive than nodal involvement;
HPV status is associated with better prognosis but is not the most
critical factor.
Question 5
A 34-year-old woman with polycystic ovary syndrome (PCOS) desires
pregnancy. She has a BMI of 36 and irregular cycles. Which of the following is
the first-line pharmacologic ovulation induction agent?
A. Clomiphene citrate
B. Letrozole
C. Metformin
D. Gonadotropins
Correct Answer: B - Letrozole
RATIONALE
Letrozole is now first-line for ovulation induction in PCOS, with
higher live birth rates than clomiphene. Metformin is adjunctive, and
gonadotropins are second-line due to higher cost and multiple
gestation risk.
Question 6
A 26-year-old woman presents with acute pelvic pain and a positive urine
pregnancy test. Transvaginal ultrasound shows no intrauterine pregnancy and a
2 cm adnexal mass. Serum hCG is 1800 mIU/mL. Which of the following is
the most appropriate next step in management?
A. Expectant management with repeat hCG in 48 hours
Page 4
A 52-year-old woman presents with 8 months of amenorrhea, severe
vasomotor symptoms, and a history of breast cancer treated with tamoxifen.
Which of the following is the most appropriate first-line pharmacologic
therapy for her vasomotor symptoms?
A. Conjugated equine estrogen 0.625 mg daily
B. Paroxetine 7.5 mg daily
C. Venlafaxine XR 75 mg daily
D. Gabapentin 300 mg three times daily
Correct Answer: C - Venlafaxine XR 75 mg daily
RATIONALE
Venlafaxine is a first-line non-hormonal option for vasomotor
symptoms in breast cancer survivors and is preferred over paroxetine
due to CYP2D6 inhibition affecting tamoxifen efficacy. Estrogen is
contraindicated post-breast cancer, and gabapentin is second-line with
less efficacy.
Question 2
A 28-year-old woman reports a 3-day history of dysuria, purulent cervical
discharge, and lower abdominal pain. NAAT testing is positive for Chlamydia
trachomatis and Neisseria gonorrhoeae. She has a severe penicillin allergy.
Which treatment regimen is most appropriate per CDC 2021 guidelines?
A. Ceftriaxone 500 mg IM single dose plus doxycycline 100 mg BID x 7
days
B. Azithromycin 1 g PO single dose plus doxycycline 100 mg BID x 7
days
C. Cefixime 800 mg PO single dose plus azithromycin 1 g PO single dose
D. Gentamicin 240 mg IM single dose plus azithromycin 2 g PO single
dose
Correct Answer: D - Gentamicin 240 mg IM single dose plus
Page 2
,azithromycin 2 g PO single dose
RATIONALE
For severe penicillin allergy, CDC recommends gentamicin 240 mg
IM plus azithromycin 2 g PO as an alternative for gonorrhea.
Ceftriaxone and cefixime are contraindicated due to cross-reactivity
risk; azithromycin monotherapy is no longer recommended due to
resistance.
Question 3
A 45-year-old woman with heavy menstrual bleeding has a PALM-COEIN
evaluation. Her ultrasound shows a 3 cm submucosal fibroid. Which of the
following is the most definitive and fertility-sparing treatment option?
A. Levonorgestrel-releasing intrauterine system (LNG-IUS)
B. Hysteroscopic myomectomy
C. Uterine artery embolization
D. Tranexamic acid 1300 mg TID during menses
Correct Answer: B - Hysteroscopic myomectomy
RATIONALE
Hysteroscopic myomectomy is the definitive, fertility-sparing surgical
treatment for submucosal fibroids. LNG-IUS and tranexamic acid
reduce bleeding but do not treat the fibroid; uterine artery
embolization is not first-line for fertility preservation.
Question 4
A 60-year-old postmenopausal woman presents with vulvar pruritus and a 2 cm
ulcerated lesion on the labia majora. Biopsy reveals squamous cell carcinoma.
Which of the following is the most important prognostic factor for survival?
A. Tumor size
B. Inguinal lymph node status
C. Depth of invasion
Page 3
, D. HPV status
Correct Answer: B - Inguinal lymph node status
RATIONALE
Inguinal lymph node status is the strongest prognostic factor for
vulvar squamous cell carcinoma survival. Tumor size and depth of
invasion are important but less predictive than nodal involvement;
HPV status is associated with better prognosis but is not the most
critical factor.
Question 5
A 34-year-old woman with polycystic ovary syndrome (PCOS) desires
pregnancy. She has a BMI of 36 and irregular cycles. Which of the following is
the first-line pharmacologic ovulation induction agent?
A. Clomiphene citrate
B. Letrozole
C. Metformin
D. Gonadotropins
Correct Answer: B - Letrozole
RATIONALE
Letrozole is now first-line for ovulation induction in PCOS, with
higher live birth rates than clomiphene. Metformin is adjunctive, and
gonadotropins are second-line due to higher cost and multiple
gestation risk.
Question 6
A 26-year-old woman presents with acute pelvic pain and a positive urine
pregnancy test. Transvaginal ultrasound shows no intrauterine pregnancy and a
2 cm adnexal mass. Serum hCG is 1800 mIU/mL. Which of the following is
the most appropriate next step in management?
A. Expectant management with repeat hCG in 48 hours
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