1
NRNP 6552 MIDTERM EXAM ACTUAL 2026/2027 | 100
Correct Answers | Brand New Version | A+ Graded | Pass
Guaranteed
Section 1: Gynecologic Health & Reproductive System Disorders (Questions 1-25)
Q1. A 28-year-old woman presents with vulvar pruritus and white, curd-like vaginal
discharge. KOH prep shows budding yeast and pseudohyphae. Which is the most
appropriate initial treatment?
A. Metronidazole 500 mg PO BID x 7 days
B. Fluconazole 150 mg PO single dose
C. Clindamycin cream 2% intravaginally qhs x 7 days
D. Azithromycin 1 g PO single dose
B. Fluconazole 150 mg PO single dose [CORRECT]
Rationale: Uncomplicated vulvovaginal candidiasis is treated with azole antifungals;
fluconazole 150 mg single oral dose is first-line per CDC guidelines. Metronidazole (A)
treats BV/trichomoniasis, clindamycin (C) treats BV, and azithromycin (D) treats
chlamydia.
Correct Answer: B
Q2. A 35-year-old woman presents with thin, gray, homogenous vaginal discharge and a
positive whiff test. Vaginal pH is 5.5. Wet mount shows clue cells. Which organism is
most likely responsible?
A. Candida albicans
B. Gardnerella vaginalis
C. Trichomonas vaginalis
D. Neisseria gonorrhoeae
B. Gardnerella vaginalis [CORRECT]
Rationale: Bacterial vaginosis is characterized by thin gray discharge, elevated pH
(>4.5), positive whiff test, and clue cells on wet mount; Gardnerella vaginalis and
anaerobes disrupt normal vaginal flora. Candida causes thick white discharge,
trichomonas causes frothy yellow-green discharge, and gonorrhea causes mucopurulent
,2
cervicitis.
Correct Answer: B
Q3. A 25-year-old woman presents with profuse, frothy, yellow-green vaginal discharge
and vulvar irritation. Wet mount shows motile, flagellated organisms. Which treatment
is most appropriate?
A. Fluconazole 150 mg PO
B. Metronidazole 2 g PO single dose or 500 mg BID x 7 days
C. Clindamycin 300 mg PO TID x 7 days
D. Doxycycline 100 mg PO BID x 7 days
B. Metronidazole 2 g PO single dose or 500 mg BID x 7 days [CORRECT]
Rationale: Trichomoniasis is treated with nitroimidazoles; metronidazole or tinidazole
are CDC-recommended. Sexual partners must be treated simultaneously to prevent
reinfection. Fluconazole (A) treats candidiasis, clindamycin (C) treats BV, and
doxycycline (D) treats chlamydia.
Correct Answer: B
Q4. A 55-year-old postmenopausal woman presents with progressive vulvar pruritus,
dyspareunia, and white, atrophic-appearing vulvar skin with a "cigarette paper"
appearance. Which diagnosis is most likely?
A. Lichen planus
B. Lichen sclerosus
C. Vulvar intraepithelial neoplasia
D. Atrophic vaginitis
B. Lichen sclerosus [CORRECT]
Rationale: Lichen sclerosus presents with intense pruritus, white atrophic plaques, and
"cigarette paper" skin changes; it carries a 3-5% risk of squamous cell carcinoma and
requires long-term ultrapotent topical corticosteroids (clobetasol) and surveillance.
Lichen planus is violaceous and erosive, VIN requires biopsy confirmation, and atrophic
vaginitis lacks the characteristic skin changes.
Correct Answer: B
Q5. A 30-year-old woman presents with a tender, fluctuant 3 cm mass at the 4 o'clock
position of the vaginal introitus. She has difficulty walking. Which is the most
appropriate definitive management?
,3
A. Oral antibiotics alone
B. Incision and drainage with Word catheter placement
C. Marsupialization
D. Needle aspiration
B. Incision and drainage with Word catheter placement [CORRECT]
Rationale: Bartholin's abscess requires incision and drainage; Word catheter placement
for 4-6 weeks allows epithelialization of a drainage tract and reduces recurrence.
Marsupialization (C) is reserved for recurrent abscesses. Antibiotics alone (A) are
insufficient, and needle aspiration (D) has high recurrence.
Correct Answer: B
Q6. A 32-year-old woman presents with cyclic pelvic pain, deep dyspareunia, and
infertility. Physical exam reveals a fixed, retroverted uterus and tender nodularity in the
uterosacral ligaments. Which diagnostic finding on imaging is most suggestive of
endometriosis?
A. Simple ovarian cyst
B. Endometrioma with homogeneous low-level internal echoes ("ground-glass"
appearance)
C. Hydrosalpinx
D. Subserosal fibroid
B. Endometrioma with homogeneous low-level internal echoes ("ground-glass"
appearance) [CORRECT]
Rationale: Endometriomas (chocolate cysts) on transvaginal ultrasound demonstrate
homogeneous low-level internal echoes creating a "ground-glass" appearance; this
distinguishes them from hemorrhagic cysts or simple cysts. Definitive diagnosis
requires laparoscopy with histologic confirmation.
Correct Answer: B
Q7. A 28-year-old woman with suspected endometriosis desires fertility preservation.
Which medical therapy is most appropriate for suppressing disease while maintaining
fertility potential?
A. Combined oral contraceptives
B. GnRH agonist with add-back therapy
C. Continuous progestin therapy
D. Aromatase inhibitors
, 4
C. Continuous progestin therapy [CORRECT]
Rationale: Continuous progestins (norethindrone acetate, depot medroxyprogesterone)
suppress endometrial proliferation and are fertility-sparing; GnRH agonists (B) require
add-back to prevent bone loss but cause amenorrhea and contraception. COCs (A) are
suitable for cyclic suppression, and aromatase inhibitors (D) are second-line with
progestins.
Correct Answer: C
Q8. A 35-year-old woman with FIGO type 3-5 uterine leiomyomas presents with heavy
menstrual bleeding and bulk symptoms. She desires future fertility. Which treatment is
most appropriate?
A. Total hysterectomy
B. Uterine artery embolization
C. Myomectomy
D. Endometrial ablation
C. Myomectomy [CORRECT]
Rationale: Myomectomy is the treatment of choice for symptomatic fibroids in women
desiring fertility; it removes fibroids while preserving the uterus. Hysterectomy (A) is
definitive but eliminates fertility. UAE (B) may compromise ovarian reserve and
pregnancy outcomes. Endometrial ablation (D) is contraindicated with desire for future
pregnancy.
Correct Answer: C
Q9. A 40-year-old woman presents with intermenstrual bleeding and a 5 cm
intracavitary fibroid seen on saline-infusion sonohysterography. Which FIGO
classification best describes this fibroid?
A. Type 0
B. Type 1
C. Type 2
D. Type 3
A. Type 0 [CORRECT]
Rationale: FIGO classification: Type 0 is pedunculated intracavitary (completely within
endometrial cavity), Type 1 is submucosal with <50% intramural, Type 2 is submucosal
with ≥50% intramural, and Type 3 is intramural contacting endometrium. Intracavitary
NRNP 6552 MIDTERM EXAM ACTUAL 2026/2027 | 100
Correct Answers | Brand New Version | A+ Graded | Pass
Guaranteed
Section 1: Gynecologic Health & Reproductive System Disorders (Questions 1-25)
Q1. A 28-year-old woman presents with vulvar pruritus and white, curd-like vaginal
discharge. KOH prep shows budding yeast and pseudohyphae. Which is the most
appropriate initial treatment?
A. Metronidazole 500 mg PO BID x 7 days
B. Fluconazole 150 mg PO single dose
C. Clindamycin cream 2% intravaginally qhs x 7 days
D. Azithromycin 1 g PO single dose
B. Fluconazole 150 mg PO single dose [CORRECT]
Rationale: Uncomplicated vulvovaginal candidiasis is treated with azole antifungals;
fluconazole 150 mg single oral dose is first-line per CDC guidelines. Metronidazole (A)
treats BV/trichomoniasis, clindamycin (C) treats BV, and azithromycin (D) treats
chlamydia.
Correct Answer: B
Q2. A 35-year-old woman presents with thin, gray, homogenous vaginal discharge and a
positive whiff test. Vaginal pH is 5.5. Wet mount shows clue cells. Which organism is
most likely responsible?
A. Candida albicans
B. Gardnerella vaginalis
C. Trichomonas vaginalis
D. Neisseria gonorrhoeae
B. Gardnerella vaginalis [CORRECT]
Rationale: Bacterial vaginosis is characterized by thin gray discharge, elevated pH
(>4.5), positive whiff test, and clue cells on wet mount; Gardnerella vaginalis and
anaerobes disrupt normal vaginal flora. Candida causes thick white discharge,
trichomonas causes frothy yellow-green discharge, and gonorrhea causes mucopurulent
,2
cervicitis.
Correct Answer: B
Q3. A 25-year-old woman presents with profuse, frothy, yellow-green vaginal discharge
and vulvar irritation. Wet mount shows motile, flagellated organisms. Which treatment
is most appropriate?
A. Fluconazole 150 mg PO
B. Metronidazole 2 g PO single dose or 500 mg BID x 7 days
C. Clindamycin 300 mg PO TID x 7 days
D. Doxycycline 100 mg PO BID x 7 days
B. Metronidazole 2 g PO single dose or 500 mg BID x 7 days [CORRECT]
Rationale: Trichomoniasis is treated with nitroimidazoles; metronidazole or tinidazole
are CDC-recommended. Sexual partners must be treated simultaneously to prevent
reinfection. Fluconazole (A) treats candidiasis, clindamycin (C) treats BV, and
doxycycline (D) treats chlamydia.
Correct Answer: B
Q4. A 55-year-old postmenopausal woman presents with progressive vulvar pruritus,
dyspareunia, and white, atrophic-appearing vulvar skin with a "cigarette paper"
appearance. Which diagnosis is most likely?
A. Lichen planus
B. Lichen sclerosus
C. Vulvar intraepithelial neoplasia
D. Atrophic vaginitis
B. Lichen sclerosus [CORRECT]
Rationale: Lichen sclerosus presents with intense pruritus, white atrophic plaques, and
"cigarette paper" skin changes; it carries a 3-5% risk of squamous cell carcinoma and
requires long-term ultrapotent topical corticosteroids (clobetasol) and surveillance.
Lichen planus is violaceous and erosive, VIN requires biopsy confirmation, and atrophic
vaginitis lacks the characteristic skin changes.
Correct Answer: B
Q5. A 30-year-old woman presents with a tender, fluctuant 3 cm mass at the 4 o'clock
position of the vaginal introitus. She has difficulty walking. Which is the most
appropriate definitive management?
,3
A. Oral antibiotics alone
B. Incision and drainage with Word catheter placement
C. Marsupialization
D. Needle aspiration
B. Incision and drainage with Word catheter placement [CORRECT]
Rationale: Bartholin's abscess requires incision and drainage; Word catheter placement
for 4-6 weeks allows epithelialization of a drainage tract and reduces recurrence.
Marsupialization (C) is reserved for recurrent abscesses. Antibiotics alone (A) are
insufficient, and needle aspiration (D) has high recurrence.
Correct Answer: B
Q6. A 32-year-old woman presents with cyclic pelvic pain, deep dyspareunia, and
infertility. Physical exam reveals a fixed, retroverted uterus and tender nodularity in the
uterosacral ligaments. Which diagnostic finding on imaging is most suggestive of
endometriosis?
A. Simple ovarian cyst
B. Endometrioma with homogeneous low-level internal echoes ("ground-glass"
appearance)
C. Hydrosalpinx
D. Subserosal fibroid
B. Endometrioma with homogeneous low-level internal echoes ("ground-glass"
appearance) [CORRECT]
Rationale: Endometriomas (chocolate cysts) on transvaginal ultrasound demonstrate
homogeneous low-level internal echoes creating a "ground-glass" appearance; this
distinguishes them from hemorrhagic cysts or simple cysts. Definitive diagnosis
requires laparoscopy with histologic confirmation.
Correct Answer: B
Q7. A 28-year-old woman with suspected endometriosis desires fertility preservation.
Which medical therapy is most appropriate for suppressing disease while maintaining
fertility potential?
A. Combined oral contraceptives
B. GnRH agonist with add-back therapy
C. Continuous progestin therapy
D. Aromatase inhibitors
, 4
C. Continuous progestin therapy [CORRECT]
Rationale: Continuous progestins (norethindrone acetate, depot medroxyprogesterone)
suppress endometrial proliferation and are fertility-sparing; GnRH agonists (B) require
add-back to prevent bone loss but cause amenorrhea and contraception. COCs (A) are
suitable for cyclic suppression, and aromatase inhibitors (D) are second-line with
progestins.
Correct Answer: C
Q8. A 35-year-old woman with FIGO type 3-5 uterine leiomyomas presents with heavy
menstrual bleeding and bulk symptoms. She desires future fertility. Which treatment is
most appropriate?
A. Total hysterectomy
B. Uterine artery embolization
C. Myomectomy
D. Endometrial ablation
C. Myomectomy [CORRECT]
Rationale: Myomectomy is the treatment of choice for symptomatic fibroids in women
desiring fertility; it removes fibroids while preserving the uterus. Hysterectomy (A) is
definitive but eliminates fertility. UAE (B) may compromise ovarian reserve and
pregnancy outcomes. Endometrial ablation (D) is contraindicated with desire for future
pregnancy.
Correct Answer: C
Q9. A 40-year-old woman presents with intermenstrual bleeding and a 5 cm
intracavitary fibroid seen on saline-infusion sonohysterography. Which FIGO
classification best describes this fibroid?
A. Type 0
B. Type 1
C. Type 2
D. Type 3
A. Type 0 [CORRECT]
Rationale: FIGO classification: Type 0 is pedunculated intracavitary (completely within
endometrial cavity), Type 1 is submucosal with <50% intramural, Type 2 is submucosal
with ≥50% intramural, and Type 3 is intramural contacting endometrium. Intracavitary
