1
NRNP 6552 FINAL EXAM WEEK 11 2026/2027 | Women's
Health Primary Care Comprehensive Final | Two Versions A
& B | Complete Detailed Answers | A+ Graded | Pass
Guaranteed
VERSION A - 100 QUESTIONS
A1: Advanced Reproductive Endocrinology & Infertility (Questions 1-15)
Q1. A 26-year-old presents with irregular menses (6–8 per year), hirsutism, and acne.
BMI is 32. Labs show LH 18 mIU/mL, FSH 6 mIU/mL, total testosterone 72 ng/dL, and
fasting glucose 108 mg/dL. Pelvic ultrasound shows 22 small follicles per ovary. Which
diagnostic criteria are met?
A. NIH 1990 criteria only
B. Rotterdam 2003 criteria (2 of 3: oligo/anovulation, hyperandrogenism, polycystic
ovaries)
C. Androgen Excess Society criteria requiring all three features
D. None; insulin resistance excludes PCOS diagnosis
Correct Answer: B. Rotterdam 2003 criteria (2 of 3: oligo/anovulation,
hyperandrogenism, polycystic ovaries) [CORRECT] Rationale: Rotterdam criteria
require 2 of 3: oligo/anovulation (irregular menses), clinical/biochemical
hyperandrogenism (hirsutism, elevated testosterone), and polycystic ovaries on
ultrasound (>20 follicles or volume >10 mL per ovary). A is outdated. C incorrectly
states all three are required. D is wrong—insulin resistance is a metabolic feature, not
an exclusion.
Correct Answer: B
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Q2. A 29-year-old with PCOS is counseled about long-term metabolic risks. Which
screening is recommended annually?
A. Transvaginal ultrasound for ovarian cancer
B. Fasting glucose or HbA1c and lipid panel
C. CA-125 for ovarian cancer screening
D. Endometrial biopsy regardless of symptoms
Correct Answer: B. Fasting glucose or HbA1c and lipid panel [CORRECT] Rationale:
PCOS is associated with insulin resistance, type 2 diabetes, and dyslipidemia; annual
metabolic screening is recommended per Endocrine Society guidelines. A and C are not
indicated for ovarian cancer screening in PCOS. D is only indicated for abnormal uterine
bleeding or endometrial thickening.
Correct Answer: B
Q3. A 32-year-old with PCOS desires pregnancy. She has tried lifestyle modification for
6 months without ovulation. Which medication is first-line for ovulation induction?
A. Metformin 1500 mg daily
B. Letrozole 2.5 mg days 3–7
C. Clomiphene citrate 100 mg days 3–7
D. Gonadotropin injections
Correct Answer: B. Letrozole 2.5 mg days 3–7 [CORRECT] Rationale: Letrozole is
first-line for ovulation induction in PCOS per ASRM/PCOS Society guidelines, with
higher live birth rates and lower multiple gestation risk than clomiphene. A may restore
ovulation but is less effective than letrozole. C is second-line after letrozole failure. D is
reserved for refractory cases due to multiple gestation risk.
Correct Answer: B
Q4. A 28-year-old presents with cyclic pelvic pain, dysmenorrhea, dyspareunia, and
infertility. Physical exam reveals a fixed, retroverted uterus and tender uterosacral
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nodules. Which finding on transvaginal ultrasound is most suggestive of deep
infiltrating endometriosis?
A. Simple ovarian cyst <3 cm
B. Hypoechoic nodules in the rectovaginal septum with tethering of the rectum
C. Free fluid in the posterior cul-de-sac
D. Endometrial thickness of 14 mm
Correct Answer: B. Hypoechoic nodules in the rectovaginal septum with tethering of
the rectum [CORRECT] Rationale: Deep infiltrating endometriosis is characterized by
hypoechoic nodules (>3 mm) in the rectovaginal septum, uterosacral ligaments, or
bowel wall with organ tethering. A describes a simple cyst, not endometrioma. C is
nonspecific. D is unrelated to endometriosis.
Correct Answer: B
Q5. A 30-year-old with suspected endometriosis undergoes diagnostic laparoscopy.
Which intraoperative finding confirms the diagnosis?
A. Chocolate-colored cysts on the ovaries
B. Powder-burn lesions, endometriomas, or deep fibrotic nodules with histologic
confirmation of endometrial glands and stroma
C. Simple ovarian cysts with clear fluid
D. Pelvic adhesions without endometrial tissue
Correct Answer: B. Powder-burn lesions, endometriomas, or deep fibrotic nodules
with histologic confirmation of endometrial glands and stroma [CORRECT] Rationale:
Definitive diagnosis of endometriosis requires visualization of lesions plus histologic
confirmation of endometrial glands and stroma. A describes endometriomas but lacks
histology. C describes benign cysts. D is nonspecific—adhesions have multiple
etiologies.
Correct Answer: B
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Q6. A 34-year-old with endometriosis-related chronic pelvic pain has failed NSAIDs and
hormonal suppression. She desires future fertility. Which treatment is most
appropriate?
A. Total abdominal hysterectomy with bilateral salpingo-oophorectomy
B. Laparoscopic excision of endometriosis with ovarian preservation
C. Continuous GnRH agonist therapy for 2 years without add-back
D. Bilateral oophorectomy with hysterectomy
Correct Answer: B. Laparoscopic excision of endometriosis with ovarian preservation
[CORRECT] Rationale: Laparoscopic excision improves pain and fertility outcomes
while preserving reproductive potential. A and D are inappropriate for a patient
desiring future fertility. C causes significant bone loss without add-back therapy and is
not definitive.
Correct Answer: B
Q7. A 35-year-old with recurrent pregnancy loss (RPL) has had three consecutive first-
trimester miscarriages. Which evaluation is indicated as part of the standard RPL
workup?
A. Routine karyotyping of all prior pregnancy tissue
B. Parental karyotype, antiphospholipid antibody panel, and uterine cavity evaluation
C. Routine thrombophilia testing including factor V Leiden and prothrombin gene
mutation
D. Hysteroscopy on cycle day 3 of every menstrual cycle
Correct Answer: B. Parental karyotype, antiphospholipid antibody panel, and uterine
cavity evaluation [CORRECT] Rationale: Standard RPL evaluation includes parental
karyotyping (balanced translocations), antiphospholipid syndrome testing, and uterine
cavity assessment (hysteroscopy, SIS, or HSG). A is not always feasible. C is
controversial and not routinely recommended. D is excessive and not standard.
Correct Answer: B
NRNP 6552 FINAL EXAM WEEK 11 2026/2027 | Women's
Health Primary Care Comprehensive Final | Two Versions A
& B | Complete Detailed Answers | A+ Graded | Pass
Guaranteed
VERSION A - 100 QUESTIONS
A1: Advanced Reproductive Endocrinology & Infertility (Questions 1-15)
Q1. A 26-year-old presents with irregular menses (6–8 per year), hirsutism, and acne.
BMI is 32. Labs show LH 18 mIU/mL, FSH 6 mIU/mL, total testosterone 72 ng/dL, and
fasting glucose 108 mg/dL. Pelvic ultrasound shows 22 small follicles per ovary. Which
diagnostic criteria are met?
A. NIH 1990 criteria only
B. Rotterdam 2003 criteria (2 of 3: oligo/anovulation, hyperandrogenism, polycystic
ovaries)
C. Androgen Excess Society criteria requiring all three features
D. None; insulin resistance excludes PCOS diagnosis
Correct Answer: B. Rotterdam 2003 criteria (2 of 3: oligo/anovulation,
hyperandrogenism, polycystic ovaries) [CORRECT] Rationale: Rotterdam criteria
require 2 of 3: oligo/anovulation (irregular menses), clinical/biochemical
hyperandrogenism (hirsutism, elevated testosterone), and polycystic ovaries on
ultrasound (>20 follicles or volume >10 mL per ovary). A is outdated. C incorrectly
states all three are required. D is wrong—insulin resistance is a metabolic feature, not
an exclusion.
Correct Answer: B
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Q2. A 29-year-old with PCOS is counseled about long-term metabolic risks. Which
screening is recommended annually?
A. Transvaginal ultrasound for ovarian cancer
B. Fasting glucose or HbA1c and lipid panel
C. CA-125 for ovarian cancer screening
D. Endometrial biopsy regardless of symptoms
Correct Answer: B. Fasting glucose or HbA1c and lipid panel [CORRECT] Rationale:
PCOS is associated with insulin resistance, type 2 diabetes, and dyslipidemia; annual
metabolic screening is recommended per Endocrine Society guidelines. A and C are not
indicated for ovarian cancer screening in PCOS. D is only indicated for abnormal uterine
bleeding or endometrial thickening.
Correct Answer: B
Q3. A 32-year-old with PCOS desires pregnancy. She has tried lifestyle modification for
6 months without ovulation. Which medication is first-line for ovulation induction?
A. Metformin 1500 mg daily
B. Letrozole 2.5 mg days 3–7
C. Clomiphene citrate 100 mg days 3–7
D. Gonadotropin injections
Correct Answer: B. Letrozole 2.5 mg days 3–7 [CORRECT] Rationale: Letrozole is
first-line for ovulation induction in PCOS per ASRM/PCOS Society guidelines, with
higher live birth rates and lower multiple gestation risk than clomiphene. A may restore
ovulation but is less effective than letrozole. C is second-line after letrozole failure. D is
reserved for refractory cases due to multiple gestation risk.
Correct Answer: B
Q4. A 28-year-old presents with cyclic pelvic pain, dysmenorrhea, dyspareunia, and
infertility. Physical exam reveals a fixed, retroverted uterus and tender uterosacral
,3
nodules. Which finding on transvaginal ultrasound is most suggestive of deep
infiltrating endometriosis?
A. Simple ovarian cyst <3 cm
B. Hypoechoic nodules in the rectovaginal septum with tethering of the rectum
C. Free fluid in the posterior cul-de-sac
D. Endometrial thickness of 14 mm
Correct Answer: B. Hypoechoic nodules in the rectovaginal septum with tethering of
the rectum [CORRECT] Rationale: Deep infiltrating endometriosis is characterized by
hypoechoic nodules (>3 mm) in the rectovaginal septum, uterosacral ligaments, or
bowel wall with organ tethering. A describes a simple cyst, not endometrioma. C is
nonspecific. D is unrelated to endometriosis.
Correct Answer: B
Q5. A 30-year-old with suspected endometriosis undergoes diagnostic laparoscopy.
Which intraoperative finding confirms the diagnosis?
A. Chocolate-colored cysts on the ovaries
B. Powder-burn lesions, endometriomas, or deep fibrotic nodules with histologic
confirmation of endometrial glands and stroma
C. Simple ovarian cysts with clear fluid
D. Pelvic adhesions without endometrial tissue
Correct Answer: B. Powder-burn lesions, endometriomas, or deep fibrotic nodules
with histologic confirmation of endometrial glands and stroma [CORRECT] Rationale:
Definitive diagnosis of endometriosis requires visualization of lesions plus histologic
confirmation of endometrial glands and stroma. A describes endometriomas but lacks
histology. C describes benign cysts. D is nonspecific—adhesions have multiple
etiologies.
Correct Answer: B
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Q6. A 34-year-old with endometriosis-related chronic pelvic pain has failed NSAIDs and
hormonal suppression. She desires future fertility. Which treatment is most
appropriate?
A. Total abdominal hysterectomy with bilateral salpingo-oophorectomy
B. Laparoscopic excision of endometriosis with ovarian preservation
C. Continuous GnRH agonist therapy for 2 years without add-back
D. Bilateral oophorectomy with hysterectomy
Correct Answer: B. Laparoscopic excision of endometriosis with ovarian preservation
[CORRECT] Rationale: Laparoscopic excision improves pain and fertility outcomes
while preserving reproductive potential. A and D are inappropriate for a patient
desiring future fertility. C causes significant bone loss without add-back therapy and is
not definitive.
Correct Answer: B
Q7. A 35-year-old with recurrent pregnancy loss (RPL) has had three consecutive first-
trimester miscarriages. Which evaluation is indicated as part of the standard RPL
workup?
A. Routine karyotyping of all prior pregnancy tissue
B. Parental karyotype, antiphospholipid antibody panel, and uterine cavity evaluation
C. Routine thrombophilia testing including factor V Leiden and prothrombin gene
mutation
D. Hysteroscopy on cycle day 3 of every menstrual cycle
Correct Answer: B. Parental karyotype, antiphospholipid antibody panel, and uterine
cavity evaluation [CORRECT] Rationale: Standard RPL evaluation includes parental
karyotyping (balanced translocations), antiphospholipid syndrome testing, and uterine
cavity assessment (hysteroscopy, SIS, or HSG). A is not always feasible. C is
controversial and not routinely recommended. D is excessive and not standard.
Correct Answer: B
