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CARE OF WOMEN KSA 2025 EXAM 2025
QUESTIONS AND CORRECT ANSWERS
You are seeing a patient for her Medicare annual wellness visit. Both she and her
husband have had knee osteoarthritis for several years, and she has noted among her
friends that men and women appear to receive different recommendations for
osteoarthritis treatment by other physicians in the community. Which one of the
following is true regarding osteoarthritis in women compared to osteoarthritis in men?
A. The prevalence of osteoarthritis is lower in women
B. Women tend to present with osteoarthritis at earlier stages than men
C. Physicians are more likely to refer women for joint replacement surgery compared
to men with the same degree of symptoms
D. Outcomes from total joint arthroplasty are similar in women and men -
CORRECT ANSWER: D
The overall prevalence of osteoarthritis (OA) of the hip, knee, and hands has been
shown to be higher in women than men, with the differences largely attributable to an
increasing incidence around menopause. The reason for this is likely multifactorial,
related to differences in anatomic and physiologic factors. Women also tend to present
with worse symptoms, including greater reports of pain and disability, and more gait
changes.
Differences in the prevalence of OA between men and women could also be
explained by other factors, such as reduced volume of cartilage, bone loss, or lower
muscle strength.
Studies have shown that men are much more likely to receive a recommendation for
knee replacement compared to women with the same presentation, even though
women benefit from total joint replacement as much as men in terms of pain and
functional outcomes.
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An 18-year-old female sees you for evaluation of heavy menstrual bleeding that has
been present since menarche. She reports that her periods have always been regular,
occurring every 28 days, but they last 8-10 days and necessitate pad changes every 1-
2 hours. On examination her vital signs and weight are normal, there is no bruising or
petechiae, and no abnormalities are noted. An in-office pregnancy test is negative and
a CBC has been ordered. Of the following underlying etiologies, which one is most
likely in this patient?
A. A bleeding disorder
B. Endometrial hyperplasia
C. Hyperprolactinemia
D. Polycystic ovary syndrome - CORRECT ANSWER: A
Abnormal uterine bleeding can be categorized as ovulatory (regular cycles) or
anovulatory (irregular cycles). This patient has ovulatory abnormal uterine bleeding
(menorrhagia) evidenced by heavy bleeding that lasts for more than 7 days and occurs
at regular intervals every 24-35 days.
Up to 20% of women presenting with heavy menstrual bleeding will have an
underlying inherited bleeding disorder, with a higher prevalence in adolescent
females. The onset of heavy menses at menarche is often the first sign. An initial
evaluation for a bleeding disorder is indicated when a patient reports heavy menstrual
bleeding since menarche, postpartum hemorrhage, surgery-related bleeding,
bleeding associated with dental work, or two or more of the following: bruising 1-2
times per month, epistaxis 1-2 times per month, frequent gum bleeding, or a family
history of bleeding symptoms. Heavy menses may be seen with platelet disorders and
factor deficiencies (factors VIII and IX, and less commonly VII and XI). The initial
evaluation should include a prothrombin time and partial thromboplastin time when a
bleeding disorder is suspected. Results may
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be normal in women with von Willebrand disease, and other testing may be
appropriate, including plasma von Willebrand antigen, a von Willebrand factor-
ristocetin cofactor assay, and factor VIII.
Polycystic ovary syndrome can cause heavy bleeding, but it is associated with
anovulatory bleeding characterized by irregular menstrual cycles.
Recurrent anovulation leads to endometrial hyperplasia. This patient is not at high risk
for endometrial hyperplasia due to her age, history of regular cycles, and lack of risk
factors. Hyperprolactinemia usually leads to anovulation, which would be characterized
by irregular or absent menstrual cycles.
A 23-year-old female presents to your office with concerns about irregular menstrual
periods occurring every 2-3 months. Her blood pressure is 138/82 mm Hg, her pulse
rate is 66 beats/min, and her BMI is 32 kg/m2. On examination you note coarse, dark
hair on her upper lip, chin, abdomen, and upper and inner thighs, and she has
moderate inflammatory acne on her face and upper back. The remainder of the
examination is normal. As you consider a diagnosis of polycystic ovary syndrome,
which one of the following conditions should be ruled out initially?
A. An androgen-secreting tumor
B. Cushing syndrome
C. HAIR-AN syndrome (severe insulin resistance)
D. Hypothyroidism
E. Primary ovarian insufficiency - CORRECT ANSWER: D
Making a diagnosis of polycystic ovary syndrome (PCOS) requires the systematic
exclusion of conditions that may mimic this syndrome. In women with evidence of
ovulatory dysfunction, other causes such as thyroid dysfunction and
hyperprolactinemia should be excluded.
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Because of the wide range of manifestations of thyroid disease and its high frequency
in women with menstrual disorders, a TSH level should be checked in women with
possible PCOS. A prolactin level should also be obtained to rule out
hyperprolactinemia as a cause of anovulation in women with suspected PCOS.
HAIR-AN syndrome, a rare subphenotype of PCOS, consists of hyperandrogenism,
severe insulin resistance, and acanthosis nigricans, and occurs in nearly 5% of women
with hyperandrogenism.
An androgen-secreting tumor is characterized by a rapid onset of virilization
symptoms, including changes in voice, male pattern androgenic balding, and
clitoromegaly. Testing is not indicated in the absence of these symptoms. Primary
ovarian insufficiency involves amenorrhea (as opposed to oligomenorrhea) combined
with symptoms of estrogen deficiency, including hot flashes or urogenital symptoms.
The patient does not have any of these symptoms so testing for this would not be
appropriate at this point.
Because Cushing syndrome is extremely rare (1 in 1,000,000 individuals) and
screening tests are not 100% sensitive or specific, routine screening for Cushing
syndrome in all women with hyperandrogenic chronic anovulation is not indicated.
Those who have coexisting signs of Cushing syndrome, including moon facies,
abdominal striae, centripetal fat distribution, or hypertension, should be considered
for screening with a 24- hour free cortisol level or a dexamethasone suppression test.
A 24-year-old graduate student comes to your office to be tested for sexually
transmitted infections. The medical assistant tells you that the patient was upset when
she saw how much she weighed. On questioning,
CARE OF WOMEN KSA 2025 EXAM 2025
QUESTIONS AND CORRECT ANSWERS
You are seeing a patient for her Medicare annual wellness visit. Both she and her
husband have had knee osteoarthritis for several years, and she has noted among her
friends that men and women appear to receive different recommendations for
osteoarthritis treatment by other physicians in the community. Which one of the
following is true regarding osteoarthritis in women compared to osteoarthritis in men?
A. The prevalence of osteoarthritis is lower in women
B. Women tend to present with osteoarthritis at earlier stages than men
C. Physicians are more likely to refer women for joint replacement surgery compared
to men with the same degree of symptoms
D. Outcomes from total joint arthroplasty are similar in women and men -
CORRECT ANSWER: D
The overall prevalence of osteoarthritis (OA) of the hip, knee, and hands has been
shown to be higher in women than men, with the differences largely attributable to an
increasing incidence around menopause. The reason for this is likely multifactorial,
related to differences in anatomic and physiologic factors. Women also tend to present
with worse symptoms, including greater reports of pain and disability, and more gait
changes.
Differences in the prevalence of OA between men and women could also be
explained by other factors, such as reduced volume of cartilage, bone loss, or lower
muscle strength.
Studies have shown that men are much more likely to receive a recommendation for
knee replacement compared to women with the same presentation, even though
women benefit from total joint replacement as much as men in terms of pain and
functional outcomes.
, Page | 2
An 18-year-old female sees you for evaluation of heavy menstrual bleeding that has
been present since menarche. She reports that her periods have always been regular,
occurring every 28 days, but they last 8-10 days and necessitate pad changes every 1-
2 hours. On examination her vital signs and weight are normal, there is no bruising or
petechiae, and no abnormalities are noted. An in-office pregnancy test is negative and
a CBC has been ordered. Of the following underlying etiologies, which one is most
likely in this patient?
A. A bleeding disorder
B. Endometrial hyperplasia
C. Hyperprolactinemia
D. Polycystic ovary syndrome - CORRECT ANSWER: A
Abnormal uterine bleeding can be categorized as ovulatory (regular cycles) or
anovulatory (irregular cycles). This patient has ovulatory abnormal uterine bleeding
(menorrhagia) evidenced by heavy bleeding that lasts for more than 7 days and occurs
at regular intervals every 24-35 days.
Up to 20% of women presenting with heavy menstrual bleeding will have an
underlying inherited bleeding disorder, with a higher prevalence in adolescent
females. The onset of heavy menses at menarche is often the first sign. An initial
evaluation for a bleeding disorder is indicated when a patient reports heavy menstrual
bleeding since menarche, postpartum hemorrhage, surgery-related bleeding,
bleeding associated with dental work, or two or more of the following: bruising 1-2
times per month, epistaxis 1-2 times per month, frequent gum bleeding, or a family
history of bleeding symptoms. Heavy menses may be seen with platelet disorders and
factor deficiencies (factors VIII and IX, and less commonly VII and XI). The initial
evaluation should include a prothrombin time and partial thromboplastin time when a
bleeding disorder is suspected. Results may
, Page | 3
be normal in women with von Willebrand disease, and other testing may be
appropriate, including plasma von Willebrand antigen, a von Willebrand factor-
ristocetin cofactor assay, and factor VIII.
Polycystic ovary syndrome can cause heavy bleeding, but it is associated with
anovulatory bleeding characterized by irregular menstrual cycles.
Recurrent anovulation leads to endometrial hyperplasia. This patient is not at high risk
for endometrial hyperplasia due to her age, history of regular cycles, and lack of risk
factors. Hyperprolactinemia usually leads to anovulation, which would be characterized
by irregular or absent menstrual cycles.
A 23-year-old female presents to your office with concerns about irregular menstrual
periods occurring every 2-3 months. Her blood pressure is 138/82 mm Hg, her pulse
rate is 66 beats/min, and her BMI is 32 kg/m2. On examination you note coarse, dark
hair on her upper lip, chin, abdomen, and upper and inner thighs, and she has
moderate inflammatory acne on her face and upper back. The remainder of the
examination is normal. As you consider a diagnosis of polycystic ovary syndrome,
which one of the following conditions should be ruled out initially?
A. An androgen-secreting tumor
B. Cushing syndrome
C. HAIR-AN syndrome (severe insulin resistance)
D. Hypothyroidism
E. Primary ovarian insufficiency - CORRECT ANSWER: D
Making a diagnosis of polycystic ovary syndrome (PCOS) requires the systematic
exclusion of conditions that may mimic this syndrome. In women with evidence of
ovulatory dysfunction, other causes such as thyroid dysfunction and
hyperprolactinemia should be excluded.
, Page | 4
Because of the wide range of manifestations of thyroid disease and its high frequency
in women with menstrual disorders, a TSH level should be checked in women with
possible PCOS. A prolactin level should also be obtained to rule out
hyperprolactinemia as a cause of anovulation in women with suspected PCOS.
HAIR-AN syndrome, a rare subphenotype of PCOS, consists of hyperandrogenism,
severe insulin resistance, and acanthosis nigricans, and occurs in nearly 5% of women
with hyperandrogenism.
An androgen-secreting tumor is characterized by a rapid onset of virilization
symptoms, including changes in voice, male pattern androgenic balding, and
clitoromegaly. Testing is not indicated in the absence of these symptoms. Primary
ovarian insufficiency involves amenorrhea (as opposed to oligomenorrhea) combined
with symptoms of estrogen deficiency, including hot flashes or urogenital symptoms.
The patient does not have any of these symptoms so testing for this would not be
appropriate at this point.
Because Cushing syndrome is extremely rare (1 in 1,000,000 individuals) and
screening tests are not 100% sensitive or specific, routine screening for Cushing
syndrome in all women with hyperandrogenic chronic anovulation is not indicated.
Those who have coexisting signs of Cushing syndrome, including moon facies,
abdominal striae, centripetal fat distribution, or hypertension, should be considered
for screening with a 24- hour free cortisol level or a dexamethasone suppression test.
A 24-year-old graduate student comes to your office to be tested for sexually
transmitted infections. The medical assistant tells you that the patient was upset when
she saw how much she weighed. On questioning,
