WHNP-BC Women's health nurse practitioner
certification validating expertise in reproductive
health, wellness, and primary care.
Question 1
A 28-year-old woman presents with 6 months of irregular menstrual cycles
occurring every 35–60 days, hirsutism, and acne. Her BMI is 32 kg/m². Which
diagnostic finding would be most consistent with polycystic ovary syndrome
(PCOS)?
A) Elevated LH:FSH ratio and clinical hyperandrogenism
B) Elevated prolactin level
C) Decreased DHEA-S levels
D) Normal ovarian volume on ultrasound
Rationale: PCOS is characterized by oligo-ovulation or anovulation, clinical or
biochemical hyperandrogenism, and polycystic ovarian morphology on ultrasound.
An elevated LH:FSH ratio (>2:1) is a common laboratory finding in PCOS, though
not required for diagnosis. Prolactin elevation suggests hyperprolactinemia rather
than PCOS. DHEA-S is typically normal or mildly elevated in PCOS, not
decreased.
Question 2
A 32-year-old woman with a BMI of 34 kg/m² and a history of PCOS presents
with a chief complaint of 8 months of amenorrhea. Which medication should be
considered first-line to induce ovulation?
A) Metformin
B) Clomiphene citrate
C) Letrozole
D) Spironolactone
Rationale: Letrozole is now considered first-line for ovulation induction in PCOS
due to higher live birth rates and lower multiple pregnancy rates compared to
clomiphene citrate. While clomiphene has been used historically, recent evidence
,supports letrozole as the preferred agent. Metformin may improve ovulation but is
less effective than letrozole. Spironolactone is an anti-androgen used for hirsutism,
not ovulation induction.
Question 3
A 45-year-old woman reports heavy menstrual bleeding occurring every 21 days
with clots and flooding. She has a negative pregnancy test, normal cervical
cytology, and endometrial biopsy showing benign proliferative endometrium. Her
hemoglobin is 9.8 g/dL. Which is the most appropriate initial management?
A) Combined oral contraceptives or progestin-only therapy
B) Endometrial ablation
C) Hysterectomy
D) Observation with iron supplementation
Rationale: Abnormal uterine bleeding (AUB) in a perimenopausal woman with
benign endometrium and anemia is initially managed with medical therapy—
combined oral contraceptives or progestin-only therapy to regulate bleeding and
reduce menstrual flow. Iron supplementation should accompany treatment.
Endometrial ablation and hysterectomy are surgical options reserved for failed
medical management or when childbearing is complete.
Question 4
A 25-year-old woman presents with a 2-day history of vaginal itching, thick white
discharge, and vulvar erythema. She reports no odor. Which diagnostic test is most
appropriate?
A) Wet mount with saline and KOH preparation
B) Cervical culture for Neisseria gonorrhoeae
C) Serum β-hCG
D) Chlamydia nucleic acid amplification test
Rationale: The patient's symptoms (itching, thick white discharge, vulvar
erythema, no odor) are classic for vulvovaginal candidiasis. A wet mount with
saline and 10% KOH preparation allows visualization of yeast buds and
pseudohyphae, confirming the diagnosis. Cervical cultures and NAAT are for STI
,screening, and β-hCG is for pregnancy testing, neither of which is the primary
diagnostic test for suspected candidiasis.
Question 5
A 34-year-old woman with a history of endometriosis reports progressive
dysmenorrhea and deep dyspareunia. She has tried NSAIDs and combined oral
contraceptives with partial relief. What is the next most appropriate medical
management option?
A) GnRH agonist with add-back therapy
B) Hysterectomy
C) Laparoscopic excision of endometriosis
D) Progestin-only pill
Rationale: For patients with moderate to severe endometriosis symptoms who
have failed first-line therapies (NSAIDs, OCPs), GnRH agonists (leuprolide
acetate) induce a temporary hypoestrogenic state, reducing endometrial implant
activity. Add-back therapy (low-dose estrogen/progestin) minimizes side effects
such as bone loss. Surgery is reserved for failed medical management or for
definitive diagnosis. Progestin-only pills are first-line options, not second-line after
OCP failure.
Question 6
A 29-year-old woman presents with a 3-month history of cyclic breast pain and
lumpiness that worsens before menses. On examination, both breasts have
generalized nodularity without discrete masses, skin changes, or nipple discharge.
What is the most appropriate management?
A) Reassurance and symptomatic management with a well-fitted bra and
NSAIDs
B) Mammogram and breast ultrasound
C) Fine-needle aspiration of the most prominent nodule
D) Referral to breast surgeon
Rationale: Fibrocystic breast changes are benign and characterized by cyclic pain,
nodularity, and lumpiness that worsens premenstrually. In the absence of discrete
masses, skin changes, or nipple discharge, reassurance and symptomatic
, management are appropriate. Imaging is indicated if a discrete mass is palpable or
if the patient is over 40 with new symptoms.
Question 7
A 52-year-old woman reports vaginal dryness, hot flashes, and mood swings over
the past 6 months. Her last menstrual period was 14 months ago. She has no
contraindications to hormone therapy. Which is the most appropriate initial
treatment?
A) Low-dose systemic estrogen therapy with progestin if she has an intact
uterus
B) Selective serotonin reuptake inhibitor
C) Vaginal estrogen cream only
D) Calcium and vitamin D supplementation only
Rationale: This patient meets criteria for menopause (12 months of amenorrhea)
and is symptomatic with vasomotor symptoms (hot flashes) and vulvovaginal
atrophy. Systemic estrogen therapy is the most effective treatment for moderate to
severe vasomotor symptoms. Progestin is required for women with an intact uterus
to prevent endometrial hyperplasia. SSRIs are second-line for vasomotor
symptoms. Vaginal estrogen addresses only genitourinary symptoms.
Question 8
A 23-year-old woman requests emergency contraception 48 hours after
unprotected intercourse. She has a BMI of 32 kg/m². Which method is most
effective for her?
A) Levonorgestrel 1.5 mg (Plan B)
B) Ulipristal acetate 30 mg (Ella)
C) Copper intrauterine device
D) Combined oral contraceptive pills (Yuzpe method)
Rationale: The copper IUD is the most effective emergency contraception method
(over 99% effective) and can be inserted up to 5 days after unprotected intercourse.
It is not affected by BMI. Ulipristal acetate is more effective than levonorgestrel in
obese women (BMI ≥30), but the copper IUD remains the most effective option
overall. The Yuzpe method is less effective and has more side effects.
certification validating expertise in reproductive
health, wellness, and primary care.
Question 1
A 28-year-old woman presents with 6 months of irregular menstrual cycles
occurring every 35–60 days, hirsutism, and acne. Her BMI is 32 kg/m². Which
diagnostic finding would be most consistent with polycystic ovary syndrome
(PCOS)?
A) Elevated LH:FSH ratio and clinical hyperandrogenism
B) Elevated prolactin level
C) Decreased DHEA-S levels
D) Normal ovarian volume on ultrasound
Rationale: PCOS is characterized by oligo-ovulation or anovulation, clinical or
biochemical hyperandrogenism, and polycystic ovarian morphology on ultrasound.
An elevated LH:FSH ratio (>2:1) is a common laboratory finding in PCOS, though
not required for diagnosis. Prolactin elevation suggests hyperprolactinemia rather
than PCOS. DHEA-S is typically normal or mildly elevated in PCOS, not
decreased.
Question 2
A 32-year-old woman with a BMI of 34 kg/m² and a history of PCOS presents
with a chief complaint of 8 months of amenorrhea. Which medication should be
considered first-line to induce ovulation?
A) Metformin
B) Clomiphene citrate
C) Letrozole
D) Spironolactone
Rationale: Letrozole is now considered first-line for ovulation induction in PCOS
due to higher live birth rates and lower multiple pregnancy rates compared to
clomiphene citrate. While clomiphene has been used historically, recent evidence
,supports letrozole as the preferred agent. Metformin may improve ovulation but is
less effective than letrozole. Spironolactone is an anti-androgen used for hirsutism,
not ovulation induction.
Question 3
A 45-year-old woman reports heavy menstrual bleeding occurring every 21 days
with clots and flooding. She has a negative pregnancy test, normal cervical
cytology, and endometrial biopsy showing benign proliferative endometrium. Her
hemoglobin is 9.8 g/dL. Which is the most appropriate initial management?
A) Combined oral contraceptives or progestin-only therapy
B) Endometrial ablation
C) Hysterectomy
D) Observation with iron supplementation
Rationale: Abnormal uterine bleeding (AUB) in a perimenopausal woman with
benign endometrium and anemia is initially managed with medical therapy—
combined oral contraceptives or progestin-only therapy to regulate bleeding and
reduce menstrual flow. Iron supplementation should accompany treatment.
Endometrial ablation and hysterectomy are surgical options reserved for failed
medical management or when childbearing is complete.
Question 4
A 25-year-old woman presents with a 2-day history of vaginal itching, thick white
discharge, and vulvar erythema. She reports no odor. Which diagnostic test is most
appropriate?
A) Wet mount with saline and KOH preparation
B) Cervical culture for Neisseria gonorrhoeae
C) Serum β-hCG
D) Chlamydia nucleic acid amplification test
Rationale: The patient's symptoms (itching, thick white discharge, vulvar
erythema, no odor) are classic for vulvovaginal candidiasis. A wet mount with
saline and 10% KOH preparation allows visualization of yeast buds and
pseudohyphae, confirming the diagnosis. Cervical cultures and NAAT are for STI
,screening, and β-hCG is for pregnancy testing, neither of which is the primary
diagnostic test for suspected candidiasis.
Question 5
A 34-year-old woman with a history of endometriosis reports progressive
dysmenorrhea and deep dyspareunia. She has tried NSAIDs and combined oral
contraceptives with partial relief. What is the next most appropriate medical
management option?
A) GnRH agonist with add-back therapy
B) Hysterectomy
C) Laparoscopic excision of endometriosis
D) Progestin-only pill
Rationale: For patients with moderate to severe endometriosis symptoms who
have failed first-line therapies (NSAIDs, OCPs), GnRH agonists (leuprolide
acetate) induce a temporary hypoestrogenic state, reducing endometrial implant
activity. Add-back therapy (low-dose estrogen/progestin) minimizes side effects
such as bone loss. Surgery is reserved for failed medical management or for
definitive diagnosis. Progestin-only pills are first-line options, not second-line after
OCP failure.
Question 6
A 29-year-old woman presents with a 3-month history of cyclic breast pain and
lumpiness that worsens before menses. On examination, both breasts have
generalized nodularity without discrete masses, skin changes, or nipple discharge.
What is the most appropriate management?
A) Reassurance and symptomatic management with a well-fitted bra and
NSAIDs
B) Mammogram and breast ultrasound
C) Fine-needle aspiration of the most prominent nodule
D) Referral to breast surgeon
Rationale: Fibrocystic breast changes are benign and characterized by cyclic pain,
nodularity, and lumpiness that worsens premenstrually. In the absence of discrete
masses, skin changes, or nipple discharge, reassurance and symptomatic
, management are appropriate. Imaging is indicated if a discrete mass is palpable or
if the patient is over 40 with new symptoms.
Question 7
A 52-year-old woman reports vaginal dryness, hot flashes, and mood swings over
the past 6 months. Her last menstrual period was 14 months ago. She has no
contraindications to hormone therapy. Which is the most appropriate initial
treatment?
A) Low-dose systemic estrogen therapy with progestin if she has an intact
uterus
B) Selective serotonin reuptake inhibitor
C) Vaginal estrogen cream only
D) Calcium and vitamin D supplementation only
Rationale: This patient meets criteria for menopause (12 months of amenorrhea)
and is symptomatic with vasomotor symptoms (hot flashes) and vulvovaginal
atrophy. Systemic estrogen therapy is the most effective treatment for moderate to
severe vasomotor symptoms. Progestin is required for women with an intact uterus
to prevent endometrial hyperplasia. SSRIs are second-line for vasomotor
symptoms. Vaginal estrogen addresses only genitourinary symptoms.
Question 8
A 23-year-old woman requests emergency contraception 48 hours after
unprotected intercourse. She has a BMI of 32 kg/m². Which method is most
effective for her?
A) Levonorgestrel 1.5 mg (Plan B)
B) Ulipristal acetate 30 mg (Ella)
C) Copper intrauterine device
D) Combined oral contraceptive pills (Yuzpe method)
Rationale: The copper IUD is the most effective emergency contraception method
(over 99% effective) and can be inserted up to 5 days after unprotected intercourse.
It is not affected by BMI. Ulipristal acetate is more effective than levonorgestrel in
obese women (BMI ≥30), but the copper IUD remains the most effective option
overall. The Yuzpe method is less effective and has more side effects.
