AGNP BOARD EXAM QUESTIONS Womens Health Prescription (101 Questions)
Question:
Which of the following is NOT a common side effect associated with the use of
etonogestrel/ethinyl estradiol (NuvaRing), a contraceptive vaginal ring?
Vaginitis
Breast tenderness
Increased appetite
Severe headache Correct
Explanation:
A common side effect NOT associated with the use of etonogestrel/ethinyl estradiol
(NuvaRing) is severe headache. The systemic side effects of NuvaRing are the same as
with oral contraceptives. Vaginitis and local skin irritation may occur with the use of the
intravaginal ring. Danger signs of contraceptives can be remembered using the
acronym ACHES: A-Severe abdominal pain (may be indicative of hepatic tumors); C-
Severe chest pain or shortness of breath; H-Severe headaches; E-eye problems (blurred
vision, flashing lights, or blindness); S-Severe leg pain.
Question:
A common side effect associated with the use of progestin-only contraceptives is:
depression.
amenorrhea. Correct
hypertension.
edema.
Explanation:
Common side effects of progestin-only contraceptives are menstrual cycle changes
(e.g., spotting, breakthrough bleeding, prolonged cycles and eventually, amenorrhea).
Other side effects are breast tenderness, headaches, and mood changes.
Question:
The drug of choice to control mild abnormal uterine bleeding in a 25-year-old woman
with future childbearing plans is:
estrogen only.
androgen therapy
gonadotropin-releasing hormone analogs.
progesterone only. Correct
Explanation:
A combined estrogen/progesterone oral contraceptive or progesterone only would be
the treatment of choice for mild abnormal uterine bleeding in a woman of childbearing
age. Severe uterine bleeding is usually treated on an emergency basis with a short
course of high-dose estrogen therapy. Treatment with androgens would only be
indicated for short-term use for refractory bleeding.
Question:
,Nonhormonal treatments for menopausal symptoms include:
benzodiazepines.
copper intrauterine device.
selective serotonin reuptake inhibitors. Correct
antiepileptic/antiseizure medications.
Explanation:
Nonhormonal treatments for menopausal symptoms include selective serotonin
reuptake inhibitors and serotonin norepinephrine reuptake inhibitors.
Question:
In the presence of mild hyperandrogenic symptoms related to polycystic ovarian
syndrome (PCOS), the initial recommended treatment is:
norethindrone/ethinyl estradiol (Lo Loestrin). Correct
medroxyprogesterone (Provera).
ethinyl estradiol (Estinyl).
metformin (Glucophage).
Explanation:
In the presence of mild hyperandrogenic symptoms related to polycystic ovarian
syndrome (PCOS), the initial recommended treatment is a combination oral
contraceptive (i.e. norethindrone/ethinyl estradiol [Lo Loestrin]). Combined oral
contraceptive therapy modestly inhibits gonadotropin secretion and thus gonadotropin-
sensitive ovarian androgen production, and increases hepatic production of sex
hormone binding globulin (SHBG), which further decreases free testosterone.
Question:
Which of the following medications would NOT be beneficial in the treatment of pain
associated with fibrocystic breast disease?
Spironolactone (Aldactone)
Norethindrone/ethinyl estradiol (Lo Loestrin)
Danazol
Fluoxetine (Sarafem) Correct
Explanation:
Fluoxetine (Sarafem), an SSRI, is NOT recommended for the treatment of pain
associated with fibrocystic breast disease. Spironolactone, a potassium-sparing diuretic;
danazol, an androgen; and norethindrone/ethinyl estradiol, a combination oral
contraceptive, may all be used for the treatment of pain associated with fibrocystic
breast disease. Vitamin B6, vitamin E and evening primrose oil may be beneficial as
well. Bromocriptine (Parlodel) may be used for more severe disease.
Question:
The copper component of the ParaGard intrauterine device to prevent pregnancy is
thought to:
thicken the endometrium and cervical mucus.
decrease the movement of ovum through the fallopian tubes.
interfere with estrogen uptake and decrease sperm motility. Correct
suppress ovulation.
,Explanation:
The copper component in the ParaGard intrauterine device is thought to prevent
pregnancy by interfering with estrogen uptake, potentiating the local inflammatory
response, and decreasing sperm motility.
Question:
The drug of choice to control mild abnormal uterine bleeding in a teenage patient is:
estrogen only.
androgen therapy.
gonadotropin-releasing hormone analogs.
combination estrogen/progesterone. Correct
Explanation:
A combined estrogen/progesterone oral contraceptive or progesterone only would be
the treatment of choice for mild abnormal uterine bleeding in a teenager. Severe uterine
bleeding is usually treated on an emergency basis with a short course of high-dose
estrogen therapy. Treatment with androgens would only be indicated for short-term use
to manage refractory bleeding.
Question:
A benefit associated with the use of medroxyprogesterone acetate (Depo-Provera), a
progestin-only contraceptive, is:
decreased risk of pelvic inflammatory disease. Correct
decreased risk of cardiovascular risk factors.
decreased risk of weight gain.
decreased risk of osteoporosis.
Explanation:
Benefits associated with the use of medroxyprogesterone acetate (Depo-Provera), a
progestin-only contraceptive, include decreased risk of endometrial cancer and pelvic
inflammatory disease. Further benefits of Depo-Provera are decreased menstrual
cramps, reduction in heavy uterine bleeding, decreased premenstrual syndrome
symptoms, and decreased breast tenderness. Patients receiving Depo-Provera are at
increased risk for experiencing a significant decrease in bone mineral density.
Question:
Progestin-only contraceptives:
do not alter the quality or quantity of breast milk. Correct
are not safe for use in women with cardiovascular disease.
increase a patient's risk for pelvic inflammatory disease.
are contraindicated in the presence of moderate hypertension.
Explanation:
Progestin-only contraceptives do not alter the quality or quantity of breast milk in
lactating women. They may be used in women with cardiovascular risk factors. They are
also safe for use in women who have an absolute or relative contraindication to
estrogen and combined oral contraceptives, such as: age >45 years, breastfeeding,
smoking, mild to moderate hypertension, well-controlled diabetes, or history of stroke or
depression.
, Question:
Late breakthrough bleeding or amenorrhea while taking an oral contraceptive may
mean that the oral contraceptive has:
not enough estrogen.
too much estrogen.
not enough progestin. Correct
too much progestin.
Explanation:
Late breakthrough bleeding or amenorrhea while taking an oral contraceptive may
mean that the oral contraceptive has too little progestin. Progesterone, LH and FSH are
responsible for regulating endometrium shedding. If a woman is not pregnant, the
corpus luteum disappears. The primary mechanism of action of hormonal
contraceptives is that they suppress the secretion of gonadotropins (follicle-stimulating
hormone, FSH and LH) through negative feedback inhibition.
Question:
In the prevention of pregnancy, medroxyprogesterone acetate (Depo-Provera) should be
administered at least every:
4 weeks.
8 weeks.
10 weeks.
12 weeks. Correct
Explanation:
Medroxyprogesterone acetate (Depo-Provera), when used for the prevention of
pregnancy, should be administered every 12-13 weeks. It has a 13-week period of
effectiveness. Depo-Provera is classified as a progestin-only, injectable contraceptive.
Question:
Tranexamic acid (Lysteda), used in the treatment of abnormal uterine bleeding, should
not be administered concomitantly with:
nonsteroidal antiinflammatory drugs (NSAIDs).
combination hormonal contraceptives. Correct
statins.
selective serotonin reuptake inhibitors.
Explanation:
Because tranexamic acid (Lysteda) is antifibrinolytic, concomitant use of hormonal
contraception and Lysteda may further exacerbate the increased thrombotic risk
associated with combination hormonal contraceptives. For this reason, concomitant use
of Lysteda with combination hormonal contraceptives is contraindicated.
Question:
When treating hirsutism associated with polycystic ovarian syndrome, the best
treatment is:
norethindrone/ethinyl estradiol (Lo Loestrin).
liraglutide (Victoza).
metformin (Glucophage).
Question:
Which of the following is NOT a common side effect associated with the use of
etonogestrel/ethinyl estradiol (NuvaRing), a contraceptive vaginal ring?
Vaginitis
Breast tenderness
Increased appetite
Severe headache Correct
Explanation:
A common side effect NOT associated with the use of etonogestrel/ethinyl estradiol
(NuvaRing) is severe headache. The systemic side effects of NuvaRing are the same as
with oral contraceptives. Vaginitis and local skin irritation may occur with the use of the
intravaginal ring. Danger signs of contraceptives can be remembered using the
acronym ACHES: A-Severe abdominal pain (may be indicative of hepatic tumors); C-
Severe chest pain or shortness of breath; H-Severe headaches; E-eye problems (blurred
vision, flashing lights, or blindness); S-Severe leg pain.
Question:
A common side effect associated with the use of progestin-only contraceptives is:
depression.
amenorrhea. Correct
hypertension.
edema.
Explanation:
Common side effects of progestin-only contraceptives are menstrual cycle changes
(e.g., spotting, breakthrough bleeding, prolonged cycles and eventually, amenorrhea).
Other side effects are breast tenderness, headaches, and mood changes.
Question:
The drug of choice to control mild abnormal uterine bleeding in a 25-year-old woman
with future childbearing plans is:
estrogen only.
androgen therapy
gonadotropin-releasing hormone analogs.
progesterone only. Correct
Explanation:
A combined estrogen/progesterone oral contraceptive or progesterone only would be
the treatment of choice for mild abnormal uterine bleeding in a woman of childbearing
age. Severe uterine bleeding is usually treated on an emergency basis with a short
course of high-dose estrogen therapy. Treatment with androgens would only be
indicated for short-term use for refractory bleeding.
Question:
,Nonhormonal treatments for menopausal symptoms include:
benzodiazepines.
copper intrauterine device.
selective serotonin reuptake inhibitors. Correct
antiepileptic/antiseizure medications.
Explanation:
Nonhormonal treatments for menopausal symptoms include selective serotonin
reuptake inhibitors and serotonin norepinephrine reuptake inhibitors.
Question:
In the presence of mild hyperandrogenic symptoms related to polycystic ovarian
syndrome (PCOS), the initial recommended treatment is:
norethindrone/ethinyl estradiol (Lo Loestrin). Correct
medroxyprogesterone (Provera).
ethinyl estradiol (Estinyl).
metformin (Glucophage).
Explanation:
In the presence of mild hyperandrogenic symptoms related to polycystic ovarian
syndrome (PCOS), the initial recommended treatment is a combination oral
contraceptive (i.e. norethindrone/ethinyl estradiol [Lo Loestrin]). Combined oral
contraceptive therapy modestly inhibits gonadotropin secretion and thus gonadotropin-
sensitive ovarian androgen production, and increases hepatic production of sex
hormone binding globulin (SHBG), which further decreases free testosterone.
Question:
Which of the following medications would NOT be beneficial in the treatment of pain
associated with fibrocystic breast disease?
Spironolactone (Aldactone)
Norethindrone/ethinyl estradiol (Lo Loestrin)
Danazol
Fluoxetine (Sarafem) Correct
Explanation:
Fluoxetine (Sarafem), an SSRI, is NOT recommended for the treatment of pain
associated with fibrocystic breast disease. Spironolactone, a potassium-sparing diuretic;
danazol, an androgen; and norethindrone/ethinyl estradiol, a combination oral
contraceptive, may all be used for the treatment of pain associated with fibrocystic
breast disease. Vitamin B6, vitamin E and evening primrose oil may be beneficial as
well. Bromocriptine (Parlodel) may be used for more severe disease.
Question:
The copper component of the ParaGard intrauterine device to prevent pregnancy is
thought to:
thicken the endometrium and cervical mucus.
decrease the movement of ovum through the fallopian tubes.
interfere with estrogen uptake and decrease sperm motility. Correct
suppress ovulation.
,Explanation:
The copper component in the ParaGard intrauterine device is thought to prevent
pregnancy by interfering with estrogen uptake, potentiating the local inflammatory
response, and decreasing sperm motility.
Question:
The drug of choice to control mild abnormal uterine bleeding in a teenage patient is:
estrogen only.
androgen therapy.
gonadotropin-releasing hormone analogs.
combination estrogen/progesterone. Correct
Explanation:
A combined estrogen/progesterone oral contraceptive or progesterone only would be
the treatment of choice for mild abnormal uterine bleeding in a teenager. Severe uterine
bleeding is usually treated on an emergency basis with a short course of high-dose
estrogen therapy. Treatment with androgens would only be indicated for short-term use
to manage refractory bleeding.
Question:
A benefit associated with the use of medroxyprogesterone acetate (Depo-Provera), a
progestin-only contraceptive, is:
decreased risk of pelvic inflammatory disease. Correct
decreased risk of cardiovascular risk factors.
decreased risk of weight gain.
decreased risk of osteoporosis.
Explanation:
Benefits associated with the use of medroxyprogesterone acetate (Depo-Provera), a
progestin-only contraceptive, include decreased risk of endometrial cancer and pelvic
inflammatory disease. Further benefits of Depo-Provera are decreased menstrual
cramps, reduction in heavy uterine bleeding, decreased premenstrual syndrome
symptoms, and decreased breast tenderness. Patients receiving Depo-Provera are at
increased risk for experiencing a significant decrease in bone mineral density.
Question:
Progestin-only contraceptives:
do not alter the quality or quantity of breast milk. Correct
are not safe for use in women with cardiovascular disease.
increase a patient's risk for pelvic inflammatory disease.
are contraindicated in the presence of moderate hypertension.
Explanation:
Progestin-only contraceptives do not alter the quality or quantity of breast milk in
lactating women. They may be used in women with cardiovascular risk factors. They are
also safe for use in women who have an absolute or relative contraindication to
estrogen and combined oral contraceptives, such as: age >45 years, breastfeeding,
smoking, mild to moderate hypertension, well-controlled diabetes, or history of stroke or
depression.
, Question:
Late breakthrough bleeding or amenorrhea while taking an oral contraceptive may
mean that the oral contraceptive has:
not enough estrogen.
too much estrogen.
not enough progestin. Correct
too much progestin.
Explanation:
Late breakthrough bleeding or amenorrhea while taking an oral contraceptive may
mean that the oral contraceptive has too little progestin. Progesterone, LH and FSH are
responsible for regulating endometrium shedding. If a woman is not pregnant, the
corpus luteum disappears. The primary mechanism of action of hormonal
contraceptives is that they suppress the secretion of gonadotropins (follicle-stimulating
hormone, FSH and LH) through negative feedback inhibition.
Question:
In the prevention of pregnancy, medroxyprogesterone acetate (Depo-Provera) should be
administered at least every:
4 weeks.
8 weeks.
10 weeks.
12 weeks. Correct
Explanation:
Medroxyprogesterone acetate (Depo-Provera), when used for the prevention of
pregnancy, should be administered every 12-13 weeks. It has a 13-week period of
effectiveness. Depo-Provera is classified as a progestin-only, injectable contraceptive.
Question:
Tranexamic acid (Lysteda), used in the treatment of abnormal uterine bleeding, should
not be administered concomitantly with:
nonsteroidal antiinflammatory drugs (NSAIDs).
combination hormonal contraceptives. Correct
statins.
selective serotonin reuptake inhibitors.
Explanation:
Because tranexamic acid (Lysteda) is antifibrinolytic, concomitant use of hormonal
contraception and Lysteda may further exacerbate the increased thrombotic risk
associated with combination hormonal contraceptives. For this reason, concomitant use
of Lysteda with combination hormonal contraceptives is contraindicated.
Question:
When treating hirsutism associated with polycystic ovarian syndrome, the best
treatment is:
norethindrone/ethinyl estradiol (Lo Loestrin).
liraglutide (Victoza).
metformin (Glucophage).
