Free WHNP Practice Test: 50 Questions with Answers

Answer: C. metronidazole (Flagyl) 500 mg orally twice daily for 7 days

For women, CDC's 2021 guidelines recommend metronidazole 500 mg orally twice daily for 7 days. In the trial behind that change, the 7-day course cut the share of women still testing positive at a one-month test of cure by half compared with a single 2 g dose. Test her for other STIs, including HIV, and retest her about 3 months after treatment because reinfection is common. The one-month result describes the trial, not a routine test-of-cure schedule. Current sex partners need treatment, and both patient and partners should avoid sex until treatment is complete and symptoms have resolved.

Why not A: CDC does not recommend metronidazole gel for trichomoniasis. It doesn't reach therapeutic levels in the urethra and perivaginal glands.

Why not B: A single 2 g dose is CDC's recommended regimen for men, not for women.

Takeaway: Trichomoniasis in women means 7 days of oral metronidazole, then a retest at about 3 months.

Content area: Gynecologic and Reproductive Health › Gynecologic Disorders. Sources: CDC, STI Treatment Guidelines: Trichomoniasis (Diagnostic Considerations; Treatment; Other Management Considerations; Follow-Up; Management of Sex Partners).

Answer: B. aspirin 81 mg daily starting after 12 weeks

Chronic hypertension is one of the USPSTF's high-risk factors for preeclampsia, along with a history of preeclampsia, multifetal gestation, type 1 or 2 diabetes, kidney disease, and autoimmune disease. For a person with any one of these, the USPSTF recommends low-dose aspirin, 81 mg a day, starting after 12 weeks' gestation. She is at 10 weeks, so the plan is to start once she passes 12 weeks.

Why not A: Both the dose and the timing are wrong for this recommendation. The USPSTF recommends 81 mg after 12 weeks, not 325 mg delayed until 32 weeks.

Why not C: Aspirin here is prevention. Waiting until preeclampsia appears defeats the purpose.

Takeaway: One high-risk factor, such as chronic hypertension, is enough to recommend 81 mg of aspirin after 12 weeks.

Content area: Obstetrics › Prenatal Care. Sources: USPSTF, Aspirin Use to Prevent Preeclampsia (Clinician Summary: risk factors and implementation; Effectiveness of Preventive Medication).

Answer: A. change to a levonorgestrel intrauterine device (IUD)

U.S. MEC rates combined hormonal contraception category 3 when systolic pressure is 140 to 159 mm Hg or diastolic pressure is 90 to 99 mm Hg. Category 3 means the risks usually outweigh the benefits. The levonorgestrel IUD is category 1 at these readings, so it keeps her on a highly effective method without the estrogen concern. She also needs follow-up for the elevated pressure itself.

Why not B: Staying on the pill leaves her on a category 3 method.

Why not C: The ring is also a combined estrogen-progestin method, so it carries the same category 3 rating as the pill.

Takeaway: Changing how estrogen is delivered (pill, patch, or ring) doesn't change the blood pressure category.

Content area: Primary Care › Problem Recognition, Management and Referral. Sources: CDC, U.S. MEC 2024: Summary of Classifications (Tables K1: definitions; smoking; hypertension; headaches; breastfeeding; STIs; drug interactions).

Answer: A. bacterial vaginosis

A clinical diagnosis of bacterial vaginosis (BV) by Amsel criteria needs at least three of four findings: a thin, homogeneous discharge; clue cells; vaginal pH above 4.5; and a fishy odor with KOH (the whiff test). She has all four. CDC also advises testing everyone diagnosed with BV for HIV and other STIs.

Why not B: Trichomoniasis can raise vaginal pH too, but her NAAT is negative. CDC describes NAAT as far more sensitive than a wet mount for detecting trichomonas.

Why not C: Clue cells and a positive whiff test are BV criteria. They don't point to yeast.

Takeaway: Amsel criteria: count the findings. Three of four supports BV.

Content area: Assessment, Diagnostic Testing and Interpretation › Diagnostic Studies. Sources: CDC, STI Treatment Guidelines: Trichomoniasis (Diagnostic Considerations; Treatment; Other Management Considerations; Follow-Up; Management of Sex Partners); CDC, STI Treatment Guidelines: Bacterial Vaginosis (Diagnostic Considerations; Treatment; Other Management Considerations).

Answer: C. switch to depot medroxyprogesterone acetate (DMPA) or an IUD

U.S. MEC lists rifampin as a drug interaction with hormonal contraception. It rates combined methods category 3 and the progestin-only pill category 3. DMPA, the copper IUD, and the levonorgestrel IUD are all category 1. The implant is category 2.

Why not A: Rifampin is a recognized interaction. U.S. MEC rates combined methods category 3 with rifampin.

Why not B: The progestin-only pill is also category 3 with rifampin, so switching to it doesn't solve the problem.

Takeaway: Rifampin plus pills is a problem. DMPA and IUDs are unaffected (category 1).

Content area: Pharmacology › Pharmacokinetics and Pharmacodynamics. Sources: CDC, U.S. MEC 2024: Summary of Classifications (Tables K1: definitions; smoking; hypertension; headaches; breastfeeding; STIs; drug interactions).

Answer: B. 31-year-old who smokes 10 cigarettes a day

Smoking at any amount before age 35 is category 2 for combined hormonal contraception. That means the advantages generally outweigh the risks. She should still get counseling and support to quit.

Why not A: Migraine with aura is category 4 for combined methods at any age because of ischemic stroke risk. The IUDs, implant, DMPA, and progestin-only pill are all category 1 for her.

Why not C: At age 35 or older, smoking 15 or more cigarettes a day is category 4. Fewer than 15 a day at that age would still be category 3.

Takeaway: For estrogen, remember three things: aura, age 35, and 15 cigarettes a day.

Content area: Gynecologic and Reproductive Health › Fertility Awareness and Contraception. Sources: CDC, U.S. MEC 2024: Summary of Classifications (Tables K1: definitions; smoking; hypertension; headaches; breastfeeding; STIs; drug interactions).

Answer: A. A nonreactive result can occur while the fetus is asleep, so further assessment is needed

Reactivity depends on gestational-age-appropriate fetal heart rate accelerations, not just any two rises in heart rate. A nonreactive result doesn't always mean a problem: the fetus may have been asleep, and some medicines can affect the result. It does mean more testing is needed to find out whether there is cause for concern. Some centers simply extend monitoring, for example to 40 minutes.

Why not B: A nonreactive NST alone doesn't confirm hypoxia or dictate delivery. It calls for further assessment.

Why not C: At 36 weeks, a nonreactive result should be followed up, not dismissed.

Takeaway: Nonreactive does not prove hypoxia. It's a reason for further assessment.

Content area: Obstetrics › Assessment of Fetal Well Being. Sources: MedlinePlus, Nonstress Test (What do the results mean?); Ohio State Wexner Medical Center, Nonstress Test (How is the test performed?; What do the results mean?).

Answer: B. prescribe the ring and document her informed choice

CDC's 2024 contraceptive guidance says services should be noncoercive and should support a person's own values, goals, and reproductive autonomy through shared decision-making. It stresses that people should be able to choose the method that best meets their needs. She understands the options and is eligible for the ring, so the NP prescribes it and documents the discussion.

Why not A: Withholding all contraception until she accepts a preferred method is coercive.

Why not C: Booking a procedure she has declined pressures her instead of respecting her choice.

Takeaway: Effectiveness is one input. The informed patient makes the choice.

Content area: Professional Practice Issues › Application of Professional Issues. Sources: CDC, Introduction to U.S. MEC 2024 (Noncoercive contraceptive services and reproductive autonomy).

Answer: A. A PCOS diagnosis can be made without a pelvic ultrasound

In adults, the 2023 guideline requires two of three features, after other causes are excluded:

• clinical or biochemical hyperandrogenism
• ovulatory dysfunction
• polycystic ovarian morphology, identified by ultrasound or, in adults, anti-Müllerian hormone (AMH) used within the guideline’s diagnostic algorithm

When irregular cycles and hyperandrogenism are both present, as they are here, neither ultrasound nor AMH is needed. The diagnostic algorithm includes TSH, prolactin, 17-hydroxyprogesterone, and FSH, with further evaluation when clinically indicated. Other causes have been excluded in this case.

Why not B: An LH-to-FSH ratio isn't one of the diagnostic criteria.

Why not C: Ultrasound is only one of three criteria. She already meets the other two.

Takeaway: After excluding other causes, irregular cycles plus hyperandrogenism is enough to diagnose PCOS in an adult. No ultrasound is required.

Content area: Gynecologic and Reproductive Health › Gynecologic Disorders. Sources: International Evidence-based PCOS Guideline, Diagnostic Algorithm (Algorithm 1, printed pp. 232–233 (PDF pp. 1–2)).

Answer: C. urine culture of a midstream clean-catch specimen now

The USPSTF recommends screening pregnant people for asymptomatic bacteriuria with a midstream, clean-catch urine culture. Screening should happen at the first prenatal visit or at 12 to 16 weeks, whichever is earlier. The goal is to lower the risk of kidney infection and its complications. This is the opposite of the advice for nonpregnant adults: the USPSTF recommends against screening them.

Why not A: The screening test is a urine culture, and waiting for symptoms misses the point of screening.

Why not B: Waiting for fever means waiting for a possible kidney infection, which is exactly what screening is meant to prevent.

Takeaway: Pregnant: screen with a urine culture early. Not pregnant and no symptoms: don't screen.

Content area: Obstetrics › Prenatal Care. Sources: USPSTF, Asymptomatic Bacteriuria in Adults: Screening (Clinician Summary: implementation and population).

Answer: B. measure her blood pressure outside the clinic with home or ambulatory monitoring to confirm the diagnosis

The USPSTF recommends screening adults for hypertension with an office measurement. Before medication starts, it recommends confirming the diagnosis with blood pressure readings taken outside the clinical setting. Either ambulatory monitoring or home monitoring with a validated device works.

Why not A: Starting medication before confirming the diagnosis skips the step the USPSTF recommends.

Why not C: An elevated screening reading needs confirmation now, not rescreening years later.

Takeaway: Screen in the office, confirm outside it, then decide on treatment.

Content area: Primary Care › Problem Recognition, Management and Referral. Sources: USPSTF, Hypertension in Adults: Screening (Recommendation Summary; Clinician Summary: diagnostic confirmation).

Answer: B. send a NAAT for Trichomonas vaginalis

CDC reports that wet-mount microscopy detects only 44% to 68% of trichomonas infections compared with culture. Sensitivity drops even further if the slide sits before it's read. NAATs are highly sensitive, and CDC advises using them alongside a negative wet mount whenever possible.

Why not A: A negative wet mount doesn't rule out trichomoniasis.

Why not C: Pap tests aren't diagnostic for trichomoniasis. If trichomonads show up on a Pap, CDC advises confirming with a sensitive test.

Takeaway: If the wet mount is negative but you still suspect trichomonas, send a NAAT.

Content area: Assessment, Diagnostic Testing and Interpretation › Diagnostic Studies. Sources: CDC, STI Treatment Guidelines: Trichomoniasis (Diagnostic Considerations; Treatment; Other Management Considerations; Follow-Up; Management of Sex Partners).

Answer: C. levonorgestrel IUD

U.S. MEC rates combined oral contraceptives category 3 when used with lamotrigine monotherapy. Its clarification is specific to that combination. Combined oral contraceptives can lower lamotrigine levels and impair seizure control. The levonorgestrel IUD, copper IUD, implant, DMPA, and progestin-only pill are all category 1 for this interaction.

Why not A: A lower-dose combined pill is still a combined oral contraceptive; the lamotrigine-monotherapy classification remains category 3.

Why not B: This combined pill also falls under the category-3 lamotrigine-monotherapy interaction.

Takeaway: Lamotrigine monotherapy plus a combined oral contraceptive is category 3. Do not extend the pill-specific clarification to every estrogen-containing route.

Content area: Pharmacology › Pharmacotherapeutics. Sources: CDC, U.S. MEC 2024: Summary of Classifications (Tables K1: definitions; smoking; hypertension; headaches; breastfeeding; STIs; drug interactions); CDC, U.S. MEC 2024: Combined Hormonal Contraceptives (Drug Interactions: anticonvulsant therapy, lamotrigine clarification and evidence; rifampin/rifabutin).

Answer: A. it predicts ovulation within about 24 to 36 hours

Home ovulation kits detect the rise in luteinizing hormone (LH) that signals the ovary to release an egg. A positive result means ovulation is expected in the next 24 to 36 hours, though that isn't guaranteed for everyone. The surge can also be missed, especially with irregular cycles.

Why not B: The kit predicts ovulation. It doesn't confirm that ovulation happened.

Why not C: The kit measures LH, not progesterone.

Takeaway: A positive LH kit means ovulation is likely soon. It is a prediction, not proof.

Content area: Gynecologic and Reproductive Health › Reproductive Anatomy and Physiology. Sources: MedlinePlus, Ovulation Home Test (How the Test Is Performed; Normal Results; Risks).

Answer: C. penicillin desensitization, then benzathine penicillin G 2.4 million units intramuscularly

Penicillin G is the only known effective treatment for fetal infection and for preventing congenital syphilis. CDC advises that pregnant patients who are allergic to penicillin be desensitized and then treated with penicillin G. Her allergy has already been confirmed. For secondary syphilis, the initial dose is benzathine penicillin G 2.4 million units IM; CDC says a second dose can be given 1 week later during pregnancy. Because she is past 20 weeks, CDC also advises a fetal ultrasound evaluation, but it shouldn't delay treatment. Offer HIV testing too.

Why not A: CDC says azithromycin should not be used, because it doesn't reliably cure maternal infection or treat an infected fetus.

Why not B: CDC advises avoiding doxycycline in the second and third trimesters.

Takeaway: Syphilis in pregnancy is treated with penicillin, even when the patient is allergic: desensitize first.

Content area: Obstetrics › Medical and Obstetrical Complications of Pregnancy. Sources: CDC, Syphilis During Pregnancy (Diagnostic Considerations; Treatment; Other Management Considerations; Penicillin Allergy); CDC, Primary and Secondary Syphilis (Recommended Regimen for Adults; Pregnancy).

Answer: C. starting a daily supplement containing 0.4 to 0.8 mg (400 to 800 mcg) of folic acid now

The USPSTF recommends that everyone planning or capable of pregnancy take a daily supplement with 0.4 to 0.8 mg of folic acid. This is an A-grade recommendation. The critical period starts at least 1 month before conception and continues through the first 2 to 3 months of pregnancy. The recommendation doesn't apply to people with a prior pregnancy affected by a neural tube defect, those at very high risk for other reasons, or those taking medicines that block folic acid.

Why not A: The USPSTF recommendation is for a supplement, not diet alone.

Why not B: Neural tube defects happen early, often before a person knows they're pregnant. Waiting for a positive test can miss part of the critical prevention period.

Takeaway: Start 0.4 to 0.8 mg of folic acid before conception, not after.

Content area: Primary Care › Health Screening, Education and Counseling. Sources: USPSTF, Folic Acid: Clinical Summary (Recommendation; applicability; dose and timing).

Answer: C. repeat cytology in 1 year

The 2019 ASCCP guidelines handle patients younger than 25 more conservatively than older adults. For LSIL at this age, the recommendation is repeat cytology in 1 year, not immediate colposcopy. The under-25 pathway repeats cytology at 1 and 2 years; colposcopy is recommended for a high-grade result at any time or low-grade cytology persisting at the 2-year follow-up. High-grade results include HSIL, ASC-H, AGC, and AIS. After two consecutive negative cytology results, the patient returns to routine age-based screening. Management switches to risk-based estimates on reaching age 25. ASC-US is not interchangeable with LSIL: an HPV-negative ASC-US result has a different follow-up interval.

Why not A: For LSIL under age 25, the recommendation is repeat cytology first, not immediate colposcopy.

Why not B: LEEP is an excisional treatment. It isn't indicated for a first LSIL result.

Takeaway: Under 25 with LSIL: repeat cytology in 1 year.

Content area: Gynecologic and Reproductive Health › Gynecologic Disorders. Sources: ASCCP, 2019 Risk-Based Management Consensus Guidelines (Section K.1, printed pp. 122–123; Figures 12–13).

Answer: B. an increase in plasma volume that outpaces the rise in red cell mass

In normal pregnancy, plasma volume expands more than red cell mass does. The result is dilutional, or physiologic, anemia. Red cell mass actually rises, just by less, and it is roughly 30% compared with about 50% for plasma. Iron deficiency is also common during pregnancy, so a low hemoglobin should not simply be attributed to dilution.

Why not A: Red cell mass increases in pregnancy. It doesn't fall.

Why not C: Hemolysis isn't part of normal pregnancy physiology. The change asked about is dilution: plasma volume expands more than red cell mass.

Takeaway: Physiologic anemia is dilution: plasma rises more than red cells.

Content area: Obstetrics › Anatomy and Physiology of Pregnancy. Sources: University of Utah, Maternal Physiology (Renal Changes; Hematologic Changes); NHLBI, Anemia in Pregnancy (Anemia in Pregnancy: increased blood production, iron needs and assessment).

Answer: B. G3 P1103

Count each part of GTPAL separately:

• G (gravida) counts every pregnancy, including the current one: 3.
• T (term births): 1.
• P (preterm births): 1. The twin delivery is one birth event, not two.
• A (abortions or losses): 0.
• L (living children): 3.

So her history is G3 P1103.

Why not A: G2 leaves out the current pregnancy.

Why not C: P2 counts the twins as two preterm births. A multiple gestation counts as one parous event.

Takeaway: Twins count once for G, T, and P, but each child counts for L.

Content area: Assessment, Diagnostic Testing and Interpretation › Health History and Physical Examination. Sources: Joint Commission, Previous Births (Definition; Notes for Abstraction, GTPAL terminology); Worked calculation from the values given in the question.

Answer: B. treat the infection and leave the IUD in place

U.S. MEC rates continuing an IUD category 2 when a user develops a chlamydial or gonococcal infection. The benefits generally outweigh the risks, so the IUD can stay in while the infection is treated. Starting a new IUD with current chlamydia, gonorrhea, or purulent cervicitis is a different situation, and U.S. MEC rates that category 4. For most nonpregnant adults, CDC's recommended chlamydia treatment is doxycycline 100 mg twice daily for 7 days.

Why not A: Removal isn't required to treat this cervical infection. Even when PID develops, CDC recommends treatment and close follow-up rather than automatic IUD removal; removal can be considered if there is no improvement after 48–72 hours.

Why not C: Replacing the device adds an unnecessary procedure.

Takeaway: With current chlamydia, gonorrhea, or purulent cervicitis, IUD initiation is category 4; continuing an existing IUD is category 2.

Content area: Gynecologic and Reproductive Health › Fertility Awareness and Contraception. Sources: CDC, U.S. MEC 2024: Summary of Classifications (Tables K1: definitions; smoking; hypertension; headaches; breastfeeding; STIs; drug interactions); CDC, Chlamydial Infections (Treatment; Other Management Considerations; Follow-Up); CDC, Pelvic Inflammatory Disease (Diagnostic Considerations; hospitalization criteria; IM/Oral Treatment; Follow-Up; Pregnancy; Intrauterine Devices).

Answer: A. a fasting 100-g, 3-hour oral glucose tolerance test

In the two-step approach, a positive nonfasting 50-g screen is followed by a diagnostic fasting 100-g, 3-hour oral glucose tolerance test. The one-step alternative is a single fasting 75-g, 2-hour test. The USPSTF describes both approaches; this question explicitly uses the two-step pathway.

Why not B: A1C isn't widely used to screen for or diagnose gestational diabetes.

Why not C: The 50-g challenge is a screening test. A positive result isn't a diagnosis.

Takeaway: Two-step pathway: a positive 50-g screen leads to the 100-g, 3-hour test.

Content area: Obstetrics › Medical and Obstetrical Complications of Pregnancy. Sources: USPSTF, Gestational Diabetes: Screening (Practice Considerations: screening tests; Table 2, Screening Strategies); Worked calculation from the values given in the question.

Answer: C. thyroid hormone replacement with levothyroxine

A high TSH with a low free T4 is overt primary hypothyroidism, and the standard treatment is levothyroxine. If her free T4 had been normal, a high TSH would instead mean subclinical hypothyroidism, which is often managed differently.

Why not A: Methimazole is an antithyroid drug used for hyperthyroidism. It would push her thyroid hormone levels lower.

Why not B: Watchful waiting may fit some cases of subclinical disease, but her free T4 is low. This is overt hypothyroidism.

Takeaway: High TSH with low free T4 means overt hypothyroidism. Treat with levothyroxine.

Content area: Primary Care › Problem Recognition, Management and Referral. Sources: American Thyroid Association, Hypothyroidism (Diagnosis; Treatment); American Thyroid Association, Thyroid Function Tests (TSH Tests; T4 Tests).

Answer: C. should follow the same age-based cervical cancer screening guidelines as cisgender women

For transgender men who have a cervix, screening follows the same recommendations as for cisgender women, including when to start, the interval, and when to stop. Screening should never be a requirement for getting testosterone. Offering comfort measures and explaining each step can make the exam easier.

Why not A: Testosterone doesn't remove the need for screening. What matters is whether he has a cervix.

Why not B: Eligibility depends on his anatomy and age-based guidelines, not his partner's anatomy.

Takeaway: Screen the organs that are present.

Content area: Gynecologic and Reproductive Health › Sexual and Reproductive Health for Males, LGBTQ+ and Gender Non-conforming Individuals. Sources: UCSF, Screening for Cervical Cancer in Transgender Men (Screening eligibility and relation to testosterone treatment).

Answer: C. progestin-only pill

Before 21 days postpartum, U.S. MEC rates combined hormonal contraception category 4 whether or not the patient is breastfeeding. The progestin-only pill is category 2 for a breastfeeding patient at this point, and so are the implant and DMPA.

Why not A: The combined pill is category 4 before 21 days postpartum.

Why not B: The ring is also a combined estrogen-progestin method, so it is category 4 too.

Takeaway: Under 21 days postpartum, avoid estrogen. Progestin-only methods are acceptable.

Content area: Obstetrics › Postpartum Care and Complications. Sources: CDC, U.S. MEC 2024: Summary of Classifications (Tables K1: definitions; smoking; hypertension; headaches; breastfeeding; STIs; drug interactions).

Answer: C. stage the infection and treat with the recommended penicillin regimen

When the RPR is negative but a second treponemal test is reactive, the result confirms current or past syphilis. Without a documented history of adequate treatment, CDC advises determining the stage and treating with the penicillin regimen for that stage. In pregnancy, a seropositive patient is considered infected unless adequate prior treatment is clearly documented.

Why not A: The second reactive treponemal test supports current or past infection, so the initial result should not be dismissed as a false positive. Without documented adequate treatment, she needs staging and treatment.

Why not B: Repeating only the RPR ignores a confirmed treponemal result and delays treatment.

Takeaway: Two reactive treponemal tests confirm infection, current or past. If there's no documented treatment, stage and treat.

Content area: Assessment, Diagnostic Testing and Interpretation › Diagnostic Studies. Sources: CDC, Syphilis During Pregnancy (Diagnostic Considerations; Treatment; Other Management Considerations; Penicillin Allergy).

Answer: C. ceftriaxone 500 mg intramuscularly once plus doxycycline 100 mg orally twice daily for 14 days plus metronidazole 500 mg orally twice daily for 14 days

This is CDC's 2021 recommended intramuscular and oral regimen for mild to moderate pelvic inflammatory disease (PID). Metronidazole is now part of the regimen because it covers anaerobes and also treats bacterial vaginosis, which often accompanies PID. Test for gonorrhea, chlamydia, HIV, and syphilis. If she hasn't improved within 72 hours, she needs reevaluation and IV therapy.

Why not A: A single dose of azithromycin isn't a recommended PID regimen.

Why not B: This leaves out metronidazole and uses the older 250 mg ceftriaxone dose.

Takeaway: Outpatient PID in this patient: ceftriaxone 500 mg IM once, plus doxycycline and metronidazole for 14 days.

Content area: Gynecologic and Reproductive Health › Gynecologic Disorders. Sources: CDC, Pelvic Inflammatory Disease (Diagnostic Considerations; hospitalization criteria; IM/Oral Treatment; Follow-Up; Pregnancy; Intrauterine Devices).

Answer: B. give Tdap now, during this pregnancy

CDC recommends a dose of Tdap during every pregnancy, preferably early in the window from 27 through 36 weeks. Pertussis antibody levels fall over time, so each pregnancy needs its own dose to pass the most antibodies to the baby. If Tdap is given earlier in a pregnancy, it isn't repeated later in the same pregnancy.

Why not A: CDC says postpartum Tdap is not optimal. It doesn't give the newborn protection through the mother's antibodies.

Why not C: A dose from a previous pregnancy doesn't count. Each pregnancy gets one dose.

Takeaway: Tdap in every pregnancy, ideally early in weeks 27 through 36.

Content area: Obstetrics › Prenatal Care. Sources: CDC, Vaccinating Pregnant Patients Against Pertussis (Tdap during each pregnancy; optimal timing; early vaccination).

Answer: A. add a progestin (or progesterone) to protect the uterine lining

Taking systemic estradiol without endometrial protection raises the risk of endometrial (uterine) cancer in a patient with a uterus. Adding a progestin or progesterone protects the uterine lining, so she needs it with this regimen. This question is about oral estradiol, not low-dose local vaginal estrogen.

Why not B: She has a uterus, so the proposed oral estradiol regimen needs endometrial protection.

Why not C: The progestin is there to prevent endometrial hyperplasia and cancer, not to react to bleeding after it happens.

Takeaway: With an intact uterus, oral estradiol needs endometrial protection with a progestogen.

Content area: Pharmacology › Pharmacotherapeutics. Sources: National Cancer Institute, Menopausal Hormone Therapy and Cancer (Types of menopausal hormone therapy; uterine status and systemic estrogen).

Answer: A. Menopausal transition (perimenopause); menopause is confirmed only after 12 months without a period

Natural menopause is established retrospectively after a full year, 12 months in a row, with no bleeding or spotting. At 8 months she is still in the menopausal transition. Hormone levels can rise and fall unpredictably during this time, so one FSH result can't replace the 12-month rule.

Why not B: A single FSH level doesn't establish menopause. Menopause is diagnosed by 12 consecutive months without a period.

Why not C: At 50, she is in the usual age range for this transition. The average age of menopause in the U.S. is 52.

Takeaway: Natural menopause is diagnosed looking back, after 12 months without a period and without another cause.

Content area: Gynecologic and Reproductive Health › Reproductive Anatomy and Physiology. Sources: Office on Women’s Health, Menopause Basics (Menopause definition; perimenopause; usual age).

Answer: A. a topical azole, such as clotrimazole, for 7 days

For vulvovaginal candidiasis in pregnancy, CDC recommends only topical azole therapy, applied for 7 days. CDC does not recommend oral fluconazole during pregnancy.

Why not B: A single oral fluconazole dose is a nonpregnant regimen. CDC doesn't recommend fluconazole in pregnancy.

Why not C: Two oral doses are still fluconazole, which CDC doesn't recommend in pregnancy.

Takeaway: Yeast infection in pregnancy: a topical azole for 7 days, no fluconazole.

Content area: Obstetrics › Medical and Obstetrical Complications of Pregnancy. Sources: CDC, Vulvovaginal Candidiasis (Diagnostic Considerations; treatment; Pregnancy).

Answer: B. biennial screening mammography

The USPSTF's 2024 recommendation is biennial (every 2 years) screening mammography for women aged 40 to 74, grade B. That lowered the starting age: in 2016, the decision for women in their 40s was individualized. Other organizations advise different intervals, so name the source you're applying.

Why not A: MRI isn't the average-risk screening test. The USPSTF found insufficient evidence for supplemental MRI after a negative screening mammogram, regardless of breast density.

Why not C: Since 2024, the USPSTF recommends starting at 40.

Takeaway: USPSTF: mammography every 2 years from 40 to 74.

Content area: Primary Care › Health Screening, Education and Counseling. Sources: USPSTF, Breast Cancer: Screening (Recommendation Summary; update from 2016; supplemental imaging).

Answer: A. endometriosis

Endometriosis can cause painful cramps that get worse over time, pain during or after sex, painful bowel movements or urination during periods, and difficulty getting pregnant. She has that whole cluster. A clinical diagnosis can be based on symptoms and imaging; surgery is not necessarily required before treatment. Because she has tried to conceive for more than 12 months, she also meets ASRM's timing for an infertility evaluation. Suspected endometriosis is itself a reason to begin evaluation without waiting for that interval.

Why not B: CDC notes that PID is unlikely when the cervical discharge looks normal and the wet prep shows no white blood cells, and her symptoms are chronic and cyclic.

Why not C: Ordinary period cramps don't explain pain with sex, painful bowel movements tied to her periods, and trouble conceiving.

Takeaway: Worsening cramps plus pain with sex, painful bowel movements, and infertility points to endometriosis.

Content area: Gynecologic and Reproductive Health › Gynecologic Disorders. Sources: CDC, Pelvic Inflammatory Disease (Diagnostic Considerations; hospitalization criteria; IM/Oral Treatment; Follow-Up; Pregnancy; Intrauterine Devices); WHO, Endometriosis (Symptoms; Diagnosis); ASRM, Fertility Evaluation of Infertile Women (Introduction: when to begin; Summary).

Answer: B. indicates an increased risk, and a diagnostic test such as chorionic villus sampling or amniocentesis can confirm or exclude it

cfDNA is a screening test. A positive result means the baby is more likely to have the condition, but it can't say for sure. Diagnosis needs a test such as chorionic villus sampling (CVS), which samples placental tissue, or amniocentesis, which is usually done between 15 and 20 weeks.

Why not A: cfDNA screens. It doesn't diagnose.

Why not C: A high-risk result deserves a prompt discussion of diagnostic options, not delay.

Takeaway: Screening shows risk. Diagnostic tests give the answer.

Content area: Obstetrics › Assessment of Fetal Well Being. Sources: MedlinePlus, Prenatal Cell-Free DNA Screening (What do the results mean?; diagnostic follow-up).

Answer: C. “What kinds of sex do you have: vaginal, anal, or oral?”

CDC's five Ps of a sexual history are partners, practices, protection from STIs, past history of STIs, and pregnancy intention. The practices question is what shows which body sites were exposed, and helps guide which sites to test. CDC reminds clinicians never to assume a patient's sexual orientation or gender identity, or their partners'.

Why not A: Relationship status doesn't tell you which body sites were exposed.

Why not B: Orientation doesn't tell you what kinds of sex someone has. Only asking about practices does.

Takeaway: Ask about practices to identify exposed sites and guide STI testing.

Content area: Assessment, Diagnostic Testing and Interpretation › Health History and Physical Examination. Sources: CDC, Guide to Taking a Sexual History (Five Ps; Practices).

Answer: C. start an infertility evaluation now

ASRM advises starting an infertility evaluation after 12 months of trying for women younger than 35, and after 6 months for women 35 and older. For women over 40, it advises more immediate evaluation. At 37 and 7 months, she is past the 6-month threshold. Conditions known to cause infertility justify testing without delay, and the evaluation should include both partners.

Why not A: Starting ovulation induction without an evaluation skips the workup and may miss the actual cause.

Why not B: The 12-month interval applies to women younger than 35.

Takeaway: Under 35: evaluate after 12 months. At 35 or older: after 6 months. Over 40: sooner.

Content area: Gynecologic and Reproductive Health › Fertility Awareness and Contraception. Sources: ASRM, Fertility Evaluation of Infertile Women (Introduction: when to begin; Summary).

Answer: B. a decrease in serum creatinine

Glomerular filtration rate rises by about 50% in pregnancy, and renal plasma flow rises by about 75%. Because more is filtered, BUN and serum creatinine both fall, by roughly 25%.

Why not A: Creatinine clearance goes up in pregnancy, not down.

Why not C: BUN falls in pregnancy, just as creatinine does.

Takeaway: More filtration means lower BUN and creatinine.

Content area: Obstetrics › Anatomy and Physiology of Pregnancy. Sources: University of Utah, Maternal Physiology (Renal Changes; Hematologic Changes).

Answer: B. 18 hours

Each half-life cuts the concentration in half:

• After 6 hours: 50%
• After 12 hours: 25%
• After 18 hours: 12.5%

That's three half-lives, or 18 hours.

Why not A: At 12 hours, after two half-lives, 25% remains.

Why not C: At 24 hours, after four half-lives, 6.25% remains.

Takeaway: Count halvings: 50, then 25, then 12.5 percent.

Content area: Pharmacology › Pharmacokinetics and Pharmacodynamics. Sources: Worked calculation from the values given in the question.

Answer: A. clobetasol propionate 0.05% ointment

A very strong (ultrapotent) topical steroid ointment, such as clobetasol propionate, is the most effective treatment for lichen sclerosus. Treatment usually continues long term as directed. Lichen sclerosus carries an increased risk of vulvar cancer, so regular follow-up matters.

Why not B: Fluconazole treats yeast, not lichen sclerosus.

Why not C: Topical testosterone is not the recommended first-line treatment. The recommended treatment is a strong topical corticosteroid ointment such as clobetasol.

Takeaway: Lichen sclerosus: clobetasol ointment and long-term follow-up.

Content area: Gynecologic and Reproductive Health › Gynecologic Disorders. Sources: CDC, Vulvovaginal Candidiasis (Diagnostic Considerations; treatment; Pregnancy); British Association of Dermatologists, Lichen Sclerosus in Females (How can lichen sclerosus be treated?; self-care and follow-up); ISSVD, Vulvar Lichen Sclerosus (Treatment, PDF p. 2; follow-up).

Answer: A. hospitalization for intravenous antibiotics, with specialist consultation

Pregnancy is one of CDC's criteria for hospitalizing a patient with PID. Pregnant patients with suspected PID are at high risk of maternal morbidity and preterm delivery, and CDC advises inpatient IV antibiotics in consultation with an infectious disease specialist.

Why not B: Outpatient treatment isn't appropriate in pregnancy.

Why not C: Treatment shouldn't wait. A negative cervical test doesn't rule out upper genital tract infection.

Takeaway: Suspected PID in pregnancy: admit for IV antibiotics.

Content area: Obstetrics › Medical and Obstetrical Complications of Pregnancy. Sources: CDC, Pelvic Inflammatory Disease (Diagnostic Considerations; hospitalization criteria; IM/Oral Treatment; Follow-Up; Pregnancy; Intrauterine Devices).

Answer: A. diabetes

CDC's A1C ranges are:

• below 5.7%: normal
• 5.7% to 6.4%: prediabetes
• 6.5% or higher: diabetes

The diagnosis is usually confirmed with a second test on another day, and she has two results in the diabetes range. Keep in mind that anemia, kidney failure, blood disorders, and pregnancy can affect how accurate an A1C is.

Why not B: A normal A1C is below 5.7%.

Why not C: Prediabetes is 5.7% to 6.4%. Both of her results are 6.5% or higher.

Takeaway: An A1C of 6.5% or higher, confirmed on repeat, is diabetes.

Content area: Primary Care › Problem Recognition, Management and Referral. Sources: American Diabetes Association, Diabetes Diagnosis (A1C; confirming a diagnosis); CDC, A1C Test for Diabetes and Prediabetes (A1C Results; Things That Affect A1C Accuracy).

Answer: C. start an evaluation for primary amenorrhea

Primary amenorrhea means never having had a period. ASRM’s 2024 committee opinion recommends evaluation when menstruation has not started by age 15 despite normal secondary sexual development. This patient is already 16 and developed breasts at 11, so evaluation is overdue. The assessment considers pregnancy, anatomy, and endocrine causes rather than prescribing hormones before identifying the cause.

Why not A: Starting hormones before an evaluation can mask the cause.

Why not B: Waiting until 18 delays an evaluation she already needs.

Takeaway: No first period by age 15 despite normal secondary sexual development needs evaluation.

Content area: Gynecologic and Reproductive Health › Reproductive Anatomy and Physiology. Sources: ASRM, Current Evaluation of Amenorrhea (Opening definition/evaluation indications; primary amenorrhea evaluation).

Answer: B. seek emergency medical care now

CDC lists trouble breathing and chest pain as urgent maternal warning signs. These warning signs can appear during pregnancy and at any time up to a year after delivery, and they call for immediate medical care. She should tell the clinicians who see her that she gave birth recently. The job here is urgent disposition; there's no need to diagnose the cause over the phone.

Why not A: Waiting two days with possible life-threatening symptoms is unsafe.

Why not C: A routine visit is too late for an urgent warning sign.

Takeaway: Chest pain or trouble breathing within a year of birth means get care now.

Content area: Obstetrics › Postpartum Care and Complications. Sources: CDC, Urgent Maternal Warning Signs and Symptoms (Key points; Trouble Breathing; Chest Pain or Fast-Beating Heart).

Answer: C. She cannot be considered reasonably certain not to be pregnant, even with the negative test

CDC's U.S. SPR lists history criteria that let a clinician be reasonably certain a patient isn't pregnant. If a patient meets none of them, the clinician can't be reasonably certain, even with a negative pregnancy test. A urine test can miss a very recent conception. She meets no criterion, and because she had unprotected sex 2 days ago, CDC advises considering emergency contraception. Uncertainty does not automatically prevent starting a non-IUD method: CDC permits considering quick-start contraception with a follow-up pregnancy test in 2–4 weeks when benefits outweigh risks. The start plan must account for the emergency-contraception choice; ulipristal requires special timing for hormonal contraception.

Why not A: Test accuracy depends on how recently intercourse occurred, and she had unprotected sex 2 days ago.

Why not B: CDC says routine pregnancy testing isn't necessary for every patient, and a serum test isn't a blanket requirement.

Takeaway: The history comes first. A negative urine test can't cancel out recent unprotected sex.

Content area: Assessment, Diagnostic Testing and Interpretation › Diagnostic Studies. Sources: CDC, U.S. SPR 2024: Reasonably Certain a Patient Is Not Pregnant (Box 3; negative-test limits; recent intercourse; non-IUD initiation); CDC, U.S. SPR 2024: Emergency Contraception (Timing; Use of Regular Contraception After ECPs: ulipristal acetate).

Answer: C. She should abstain from sex or use condoms consistently and correctly during treatment

CDC advises avoiding sex or using condoms consistently and correctly during BV treatment. Oral metronidazole 500 mg twice daily for 7 days is one recommended regimen. Vaginal metronidazole gel is an alternative regimen, not a required addition. She should also be tested for HIV and other STIs.

Why not A: Douching might increase the risk of relapse, and no data support using it.

Why not B: The recommended oral and vaginal regimens are alternatives. They do not have to be combined for initial treatment.

Takeaway: During BV treatment, abstain from sex or use condoms consistently and correctly. Do not douche.

Content area: Gynecologic and Reproductive Health › Gynecologic Disorders. Sources: CDC, STI Treatment Guidelines: Bacterial Vaginosis (Diagnostic Considerations; Treatment; Other Management Considerations).

Answer: B. plan Rh immune globulin now, and again after birth if the newborn is Rh-positive

An Rh-negative patient who hasn't formed antibodies gets Rh immune globulin at around 28 weeks, and again within 72 hours of birth if the baby is Rh-positive. Separate doses can be needed after sensitizing events during pregnancy, such as amniocentesis; those decisions depend on the event and gestational age.

Why not A: Routine prophylaxis at 28 weeks doesn't depend on bleeding. Bleeding is an extra reason for a dose.

Why not C: Waiting until delivery skips the routine 28-week dose.

Takeaway: Rh-negative and unsensitized: give Rh immune globulin at about 28 weeks and again after birth if needed.

Content area: Obstetrics › Prenatal Care. Sources: Rho(D) Immune Globulin Prescribing Information (Section 2.1, PDF p. 3: antepartum and postpartum dosing table).

Answer: B. 90.0%

Sensitivity is the number of true positives divided by everyone who has the condition: 90 ÷ (90 + 10) = 90.0%.

Why not A: 81.8% is the positive predictive value: 90 ÷ (90 + 20). It answers “if the test is positive, how likely is disease?”

Why not C: 97.8% is the specificity: 880 ÷ (880 + 20). It measures how well the test clears people who don't have the condition.

Takeaway: For sensitivity, divide by the people with the disease. For PPV, divide by the people with a positive test.

Content area: Professional Practice Issues › Application of Professional Issues. Sources: FDA, Statistical Guidance on Diagnostic Test Studies (Sections 3 and 7.1: sensitivity, specificity and formulas); Worked calculation from the values given in the question.

Answer: C. ceftriaxone 500 mg intramuscularly once

For uncomplicated gonorrhea of the cervix, urethra, or rectum, CDC's 2021 guidelines recommend a single dose of ceftriaxone 500 mg IM for people who weigh less than 150 kg, and 1 g for those who weigh 150 kg or more. Doxycycline is added only if chlamydia hasn't been ruled out. Here it has been.

Why not A: Azithromycin monotherapy is not recommended because resistance can develop readily and treatment failures have been documented.

Why not B: This older dual regimen is not the current recommended regimen for uncomplicated cervical gonorrhea.

Takeaway: For this nonpregnant patient under 150 kg: ceftriaxone 500 mg IM once; add doxycycline if chlamydia has not been excluded.

Content area: Gynecologic and Reproductive Health › Gynecologic Disorders. Sources: CDC, Gonococcal Infections Among Adolescents and Adults (Uncomplicated cervical/urethral/rectal infection: recommended and alternative regimens).

Answer: A. a copper IUD

A copper IUD can be placed within 5 days of the first act of unprotected intercourse as emergency contraception. CDC describes it as highly effective, and it can stay in as her regular method, which meets both of her goals. The usual IUD eligibility criteria apply.

Why not B: Levonorgestrel pills are hormonal and don't provide ongoing contraception.

Why not C: Ulipristal can be taken within 5 days, but an emergency-contraceptive pill doesn't provide the long-term contraception she wants.

Takeaway: Emergency contraception plus a long-term nonhormonal method: the copper IUD.

Content area: Gynecologic and Reproductive Health › Fertility Awareness and Contraception. Sources: CDC, U.S. SPR 2024: Emergency Contraception (Timing; Use of Regular Contraception After ECPs: ulipristal acetate).

Answer: A. class 1 obesity

BMI is weight in kilograms divided by height in meters squared: 78 ÷ (1.60 × 1.60) = 78 ÷ 2.56 = 30.46875 kg/m², or 30.5 rounded to one decimal place. CDC's adult categories are:

• overweight: 25 to less than 30
• class 1 obesity: 30 to less than 35
• class 2 obesity: 35 to less than 40

A BMI of 30.5 is class 1 obesity. BMI is a screening measure and should be considered alongside other factors.

Why not B: Class 2 obesity starts at 35.

Why not C: Overweight ends just below 30. Her BMI is 30.5.

Takeaway: Square the height in meters before you divide.

Content area: Assessment, Diagnostic Testing and Interpretation › Health History and Physical Examination. Sources: CDC, Adult BMI Categories (BMI categories for adults aged 20 and older); Worked calculation from the values given in the question.

Answer: B. start the pills no sooner than 5 days after ulipristal, using condoms or abstinence during the wait and for 7 days after starting pills (or until her next period, whichever comes first)

CDC advises starting or resuming hormonal contraception no sooner than 5 days after ulipristal, because the regular method might make ulipristal less effective. She should use condoms or abstain during the 5-day wait. After starting the pills, she should abstain or use a barrier method for 7 days or until her next period, whichever comes first. Nonhormonal methods can start right away. She should take a pregnancy test if she has no withdrawal bleed within 3 weeks.

Why not A: Starting pills the same day risks lowering ulipristal's effectiveness.

Why not C: Going without contraception leaves her unprotected. She can use condoms now and start pills after 5 days.

Takeaway: After ulipristal: use condoms or abstain while waiting 5 days to start pills, then use backup for 7 days after starting or until the next period, whichever comes first.

Content area: Pharmacology › Pharmacotherapeutics. Sources: CDC, U.S. SPR 2024: Emergency Contraception (Timing; Use of Regular Contraception After ECPs: ulipristal acetate).