Gynecologic disorders at the women's health NP level
Facts read from nccwebsite.org · last checked Nov 7, 2026
Gynecology is the largest area of the outline, 33% of the exam, and this page covers its clinical half: discharge, bleeding, pain, masses, menopause and the vulva. Method choice and infertility, the other half, are on contraception and fertility.
Practice questions
60 questions written to the WHNP-BC outline; each choice is explained once you pick.
From the guide's gynecology study list, sections I and II (guide, p. 12):
Anatomy and physiology of reproduction through the life cycle, menarche and menopause
Bartholin gland cyst or abscess, and menstrual disorders such as amenorrhea and dysmenorrhea
Vaginitis and vaginosis, and sexually transmitted infections
Pelvic pain, endometriosis and adenomyosis
Adnexal masses, abnormal uterine bleeding, cervical and endometrial polyps, and leiomyomas
Malignant disorders of the endometrium, cervix, ovary, vagina and vulva
Breast disorders, from fibroadenoma, fibrocystic change and nipple discharge to cancer, and breast augmentation or reduction
Pelvic organ prolapse, polycystic ovary syndrome, urinary incontinence, vulvar dystrophies and dermatoses, and Müllerian defects
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16 gynecology questions
0 / 16 answered16 questions
Tap an option: why each one is right or wrong appears under it.
Gynecologic disorders
A 34-year-old is diagnosed with primary ovarian insufficiency after 5 months of amenorrhea and repeatedly elevated FSH. TSH and prolactin are normal. Which additional evaluation is recommended?
Anti-ovarian antibodies are neither sensitive nor specific; the recommended autoimmune screen is adrenal (21-hydroxylase) antibodies, along with thyroid tests.
After POI is confirmed, a karyotype looks for Turner variants or Y material and FMR1 testing looks for the fragile X premutation; both change counseling and family risk.
Endometrial biopsy evaluates bleeding or hyperplasia risk; in an estrogen-deficient patient with amenorrhea it adds nothing to finding the cause.
A 32-year-old has bilateral breast tenderness and lumpiness in the week before menses that resolves with flow. Examination shows diffuse nodularity without a dominant mass. The nurse practitioner should recommend
Cyclic bilateral tenderness with diffuse nodularity and no dominant mass is fibrocystic change, managed with reassurance, a supportive bra and NSAIDs.
Danazol has androgenic side effects and is reserved for severe refractory mastalgia, not first-line care.
Diagnostic imaging is for a focal finding such as a dominant mass or nipple change; diffuse cyclic nodularity at 32 does not need it.
A 38-year-old has an incidental 3-cm intramural leiomyoma on ultrasound. Her menses are normal, she has no pressure symptoms, and her hemoglobin is normal. The nurse practitioner should recommend
Embolization is a procedure for symptomatic fibroids; treating an asymptomatic one adds risk for no benefit.
An incidental intramural fibroid without bleeding, pressure symptoms or anemia needs no treatment; fibroids often stay stable and shrink after menopause.
A GnRH antagonist with add-back treats heavy bleeding from fibroids; there are no symptoms here to justify drug therapy.
A 70-year-old reports a spraying urinary stream. The labia minora are fused in the midline by a thin, translucent line, covering most of the introitus; the vulvar skin is pale and thin without white plaques. The most appropriate initial treatment is
Surgery is kept for dense adhesions or failure of topical therapy; a thin translucent line usually separates with estrogen.
Thin labial adhesions on atrophic skin respond to topical estrogen, which is the first step before any separation procedure.
Clobetasol treats lichen sclerosus, which shows white, thinned or fissured plaques; skin that is pale and thin without white plaques points to atrophy.
A hysterosalpingogram shows two separate uterine cavities. To distinguish a septate from a bicornuate uterus, the next study should assess the
Tubal patency is already shown on HSG and does not differ between the two anomalies.
A septate uterus has a normal or minimally indented outer fundus, while a bicornuate uterus has a deep external cleft, so 3D ultrasound or MRI of the fundal contour separates them.
Cervical length matters for preterm birth risk, not for classifying a uterine anomaly.
A 40-year-old with a history of atopic dermatitis has intense vulvar itching that is worse at night. The labia majora are thickened and leathery, with exaggerated skin markings and excoriations. The most likely diagnosis is
Thick, leathery skin with exaggerated markings from chronic scratching in a patient with atopy is lichen simplex chronicus; the itch-scratch cycle is broken with a topical steroid and night-time itch control.
VIN appears as raised, often pigmented or white plaques and needs biopsy; it does not cause diffuse leathery thickening from scratching.
Lichen sclerosus makes the skin thin, white and crinkled, with loss of architecture, which is the opposite of the thickened skin here.
A 42-year-old has postcoital spotting. There is a 1-cm smooth, red, pedunculated mass protruding from the cervical os, and her screening is current and normal. The most appropriate management is
Cryotherapy treats a dysplastic transformation zone; it destroys tissue without giving a specimen for pathology.
A small smooth pedunculated cervical polyp causing postcoital spotting is removed in the office by twisting it off, and it is sent for histology because rare polyps are malignant.
Colposcopy is used for abnormal cytology; a visible symptomatic polyp is removed now, not watched.
A 55-year-old has painful, raw, glazed vulvar areas with white, lacy borders, vaginal adhesions, and white reticular lesions on the buccal mucosa. The most likely diagnosis is
Lichen sclerosus rarely involves the vagina or mouth; it causes white, thinned vulvar skin rather than lacy erosions.
Herpes causes recurrent painful ulcers that heal in 1 to 2 weeks; it does not produce lacy white borders, vaginal adhesions or oral reticular lesions.
Painful erosions with white lacy (Wickham) borders, vaginal involvement with adhesions and oral reticular lesions are the triad of erosive lichen planus; biopsy confirms it.
A 36-year-old BRCA1 carrier has completed childbearing. The most effective way to reduce her risk of ovarian cancer is
Surveillance with ultrasound and CA-125 has not lowered ovarian cancer deaths even in carriers; it is a stopgap for those deferring surgery, not prevention.
Combined pills lower ovarian cancer risk in carriers, but far less than surgery, and they cannot replace removal of the tubes and ovaries.
Removing both tubes and ovaries after childbearing, usually by age 35 to 40 in BRCA1 carriers, lowers ovarian and tubal cancer risk by about 80 % and is the most effective option.
A 43-year-old has heavy menstrual bleeding and worsening dysmenorrhea. The uterus is uniformly enlarged, boggy and tender. The most appropriate initial imaging is
Hysteroscopy views the cavity for polyps or submucosal fibroids; it cannot assess disease within the myometrium.
Transvaginal ultrasound is the first imaging test for a boggy enlarged uterus and shows adenomyosis features such as a heterogeneous myometrium and myometrial cysts.
MRI is more accurate for adenomyosis but is a second-line test when ultrasound is inconclusive or before surgery.
A 60-year-old has vulvar burning and dyspareunia. The vestibule is pale, dry and thin, vaginal rugae are lost, pH is 6.5, whiff test is negative, and wet mount shows parabasal cells. The most likely diagnosis is
Lichen sclerosus causes white, crinkled vulvar plaques and does not change vaginal pH or produce parabasal cells.
Bacterial vaginosis also raises pH, but it shows clue cells and a positive whiff test; parabasal cells and a negative whiff test point to atrophy.
Loss of rugae, pale thin tissue, a pH above 5 and parabasal cells on wet mount in a postmenopausal woman are signs of estrogen-deficient atrophy (genitourinary syndrome of menopause).
A 28-year-old who carries an FMR1 (fragile X) premutation asks about the risk to her future children. The nurse practitioner should explain that the premutation
Maternal transmission is exactly when the repeat is unstable, so assuming it passes unchanged underestimates the risk of fragile X syndrome in her children.
Paternal transmission usually passes a premutation unchanged to daughters; expansion to a full mutation happens through the mother.
FMR1 premutations are unstable when a mother passes them on, and in some of her children they expand to a full mutation; the chance rises with the number of CGG repeats.
A 20-year-old with Müllerian agenesis (MRKH syndrome) asks whether she can have genetically related children. The nurse practitioner should explain that
Dilation creates a functional vagina for intercourse but cannot create a uterus, so she cannot carry a pregnancy.
Her ovaries work, so her own oocytes can be used; MRKH rules out carrying a pregnancy, not genetic parenthood.
In MRKH syndrome the ovaries work normally, so her own oocytes can be retrieved for IVF and the embryos carried by a gestational carrier.
A 28-year-old who is not pregnant has HSIL cytology with a positive HPV 16 test, and colposcopy shows a fully visible transformation zone. The most appropriate management is
HSIL with HPV 16 at 25 or older carries an immediate CIN 3+ risk of 60 % or more, so ASCCP 2019 prefers expedited treatment, and LEEP is the excision used when the transformation zone is fully visible.
Repeat cytology alone is not an option for HSIL; the immediate risk of CIN 3 is high enough to warrant excision or, at most, close colposcopic surveillance.
Ablation requires a prior biopsy that excludes invasion and a fully visible lesion; treating HSIL without tissue risks missing cancer.
A running total sits here; it fills in after your last pick.
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Where gynecology answers slip
Trichomoniasis dosing by sex. The CDC STI Treatment Guidelines (2021) treat women with metronidazole 500 mg twice daily for 7 days; the single 2 g dose remains the regimen for men.
Retesting is not a test of cure. After treatment for chlamydia, gonorrhea or trichomoniasis, CDC recommends retesting women about 3 months later. A test of cure is kept for narrower cases, such as chlamydia in pregnancy.
The current gonorrhea and chlamydia regimens. Ceftriaxone 500 mg IM once for uncomplicated gonorrhea, and doxycycline for 7 days for chlamydia outside pregnancy (CDC 2021). Keys built on 250 mg or routine azithromycin follow the 2015 edition.
When to treat PID. CDC 2021 advises empiric treatment for a sexually active patient with pelvic or lower abdominal pain and cervical motion, uterine or adnexal tenderness when no other cause fits; waiting for test results is the wrong choice.
Who needs endometrial sampling. ACOG Practice Bulletin 128 sets age 45 and older for abnormal bleeding, and earlier with unopposed estrogen exposure or failed treatment. After menopause, a transvaginal endometrial thickness of 4 mm or less carries low cancer risk (ACOG Committee Opinion 734).
PCOS in adults. Rotterdam criteria need two of three features after mimics are excluded; the 2023 international PCOS guideline lets AMH stand in for ovarian ultrasound in adults only.
Hormone therapy. Systemic estrogen for a woman who still has her uterus requires a progestogen, and the USPSTF (2022) recommends against hormone therapy to prevent chronic disease. Low-dose vaginal estrogen for genitourinary symptoms is a different decision.
This page treats gynecologic and breast cancers at the level of recognition, work-up and referral. Treatment and its side effects are written up on AOCNP cancer treatment.
Which STI guideline should I study?
The guide's resource list names textbooks, not guideline editions (p. 16). The CDC STI Treatment Guidelines of 2021 are the current full edition as of November 2026.