MCQ For Obstetric-Gynecology Part A-Sele

MCQ FOR OBSTETRIC-GYNECOLOGY
Part A- Selected 155 MCQs/ 37pp

Contents
Preconception Counseling, Genetics, and Prenatal Diagnosis ................................................................ 2
Maternal-Fetal Physiology and Placentation ........................................................................................... 3
Antepartum Care and Fetal Surveillance ................................................................................................. 5
Obstetrical Complications of Pregnancy ................................................................................................. 9
Medical and Surgical Complications of Pregnancy .............................................................................. 13
Normal and Abnormal Labor and Delivery........................................................................................... 14
The Puerperium, Lactation, and Immediate Care of the Newborn ........................................................ 18
Gynecology- Preventive Care and Health Maintenance........................................................................ 24
Benign and Malignant Disorders of the Breast and Pelvis .................................................................... 26
Infertility, Endocrinology, and Menstrual Dysfunction ........................................................................ 28
Pelvic Relaxation and Urology.............................................................................................................. 31
Human Sexuality and Contraception ..................................................................................................... 32
Sexual Abuse and Domestic Violence .................................................................................................. 36
1
Preconception Counseling, Genetics, and Prenatal Diagnosis
1/ . A 20-year-old female presents to your office for routine well-woman examination. She has a
history of acne, for which she takes minocycline and isotretinoin on a daily basis. She also has a
history of epilepsy that is well controlled on valproic acid. She also takes a combined oral
contraceptive birth control pill containing norethindrone acetate and ethinyl estradiol. She is
a nonsmoker but drinks alcohol on a daily basis. She is concerned about the effectiveness of her
birth control pill, given all the medications that she takes. She is particularly worried about the
effects of her medications on a developing fetus in the event of an unintended pregnancy.
Which of the following drugs has the lowest potential to cause birth defects?
a. Alcohol
b. Isotretinoin (Accutane)
c. Tetracyclines
d. Progesterone
e. Valproic acid (Depakote)
2/ . A patient presents for prenatal care in the second trimester. She was born outside the United
States and has never had any routine vaccinations. Which of the following vaccines is
contraindicated in pregnancy?
a. Hepatitis A
b. Tetanus
c. Typhoid
d. Hepatitis B
e. Measles
3/ . Your 25-year-old patient is pregnant at 36 weeks gestation. She has an acute urinary tract
infection (UTI). Which of the following medications is contraindicated in the treatment of the
UTI in this patient?
a. Ampicillin
b. Nitrofurantoin
c. Trimethoprim/sulfamethoxazole
d. Cephalexin
e. Amoxicillin/clavulanate
4/ . You diagnose a 21-year-old woman at 12 weeks gestation with gonorrhea cervicitis. Which of
the following is the most appropriate treatment for her infection?
a. Doxycycline
b. Chloramphenicol
c. Tetracycline
d. Minocycline
e. Ceftriaxone
5/ . A 36-year-old G0 who has been epileptic for many years is contem- plating pregnancy. She
wants to go off her phenytoin because she is concerned about the adverse effects that this
medication may have on her unborn fetus. She has not had a seizure in the past 5 years. Which
of the following is the most appropriate statement to make to the patient?
a. Babies born to epileptic mothers have an increased risk of structural anomalies even in
the absence of anticonvulsant medications.
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b. She should see her neurologist to change from phenytoin to valproic acid because
valproic acid is not associated with fetal anomalies.
c. She should discontinue her phenytoin because it is associated with a 1% to 2%
risk of spina bifida.
d. Vitamin C supplementation reduces the risk of congenital anomalies in fetuses of
epileptic women taking anticonvulsants.
e. The most frequently reported congenital anomalies in fetuses of epileptic women are limb
defects.
6/ . At 1 year of age, a child has six deciduous teeth, which are discolored and have hypoplasia of
the enamel.
Match the appropriate scenario with the antibiotic most likely responsible for the clinical
findings presented.
a. Tetracycline
b. Streptomycin
c. Nitrofurantoin
d. Chloramphenicol
e. Sulfonamides
7/ . During routine auditory testing of a 2-day-old baby, the baby failed to respond to high-pitched
tones.
Match the appropriate scenario with the antibiotic most likely responsible for the clinical
findings presented.
a. Tetracycline
b. Streptomycin
c. Nitrofurantoin
d. Chloramphenicol
e. Sulfonamides
Maternal-Fetal Physiology and Placentation
8/ . A 24-year-old primigravida with twins presents for routine ultrasonography at 20 weeks
gestation. Based on the ultrasound findings, the patient is diagnosed with dizygotic twins.
Which of the following is true regarding the membranes and placentas of dizygotic twins?
a. They are dichorionic and monoamniotic only if the fetuses are of the same sex.
b. They are dichorionic and monoamniotic regardless of the sex of the fetuses.
c. They are monochorionic and monoamniotic if they are conjoined twins.
d. They are dichorionic and diamniotic regardless of the sex of the twins.
e. They are monochorionic and diamniotic if they are of the same sex.
9/ . After delivery of a term infant with Apgar scores of 2 at 1 minute and 7 at 5 minutes, you ask
that umbilical cord blood be collected for pH. The umbilical arteries carry which of the
following?
a. Oxygenated blood to the placenta
b. Oxygenated blood from the placenta
c. Deoxygenated blood to the placenta
d. Deoxygenated blood from the placenta
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10/ . During the routine examination of the umbilical cord and placenta after a spontaneous vaginal
delivery, you notice that the baby had only one umbilical artery. Which of the following is true
regarding the finding of a single umbilical artery?
a. It is a very common finding and is insignificant.
b. It is a rare finding in singleton pregnancies and is therefore not significant.
c. It is an indicator of an increased incidence of congenital anomalies of the fetus.
d. It is equally common in newborns of diabetic and nondiabetic mothers.
e. It is present in 5% of all births.
11/ . A 22-year-old G1P0 at 28 weeks gestation by LMP presents to labor and delivery complaining
of decreased fetal movement. She has had no prenatal care. On the fetal monitor there are no
contractions. The fetal heart rate is 150 beats per minute and reactive. There are no
decelerations in the fetal heart tracing. An ultrasound is performed in the radiology department
and shows a 28-week fetus with normal-appearing anatomy and size consistent with dates. The
placenta is implanted on the posterior uterine wall and its margin is well away from the cervix.
A succenturiate lobe of the placenta is seen implanted low on the anterior wall of the uterus.
Doppler flow studies indicate a blood vessel is traversing the cervix connecting the two lobes.
This patient is most at risk for which of the following?
a. Premature rupture of the membranes
b. Fetal exsanguination after rupture of the membranes
c. Torsion of the umbilical cord caused by velamentous insertion of the umbilical cord
d. Amniotic fluid embolism
e. Placenta accreta
12/ . A healthy 34-year-old G1P0 patient comes to see you in your office for a routine OB visit at 12
weeks gestational age. She tells you that she has stopped taking her prenatal vitamins with iron
supplements because they make her sick and she has trouble remembering to take a pill every
day. A review of her prenatal labs reveals that her hematocrit is 39%. Which of the following
statements is the best way to counsel this patient?
a. Tell the patient that she does not need to take her iron supplements because her prenatal
labs indicate that she is not anemic and therefore she will not absorb the iron supplied in
prenatal vitamins
b. Tell the patient that if she consumes a diet rich in iron, she does not need to take any iron
supplements
c. Tell the patient that if she fails to take her iron supplements, her fetus will be anemic
d. Tell the patient that she needs to take the iron supplements even though she is not anemic
in order to meet the demands of pregnancy
e. Tell the patient that she needs to start retaking her iron supplements when her
hemoglobin falls below 11 g/dL
13/ . A pregnant patient of yours goes to the emergency room at 20 weeks gestational age with
complaints of hematuria and back pain. The emergency room physician orders an intravenous
pyelogram (IVP) as part of a workup for a possible kidney stone. The radiologist indicates the
absence of nephrolithiasis but reports the presence of bilateral hydronephrosis and hydroureter,
which is greater on the right side than on the left. Which of the following statements is true
regarding this IVP finding?
a. The bilateral hydronephrosis is of concern, and renal function tests, including
BUN and creatinine, should be run and closely monitored.
b. These findings are consistent with normal pregnancy and are not of concern.
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c. The bilateral hydronephrosis is of concern, and a renal sonogram should be ordered
emergently.
d. The findings indicate that a urology consult is needed to obtain recommendations for
further workup and evaluation.
e. The findings are consistent with ureteral obstruction, and the patient should be referred
for stent placement.
14/ . During a routine return OB visit, an 18-year-old G1P0 patient at 23 weeks gestational age
undergoes a urinalysis. The dipstick done by the nurse indicates the presence of trace
glucosuria. All other parameters of the urine test are normal. Which of the following is the most
likely etiology of the increased sugar detected in the urine?
a. The patient has diabetes.
b. The patient has a urine infection.
c. The patient’s urinalysis is consistent with normal pregnancy.
d. The patient’s urine sample is contaminated.
e. The patient has kidney disease.
15/ . A 33-year-old G2P1 is undergoing an elective repeat cesarean section at term. The infant is
delivered without any difficulties, but the placenta cannot be removed easily because a clear
plane between the placenta and uterine wall cannot be identified. The placenta is removed in
pieces. This is followed by uterine atony and hemorrhage.
Match the descriptions with the appropriate placenta type.
a. Succenturiate placenta
b. Vasa previa
c. Placenta previa
d. Membranaceous placenta
e. Placenta accreta
Antepartum Care and Fetal Surveillance
16/ . The shortest distance between the sacral promontory and the symphysis pubis is called which of
the following?
a. Interspinous diameter
b. True conjugate
c. Diagonal conjugate
d. Obstetric (OB) conjugate
e. Biparietal diameter
17/ . A patient presents in labor at term. Clinical pelvimetry is performed. She has an oval-shaped
pelvis with the anteroposterior diameter at the pelvic inlet greater than the transverse diameter.
The baby is occiput posterior. The patient most likely has what kind of pelvis?
a. A gynecoid pelvis
b. An android pelvis
c. An anthropoid pelvis
d. A platypelloid pelvis
e. An androgenous pelvis
18/ . On pelvic examination of a patient in labor at 34 weeks, the patient is noted to be 6 cm dilated,
completely effaced with the fetal nose and mouth palpable. The chin is pointing toward the
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maternal left hip. This is an example of which of the following?
a. Transverse lie
b. Mentum transverse position
c. Occiput transverse position
d. Brow presentation
e. Vertex presentation
19/ . A patient comes to your office with her last menstrual period 4 weeks ago. She denies any
symptoms such as nausea, fatigue, urinary frequency, or breast tenderness. She thinks that she
may be pregnant because she has not had her period yet. She is very anxious to find out because
she has a history of a previous ectopic pregnancy and wants to be sure to get early prenatal care.
Which of the following actions is most appropriate at this time?
a. No action is needed because the patient is asymptomatic, has not missed her period, and
cannot be pregnant.
b. Order a serum quantitative pregnancy test.
c. Listen for fetal heart tones by Doppler equipment.
d. Perform an abdominal ultrasound.
e. Perform a bimanual pelvic examination to assess uterine size
.
20/ . A patient presents for her first initial OB visit after performing a home pregnancy test and gives
a last menstrual period of about 8 weeks ago. She says she is not entirely sure of her dates,
however, because she has a long history of irregular menses. Which of the following is the most
accurate way of dating the pregnancy?
a. Determination of uterine size on pelvic examination
b. Quantitative serum human chorionic gonadotropin (HCG) level
c. Crown-rump length on abdominal or vaginal ultrasound
c. Determination of progesterone level along with serum HCG level
d. Quantification of a serum estradiol level
21/ . A healthy 31-year-old G3P2002 patient presents to the obstetrician’s office at 34 weeks
gestational age for a routine return visit. She has had an uneventful pregnancy to date. Her
baseline blood pressures were 100 to 110/60 to70, and she has gained a total of 20 lb so far.
During the visit, the patient complains of bilateral pedal edema that sometimes causes her feet
to ache at the end of the day. Her urine dip indicates trace protein, and her blood pressure in the
office is currently 115/75. She denies any other symptoms or complaints. On physical
examination, there is pitting edema of both legs without any calf tenderness. Which of the
following is the most appropriate response to the patient’s concern?
a. Prescribe Lasix to relieve the painful swelling.
b. Immediately send the patient to the radiology department to have venous.
Doppler studies done to rule out deep vein thromboses.
c. Admit the patient to L and D to rule out preeclampsia.
d. Reassure the patient that this is a normal finding of pregnancy and no treatment is
needed.
e. Tell the patient that her leg swelling is caused by too much salt intake and instruct her to
go on a low-sodium diet.
22/ . A 28-year-old G1P0 presents to your office at 18 weeks gestational age for an unscheduled visit
secondary to right-sided groin pain. She describes the pain as sharp and occurring with
movement and exercise. She denies any change in urinary or bowel habits. She also denies any
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fever or chills. The application of a heating pad helps alleviate the discomfort. As her
obstetrician, what should you tell this patient is the most likely etiology of this pain?
a. Round ligament pain
b. Appendicitis
c. Preterm labor
d. Kidney stone
e. Urinary tract infection
23/ . A 19-year-old G1P0 presents to her obstetrician’s office for a routine OB visit at 32 weeks
gestation. Her pregnancy has been complicated by gestational diabetes requiring insulin for
control. She has been noncompli- ant with diet and insulin therapy. She has had two prior
normal ultra- sounds at 20 and 28 weeks gestation. She has no other significant past medical or
surgical history. During the visit, her fundal height measures 38 cm. Which of the following is
the most likely explanation for the discrepancy between the fundal height and the gestational
age?
a. Fetal hydrocephaly
b. Uterine fibroids
c. Polyhydramnios
d. Breech presentation
e. Undiagnosed twin gestation
24/ . A 30-year-old G2P1001 patient comes to see you in the office at 37 weeks gestational age for
her routine OB visit. Her first pregnancy resulted in a vaginal delivery of a 9-lb 8-oz baby boy
after 30 minutes of pushing. On doing Leopold maneuvers during this office visit, you
determine that the fetus is breech. Vaginal examination demonstrates that the cervix is 50%
effaced and 1 to 2 cm dilated. The presenting breech is high out of the pelvis. The estimated
fetal weight is about 7 lb. The patient denies having any contractions. You send the patient for a
sonogram, which confirms a fetus with a double footling breech presentation. There is a normal
amount of amniotic fluid present and the head is hyperextended in the “stargazer” position.
Which of the following is the best next step in the management of this patient?
a. Allow the patient to undergo a vaginal breech delivery whenever she goes into labor.
b. Send the patient to labor and delivery immediately for an emergent cesarean section.
c. Schedule a cesarean section at or after 41 weeks gestational age.
d. Schedule an external cephalic version in the next few days.
e. Allow the patient to go into labor and do an external cephalic version at that time if the
fetus is still in the double footling breech presentation.
25/ . A 29-year-old G1P0 presents to the obstetrician’s office at 41 weeks gestation. On physical
examination, her cervix is 1 centimeter dilated, 0% effaced, firm, and posterior in position. The
vertex is presenting at –3 station. Which of the following is the best next step in the
management of this patient?
a. Send the patient to the hospital for induction of labor since she has a favorable
Bishop score.
b. Teach the patient to measure fetal kick counts and deliver her if at any time there are less
than 20 perceived fetal movements in 3 hours.
c. Order BPP testing for the same or next day.
d. Schedule the patient for induction of labor at 43 weeks gestation.
e. Schedule cesarean delivery for the following day since it is unlikely that the patient will
go into labor.
26/ . Your patient had an ultrasound examination today at 39 weeks gestation for size less than dates.
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The ultrasound showed oligohydramnios with an amniotic fluid index of 1.5 centimeters. The
patient’s cervix is unfavorable. Which of the following is the best next step in the management
of this patient?
a. Admit her to the hospital for cesarean delivery.
b. Admit her to the hospital for cervical ripening then induction of labor.
c. Write her a prescription for misoprostol to take at home orally every 4 hours until she
goes into labor.
d. Perform stripping of the fetal membranes and perform a BPP in 2 days.
e. Administer a cervical ripening agent in your office and have the patient present to the
hospital in the morning for induction with oxytocin.
27/ . An 18-year-old G2P1001 with the first day of her last menstrual period of May 7 presents for
her first OB visit at 10 weeks. What is this patient’s estimated date of delivery?
a. February 10 of the next year
b. February 14 of the next year
c. December 10 of the same year
d. December 14 of the same year
e. December 21of the same year
28/ . A new patient presents to your office for her first prenatal visit. By her last menstrual period she
is 11 weeks pregnant. This is the first pregnancy for this 36-year-old woman. She has no
medical problems. At this visit you observe that her uterus is palpable midway between the
pubic symphysis and the umbilicus. No fetal heart tones are audible with the Doppler
stethoscope. Which of the following is the best next step in the management of this patient?
a. Reassure her that fetal heart tones are not yet audible with the Doppler stethoscope at
this gestational age.
b. Tell her the uterine size is appropriate for her gestational age and schedule her for routine
ultrasonography at 20 weeks.
c. Schedule genetic amniocentesis right away because of her advanced maternal age.
d. Schedule her for a dilation and curettage because she has a molar pregnancy since her
uterus is too large and the fetal heart tones are not audible.
e. Schedule an ultrasound as soon as possible to determine the gestational age and viability
of the fetus.
29/ . A 16-year-old primigravida presents to your office at 35 weeks gestation. Her blood pressure
is 170/110 mm Hg and she has 4+ proteinuria on a clean catch specimen of urine. She has
significant swelling of her face and extremities. She denies having contractions. Her cervix is
closed and unef- faced. The baby is breech by bedside ultrasonography. She says the baby’s
movements have decreased in the past 24 hours. Which of the following is the best next step in
the management of this patient?
a. Send her to labor and delivery for a BPP.
b. Send her home with instructions to stay on strict bed rest until her swelling and blood
pressure improve.
c. Admit her to the hospital for enforced bed rest and diuretic therapy to improve her
swelling and blood pressure.
d. Admit her to the hospital for induction of labor.
e. Admit her to the hospital for cesarean delivery.
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Obstetrical Complications of Pregnancy
30/ . A 29-year-old G3P2 presents to the emergency center with complaints of abdominal
discomfort for 2 weeks. Her vital signs are: blood pressure 120/70 mm Hg, pulse 90 beats per
minute, temperature 36.94°C, respiratory rate 18 breaths per minute. A pregnancy test is
positive and an ultrasound of the abdomen and pelvis reveals a viable 16-week gestation located
behind a normal-appearing 10 × 6 × 5.5 cm uterus. Both ovaries appear normal. No free fluid is
noted. Which of the following is the most likely cause of these findings?
a. Ectopic ovarian tissue
b. Fistula between the peritoneum and uterine cavity
c. Primary peritoneal implantation of the fertilized ovum
d. Tubal abortion
e. Uterine rupture of prior cesarean section scar
31/ . A 32-year-old G2P1 at 28 weeks gestation presents to labor and delivery with the complaint of
vaginal bleeding. Her vital signs are: blood pressure 115/67 mm Hg, pulse 87 beats per minute,
temperature 37.0°C, respiratory rate 18 breaths per minute. She denies any contraction and
states that the baby is moving normally. On ultrasound the placenta is anteriorly located and
completely covers the internal cervical os. Which of the following would most increase her risk
for hysterectomy?
a. Desire for sterilization
b. Development of disseminated intravascular coagulopathy (DIC)
c. Placenta accreta
d. Prior vaginal delivery
e. Smoking
32/ . A patient at 17 weeks gestation is diagnosed as having an intrauterine fetal demise. She returns
to your office 5 weeks later and her vital signs are: blood pressure 110/72 mm Hg, pulse 93
beats per minute, temperature 36.38°C, respiratory rate 16 breaths per minute. She has not had
a miscarriage, although she has had some occasional spotting. Her cervix is closed on
examination. This patient is at increased risk for which of the following?
a. Septic abortion
b. Recurrent abortion
c. Consumptive coagulopathy with hypofibrinogenemia
d. Future infertility
e. Ectopic pregnancies
33/ . A 24-year-old presents at 30 weeks with a fundal height of 50 cm. Which of the following
statements concerning polyhydramnios is true?
a. Acute polyhydramnios rarely leads to labor prior to 28 weeks.
b. The incidence of associated malformations is approximately 3%.
c. Maternal edema, especially of the lower extremities and vulva, is rare.
d. Esophageal atresia is accompanied by polyhydramnios in nearly 10% of cases.
e. Complications include placental abruption, uterine dysfunction, and postpartum
hemorrhage.
34/ . A 20-year-old G1 at 32 weeks presents for her routine obstetric (OB) visit. She has no medical
problems. She is noted to have a blood pressure of 150/96 mm Hg, and her urine dip shows 1+
protein. She complains of a constant headache and vision changes that are not relieved with rest
or a pain reliever. The patient is sent to the hospital for further management. At the hospital, her
blood pressure is 158/98 mm Hg and she is noted to have tonic-clonic seizure. Which of the
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following is indicated in the management of this patient?
a. Low-dose aspirin
b. Dilantin (phenytoin)
c. Antihypertensive therapy
d. Magnesium sulfate
e. Cesarean delivery
35/ . A 32-year-old G5P1 presents for her first prenatal visit. A complete obstetrical, gynecological,
and medical history and physical examination is done. Which of the following would be an
indication for elective cerclage placement?
a. Three spontaneous first-trimester abortions
b. Twin pregnancy
c. Three second-trimester pregnancy losses without evidence of labor or abruption
d. History of loop electrosurgical excision procedure for cervical dysplasia
e. Cervical length of 35 mm by ultrasound at 18 weeks
36/ . Uterine bleeding at 12 weeks gestation accompanied by cervical dilation without passage of
tissue.
Match above description with the correct type of abortion.
a. Complete abortion
b. Incomplete abortion
c. Threatened abortion
d. Missed abortion
e. Inevitable abortion
37/ . Passage of some but not all placental tissue through the cervix at 9 weeks gestation.
d. Missed abortion
38/ . Fetal death at 15 weeks gestation without expulsion of any fetal or maternal tissue for at least 8
weeks.
d. Missed abortion
39/ . Uterine bleeding at 7 weeks gestation without any cervical dilation.
d. Missed abortion
40/ . Expulsion of all fetal and placental tissue from the uterine cavity at 10 weeks gestation.
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d. Missed abortion
41/ . A 20-year-old G1P0 presents to your clinic for follow-up for a suction dilation and curettage
for an incomplete abortion. She is asymptomatic without any vaginal bleeding, fever, or chills.
Her examination is normal. The pathology report reveals trophoblastic proliferation and
hydropic degenera- tion with the absence of vasculature; no fetal tissue is identified. A chest x-
ray is negative for any evidence of metastatic disease. Which of the following is the best next
step in her management?
a. Weekly human chorionic gonadotropin (hCG) titers
b. Hysterectomy
c. Single-agent chemotherapy
d. Combination chemotherapy
e. Radiation therapy
42/ . A 22-year-old G1P0 presents to your clinic for follow-up of evacuation of a complete
hydatidiform mole. She is asymptomatic and her examination is normal. Which of the following
would be an indication to start single-agent chemotherapy?
a. A rise in hCG titers
b. A plateau of hCG titers for 1 week
c. Return of hCG titer to normal at 6 weeks after evacuation
d. Appearance of liver metastasis
e. Appearance of brain metastasis
43/ . A 32-year-old female presents to the emergency department with abdominal pain and vaginal
bleeding. Her last menstrual period was 8 weeks ago and her pregnancy test is positive. On
examination she is tachycardic and hypotensive and her abdominal examination findings reveal
peritoneal signs, a bedside abdominal ultrasound shows free fluid within the abdominal cavity.
The decision is made to take the patient to the operating room for emergency exploratory
laparotomy. Which of the following is the most likely diagnosis?
a. Ruptured ectopic pregnancy
b. Hydatidiform mole
c. Incomplete abortion d. Missed abortion
e. Torsed ovarian corpus luteal cyst
44/ . A 27-year-old has just had an ectopic pregnancy. Which of the following events would be most
likely to predispose to ectopic pregnancy?
a. Previous cervical conization
b. Pelvic inflammatory disease (PID)
c. Use of a contraceptive uterine device (IUD)
d. Induction of ovulation
e. Exposure in utero to diethylstilbestrol (DES)
45/ . A 34-year-old G2P1 at 31 weeks gestation presents to labor and delivery with complaints of
vaginal bleeding earlier in the day that resolved on its own. She denies any leakage of fluid or
uterine contractions. She reports good fetal movement. In her last pregnancy, she had a low
transverse cesarean delivery for breech presentation at term. She denies any medical problems.
Her vital signs are normal and electronic external monitoring reveals a reactive fetal heart rate
tracing and no uterine contractions. Which of the following is the most appropriate next step in
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the management of this patient?
a. Send her home, since the bleeding has completely resolved and she is experiencing good
fetal movements
b. Perform a sterile digital examination
c. Perform an amniocentesis to rule out infection
d. Perform a sterile speculum examination
e. Perform an ultrasound examination
46/ . A 34-year-old G2P1 at 31 weeks gestation with a known placenta previa presents to the hospital
with vaginal bleeding. On assessment, she has normal vital signs and the fetal heart rate tracing
is 140 beats per minute with accelerations and no decelerations. No uterine contractions are
demonstrated on external tocometer. Heavy vaginal bleeding is noted. Which of the following is
the best next step in the management of this patient?
a. Administer intramuscular terbutaline
b. Administer methylergonovine
c. Admit and stabilize the patient
d. Perform cesarean delivery
e. Induce labor
47/ . A 40-year-old G2P1001 presents to your office for a routine OB visit at 30 weeks gestational
age. Her first pregnancy was delivered 10 years ago and was uncomplicated. She had a normal
vaginal delivery at 40 weeks and the baby weighed 7 lb. During this present pregnancy, she has
not had any complications, and she reports no significant medical history. She is a nonsmoker
and has gained about 25 lb to date. Despite being of advanced maternal age, she declined any
screening or diagnostic testing for Down syndrome. Her blood pressure range has been 100 to
120/60 to 70. During her examination, you note that her fundal height measures only 25 cm.
Which of the following is a likely explanation for this patient’s decreased fundal height?
a. Multiple gestation
b. Hydramnios
c. Fetal growth restriction
d. The presence of fibroid tumors in the uterus
e. Large ovarian mass
48/ . A 26-year-old G1 at 37 weeks presents to the hospital in active labor. She has no medical
problems and has a normal prenatal course except for fetal growth restriction. She undergoes an
uncomplicated vaginal delivery of a female infant weighing 1950 g. The infant is at risk for
which of the following complications?
a. Hyperglycemia
b. Fever
c. Hypertension
d. Anemia
e. Hypoxia
49/ . A 39-year-old G1P0 at 39 weeks gestational age is sent to labor and delivery from her
obstetrician’s office because of a blood pressure reading of 150/100 mm Hg obtained during a
routine OB visit. Her baseline blood pressures during the pregnancy were 100 to 120/60 to 70.
On arrival to labor and delivery, the patient denies any headache, visual changes, nausea,
vomiting, or abdominal pain. The heart rate strip is reactive and the toco- dynamometer
indicates irregular uterine contractions. The patient’s cervix is 3 cm dilated. Her repeat blood
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pressure is 160/90 mm Hg. Hematocrit is
34.0, platelets are 160,000, SGOT is 22, SGPT is 15, and urinalysis is negative for protein.
Which of the following is the most likely diagnosis?
a. Preeclampsia
b. Chronic hypertension
c. Chronic hypertension with superimposed preeclampsia
d. Eclampsia
e. Gestational hypertension
50/ . A 20-year-old G1 at 36 weeks is being monitored for preeclampsia; she rings the bell for the
nurse because she is developing a headache and feels funny. As you and the nurse enter the
room, you witness the patient undergoing a tonic-clonic seizure. You secure the patient’s
airway, and within a few minutes the seizure is over. The patient’s blood pressure monitor
indicates a pressure of 160/110 mm Hg. Which of the following medications is recommended
for the prevention of a recurrent eclamptic seizure?
a. Hydralazine
b. Magnesium sulfate
c. Labetalol
d. Pitocin
e. Nifedipine
Medical and Surgical Complications of Pregnancy
51/ . A 22-year-old G1 at 14 weeks gestation presents to your office with a history of recent exposure
to her 3-year-old nephew who had a rubella viral infection. In which time period does maternal
infection with rubella virus carry the greatest risk for congenital rubella syndrome in the fetus?
a. Preconception
b. First trimester
c. Second trimester
d. Third trimester
e. Postpartum
52/ . A 30-year-old class D diabetic is concerned about pregnancy. She can be assured that which of
the following risks is the same for her as for the general population?
a. Preeclampsia and eclampsia
b. Infection
c. Fetal cystic fibrosis
d. Postpartum hemorrhage after vaginal delivery
e. Hydramnios
53/ . A 23-year-old G1P0 reports to your office for a routine OB visit at 28 weeks gestational age.
Labs drawn at her prenatal visit 2 weeks ago reveal a 1-hour glucose test of 128, hemoglobin of
10.8, and a platelet count of 80,000. All her other labs were within normal limits. During the
present visit, the patient has a blood pressure of 120/70 mm Hg. Her urine dip is negative for
protein, glucose, and blood. The patient denies any complaints. The only medication she is
currently taking is a prenatal vitamin. She does report a history of epistaxis on occasion, but no
other bleeding. Which of the following medical treatments should you recommend to treat the
thrombocytopenia?
13
a. No treatment is necessary
b. Stop prenatal vitamins
c. Oral corticosteroid therapy
d. Intravenous immune globulin
e. Splenectomy
Normal and Abnormal Labor and Delivery
54/ . A 20-year-old G1 at 38 weeks gestation presents with regular painful contractions every 3 to 4
minutes lasting 60 seconds. On pelvic examination, she is 3 cm dilated and 90% effaced; an
amniotomy is performed and clear fluid is noted. The patient receives epidural analgesia for
pain management. The fetal heart rate tracing is reactive. One hour later on repeat
examination, her cervix is 5 cm dilated and 100% effaced. Which of the following is the best
next step in her management?
a. Begin pushing
b. Initiate Pitocin augmentation for protracted labor
c. No intervention; labor is progressing normally
d. Perform cesarean delivery for inadequate cervical effacement
e. Stop epidural infusion to enhance contractions and cervical change
55/ . A 30-year-old G2P0 at 39 weeks is admitted in active labor with spontaneous rupture of
membranes occurring 2 hours prior to admission. The patient noted clear fluid at the time. On
examination, her cervix is 4 cm dilated and completely effaced. The fetal head is at 0 station
and the fetal heart rate tracing is reactive. Two hours later on repeat examination her cervix is 5
cm dilated and the fetal head is at +1 station. Early decelerations are noted on the fetal heart rate
tracing. Which of the following is the best next step in her labor management?
a. Administer terbutaline
b. Initiate amnioinfusion
c. Initiate Pitocin augmentation
d. Perform cesarean delivery for arrest of descent
e. Perform cesarean delivery of early decelerations
56/ . A 27-year-old G2P1 at 38 weeks gestation was admitted in active labor at 4 cm dilated;
spontaneous rupture of membranes occurred prior to admission. She has had one prior
uncomplicated vaginal delivery and denies any medical problems or past surgery. She reports
an allergy to sulfa drugs. Currently, her vital signs are normal and the fetal heart rate tracing is
reactive. Her prenatal record indicates that her Group B streptococcus (GBS) culture at 36
weeks was positive. What is the recommended antibiotic for prophylaxis during labor?
a. Cefazolin
b. Clindamycin
c. Erythromycin
d. Penicillin
e. Vancomycin
57/ . A 23-year-old G1 at 38 weeks gestation presents in active labor at

6 cm dilated with ruptured membranes. On cervical examination the fetal nose, eyes, and lips
can be palpated. The fetal heart rate tracing is 140 beats per minute with accelerations and no
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decelerations. The patient’s pelvis is adequate. Which of the following is the most
appropriate management for this patient?
a. Perform immediate cesarean section without labor.
b. Allow spontaneous labor with vaginal delivery.
c. Perform forceps rotation in the second stage of labor to convert mentum posterior to
mentum anterior and to allow vaginal delivery.
d. Allow patient to labor spontaneously until complete cervical dilation is achieved and
then perform an internal podalic version with breech extraction.
e. Attempt manual conversion of the face to vertex in the second stage of labor.
58/ . A 32-year-old G3P2 at 39 weeks gestation presented to the hospital with ruptured membranes
and 4 cm dilated. She has a history of two prior vaginal deliveries, with her largest child
weighing 3800 g at birth. Over the next 2 hours she progresses to 7 cm dilated. Two hours later,
she remains 7 cm dilated. The estimated fetal weight by ultrasound is 3200 g. Which of the
following labor abnormalities best describes this patient?
a. Prolonged latent phase
b. Protracted active-phase dilation
c. Hypertonic dysfunction
d. Secondary arrest of dilation
e. Primary dysfunction
59/ . You are following a 38-year-old G2P1 at 39 weeks in labor. She has had one prior vaginal
delivery of a 3800-g infant. One week ago, the estimated fetal weight was 3200 g by
ultrasound. Over the past 3 hours her cervical examination remains unchanged at 6 cm. Fetal
heart rate tracing is reactive. An intrauterine pressure catheter (IUPC) reveals two contractions
in 10 minutes with amplitude of 40 mm Hg each. Which of the following is the best
management for this patient?
a. Ambulation
b. Sedation
c. Administration of oxytocin
d. Cesarean section
e. Expectant
60/ . A primipara is in labor and an episiotomy is about to be cut. Compared with a midline
episiotomy, which of the following is an advantage of mediolateral episiotomy?
a. Ease of repair
b. Fewer breakdowns
c. Less blood loss
d. Less dyspareunia
e. Less extension of the incision
61/ . A 27-year-old woman (G3P2) comes to the delivery floor at 37 weeks gestation. She has had no
prenatal care. She complains that, on bending down to pick up her 2-year-old child, she
experienced sudden, severe back pain that now has persisted for 2 hours. Approximately 30
minutes ago she noted bright red blood coming from her vagina. By the time she arrives at the
delivery floor, she is contracting strongly every 3 minutes; the uterus is quite firm even between
contractions. By abdominal palpation, the fetus is vertex with the head deeply engaged. Fetal
heart rate is 130 beats per minutes. The fundus is 38 cm above the symphysis. Blood for clotting
is drawn, and a clot forms in 4 minutes. Clotting studies are sent to the laboratory. Which of the
following actions can most likely wait until the patient is stabilized?
a. Stabilizing maternal circulation
b. Attaching a fetal electronic monitor
15
c. Inserting an intrauterine pressure catheter
d. Administering oxytocin
e. Preparing for cesarean section
62/ . A 24-year-old primigravid woman, at term, has been in labor for 16 hours and has been dilated
to 9 cm for 3 hours. The fetal vertex is in the right occiput posterior position, at +1 station, and
molded. There have been mild late decelerations for the past 30 minutes. Twenty minutes ago,
the fetal scalp pH was 7.27; it is now 7.20.
For above clinical description, select the most appropriate procedure.
a. External version
b. Internal version
c. Midforceps rotation
d. Low transverse cesarean section
e. Classic cesarean section
63/ . You have just delivered an infant weighing 2.5 kg (5.5 lb) at 39 weeks gestation. Because the
uterus still feels large, you do a vaginal examination. A second set of membranes is bulging
through a fully dilated cervix, and you feel a small part presenting in the sac. A fetal heart is
auscultated at 60 beats per minute.
a. External version
b. Internal version
64/ . A 24-year-old woman (G3P2) is at 40 weeks gestation. The fetus is in the transverse lie
presentation.
a. External version
b. Internal version
65/ . A nulliparous woman is in active labor (cervical dilation 5 cm with complete effacement, vertex
at 0 station); the labor curve shows protracted progression without descent following the
administration of an epidural block. An IUPC shows contractions every 4 to 5 minutes, peaking
at 40 mm Hg.
Select the most appropriate treatment for above clinical situation.
a. Epidural block
b. Meperidine (Demerol) 100 mg intramuscularly
c. Oxytocin intravenously
d. Midforceps delivery
e. Cesarean section
66/ . A nulliparous woman has had arrest of descent for the past 2 hours and arrest of dilation for the
past 3 hours. The cervix is dilated to 7 cm and the vertex is at +1 station. Monitoring shows a
normal pattern and adequate contractions. Fetal weight is estimated at 7.5 lb.
Select the most appropriate treatment for above clinical situation.
a. Epidural block
b. Meperidine (Demerol) 100 mg intramuscularly
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c. Oxytocin intravenously
d. Midforceps delivery
e. Cesarean section
67/ . Appears to lengthen the second stage of labor.
Match above description with the most appropriate type of obstetric anesthesia.
a. Paracervical block
b. Pudendal block
c. Spinal block
d. Epidural block
68/ . A 23-year-old G1 at 40 weeks gestation presents to the hospital with the complaint of
contractions. She states they are occurring every 4 to 8 minutes and each lasts approximately 1
minute. She reports good fetal movement and denies any leakage of fluid or vaginal bleeding.
The nurse places an external tocometer and fetal monitor and reports that the patient is having
contractions every 2 to 10 minutes. The nurse states that the contractions are mild to palpation.
On examination the cervix is 2 cm dilated, 50% effaced, and the vertex is at −1 station. The
patient had the same cervical examination in your office last week. The fetal heart rate tracing
isn140 beats per minute with accelerations and no decelerations. Which of the following stages
of labor is this patient in?
a. Active labor
b. Latent labor
c. False labor
d. Stage 1 of labor
e. Stage 2 of labor
69/ . A 28-year-old G1 at 38 weeks had a normal progression of her labor. She has an epidural and
has been pushing for 2 hours. The fetal head is direct occiput anterior at +3 station. The fetal
heart rate tracing is 150 beats per minute with variable decelerations. With the patient’s last
push the fetal heart rate had a prolonged deceleration to the 80s for 3 minutes. You recommend
forceps to assist the delivery owing to the nonreassuring fetal heart rate tracing. Compared to
the use of the vacuum extractor, forceps are associated with an increased risk of which of the
following neonatal complications?
a. Cephalohematoma
b. Retinal hemorrhage
c. Jaundice
d. Intracranial hemorrhage
e. Corneal abrasions
70/ . You performed a forceps-assisted vaginal delivery on a 20-year-old G1 at 40 weeks for
maternal exhaustion. The patient had pushed for 3 hours with an epidural for pain management.
A second-degree episiotomy was cut to facilitate delivery. Eight hours after delivery, you are
called to see the patient because she is unable to void and complains of severe pain. On
examination you note a large fluctuant purple mass inside the vagina. What is the best
management for this patient?
a. Apply an ice pack to the perineum
b. Embolize the internal iliac artery
c. Incision and evacuation of the hematoma
d. Perform dilation and curettage to remove retained placenta
e. Place a vaginal pack for 24 hours
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71/ . A 20-year-old G1 at 41 weeks has been pushing for 21/2 hours. The fetal head is at the introitus
and beginning to crown. It is necessary to cut an episiotomy. The tear extends through the
sphincter of the rectum, but the rectal mucosa is intact. How should you classify this type of
episiotomy?
a. First-degree
b. Second-degree
c. Third-degree
d. Fourth-degree
e. Mediolateral episiotomy
72/ . A 25-year-old G1P0 patient at 41 weeks presents to labor and delivery complaining of gross
rupture of membranes and painful uterine contractions every 2 to 3 minutes. On digital
examination, her cervix is 3 cm dilated and completely effaced with fetal feet palpable through
the cervix. The estimated weight of the fetus is about 6 lb, and the fetal heart rate tracing is
reactive. Which of the following is the best method to achieve delivery?
a. Deliver the fetus vaginally by breech extraction
b. Deliver the baby vaginally after external cephalic version
c. Perform an emergent cesarean section
d. Perform an internal podalic version
e. Perform a forceps-assisted vaginal delivery
73/ . A 25-year-old G1 at 37 weeks presents to labor and delivery with gross rupture of membranes.
The fluid is noted to be clear and the patient is noted to have regular painful contractions every
2 to 3 minutes lasting for 60 seconds each. The fetal heart rate tracing is reactive. On cervical
examination she is noted to be 4 cm dilated, 90% effaced with the presenting part a −3 station.
The presenting part is soft and felt to be the fetal buttock. A quick bedside ultrasound reveals a
breech presentation with both hips flexed and knees extended. What type of breech
presentation is described?
a. Frank
b. Incomplete, single footling
c. Complete
d. Double footling
The Puerperium, Lactation, and Immediate Care of the Newborn
74/ . On postoperative day 3 after an uncomplicated repeat cesarean delivery, the patient develops a
fever of 38.2°C (100.8°F). She has no complaints except for some fullness in her breasts. On
examination she appears in no distress; lung and cardiac examinations are normal. Her breast
examination reveals full, firm breasts bilaterally slightly tender with no erythema or masses.
She is not breast-feeding. The abdomen is soft with firm, nontender fundus at the umbilicus.
The lochia appears normal and is non- odorous. Urinalysis and white blood cell count are
normal. Which of the following is a characteristic of the cause of her puerperal fever?
a. Appears in less than 5% of postpartum women
b. Appears 3 to 4 days after the development of lacteal secretion
c. Is almost always painless
d. Fever rarely exceeds 37.8°C (99.8°F)
e. Is less severe and less common if lactation is suppressed
75/ . A 38-year-old G3P3 begins to breast-feed her 5-day-old infant. The baby latches on
appropriately and begins to suckle. In the mother, which of the following is a response to
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suckling?
a. Decrease of oxytocin
b. Increase of prolactin-inhibiting factor
c. Increase of hypothalamic dopamine
d. Increase of hypothalamic prolactin
e. Increase of luteinizing hormone—releasing factor
76/ . A 24-year-old G1P1 presents for her routine postpartum visit 6 weeks after an uncomplicated
vaginal delivery. She states that she is having problems sleeping and is feeling depressed over
the past 2 to 3 weeks. She reveals that she cries on most days and feels anxious about taking
care of her newborn son. She denies any weight loss or gain, but states she doesn’t feel like
eating or doing any of her normal activities. She denies suicidal or homicidal ideation. Which of
the following is true regarding this patient’s condition?
a. A history of depression is not a risk factor for developing postpartum depression.
b. Prenatal preventive intervention for patients at high risk for postpartum depression is
best managed alone by a mental health professional.
c. Young, multiparous patients are at highest risk.
d. Postpartum depression is a self-limiting process that lasts for a maximum of 3 months.
e. About 8% to 15% of women develop postpartum depression.
77/ . A 21-year-old G1 at 40 weeks, who underwent induction of labor for severe preeclampsia,
delivered a 3900-g male infant via vaginal delivery after pushing for 21/2 hours. A second-
degree midline laceration and side- wall laceration were repaired in the usual fashion under
local analgesia. The estimated blood loss was 450 cc. Magnesium sulfate is continued post-
partum for the seizure prophylaxis. Six hours after the delivery, the patient has difficulty
voiding. Which is the most likely cause of her problem?
a. Preeclampsia
b. Infusion of magnesium sulfate
c. Vulvar hematoma
d. Ureteral injury
e. Use of local analgesia for repair
78/ . A 32-year-old G2P2 develops fever and uterine tenderness 2 days after cesarean delivery for
nonreassuring fetal heart tones. She is placed on intravenous penicillin and gentamicin for her
infection. After 48 hours of antibiotics she remains febrile, and on examination she continues to
have uterine tenderness. Which of the following bacteria is resistant to these antibiotics and is
most likely to be responsible for this woman’s infection?
a. Proteus mirabilis
b. Bacteroides fragilis
c. Escherichia coli
d. α-Streptococci
e. Anaerobic streptococci
79/ . A 21-year-old G2P2 calls her physician 7 days postpartum because she is concerned that she is
still bleeding from the vagina. She describes the bleeding as light pink to bright red and less
heavy than the first few days postdelivery. She denies fever or any cramping pain. On
examination she is afebrile and has an appropriately sized, nontender uterus. The vagina con-
tains about 10 cc of old, dark blood. The cervix is closed. Which of the following is the most
19
appropriate treatment?
a. Antibiotics for endometritis
b. High-dose oral estrogen for placental subinvolution
c. Oxytocin for uterine atony
d. Suction dilation and curettage for retained placenta
e. Reassurance
80/ . A 28-year-old G2P2 presents to the hospital 2 weeks after vaginal delivery with the complaint
of heavy vaginal bleeding that soaks a sanitary napkin every hour. Her pulse is 89 beats per
minute, blood pressure 120/76 mm Hg, and temperature 37.1°C (98.9°F). Her abdomen is non-
tender and her fundus is located above the symphysis pubis. On pelvic examination, her vagina
contained small blood clots and no active bleeding is noted from the cervix. Her uterus is about
12 to 14 weeks size and nontender. Her cervix is closed. An ultrasound reveals an 8-mm
endometrial stripe. Her hemoglobin is 10.9, unchanged from the one at her vaginal delivery. β-
hCG is negative. Which of the following potential treatments would be contraindicated?
a. Methylergonovine maleate (Methergine)
b. Oxytocin injection (Pitocin)
c. Ergonovine maleate (Ergotrate)
d. Prostaglandins
e. Dilation and curettage
81/ . A 22-year-old G1P0 has just undergone a spontaneous vaginal delivery. As the placenta is being
delivered, a red fleshy mass is noted to be protruding out from behind the placenta. Which of
the following is the best next step in management of this patient?
a. Begin intravenous oxytocin infusion
b. Call for immediate assistance from other medical personnel
c. Continue to remove the placenta manually
d. Have the anesthesiologist administer magnesium sulfate
e. Shove the placenta back into the uterus
82/ . Following a vaginal delivery, a woman develops a fever, lower abdominal pain, and uterine
tenderness. She is alert, and her blood pressure and urine output are good. Large gram-positive
rods suggestive of clostridia are seen in a smear of the cervix. Which of the following is most
closely tied to a decision to proceed with hysterectomy?
a. Close observation for renal failure or hemolysis
b. Immediate radiographic examination for hydrosalpinx
c. High-dose antibiotic therapy
d. Fever of 103°F
e. Gas gangrene
83/ . Three days ago you delivered a 40-year-old G1P1 by cesarean section following arrest of
descent after 2 hours of pushing. Labor was also significant for prolonged rupture of
membranes. The patient had an epidural, which was removed the day following delivery. The
nurse pages you to come to see the patient on the postpartum floor because she has a fever of
38.8°C (102°F) and is experiencing shaking chills. Her blood pressure is 120/70 mm Hg and her
pulse is 120 beats per minute. She has been eating a regular diet without difficulty and had a
normal bowel movement this morning. She is attempting to breast-feed, but says her milk has
not come in yet. On physical examination, her breasts are mildly engorged and tender
bilaterally. Her lungs are clear. Her abdomen is tender over the fundus, but no rebound is
present. Her incision has some serous drainage at the right apex, but no erythema is noted. Her
pelvic examination reveals uterine tenderness but no masses. Which of the following is the most
likely diagnosis?
20
a. Pelvic abscess
b. Septic pelvic thrombophlebitis
c. Wound infection
d. Endometritis
e. Atelectasis
84/ . You are doing postpartum rounds on a 23-year-old G1P1 who is postpartum day 2 after an
uncomplicated vaginal delivery. As you walk in the room, you note that she is crying. She states
she can’t seem to help it. She denies feeling sad or anxious. She has not been sleeping well
because of getting up every 2 to 3 hours to breast-feed her new baby. Her past medical history is
unremarkable. Which of the following is the most appropriate treatment recommendation?
a. Time and reassurance, because this condition is self-limited
b. Referral to psychiatry for counseling and antidepressant therapy
c. Referral to psychiatry for admission to a psychiatry ward and therapy with Haldol
d. A sleep aid
e. Referral to a psychiatrist who can administer electroconvulsive therapy
85/ . A 20-year-old G1P1 is postpartum day 2 after an uncomplicated vaginal delivery of a 6-lb 10-
oz baby boy. She is trying to decide whether to have you perform a circumcision on her
newborn. The boy is in the well- baby nursery and is doing very well. In counseling this patient,
you tell her which of the following recommendations from the American Pediatric
Association?
a. Circumcisions should be performed routinely because they decrease the incidence of
male urinary tract infections.
b. Circumcisions should be performed routinely because they decrease the incidence of
penile cancer.
c. Circumcisions should be performed routinely because they decrease the incidence of
sexually transmitted diseases.
d. Circumcisions should not be performed routinely because of insufficient data regarding
risks and benefits.
e. Circumcisions should not be performed routinely because it is a risky procedure and
complications such as bleeding and infection are common.
86/ . You are counseling a new mother and father on the risks and benefits of circumcision for their
1-day-old son. The parents ask if you will use analgesia during the circumcision. What do you
tell them regarding the recommendations for administering pain medicine for circumcisions?
a. Analgesia is not recommended because there is no evidence that newborns undergoing
circumcision experience pain.
b. Analgesia is not recommended because it is unsafe in newborns.
c. Analgesia in the form of oral Tylenol is the pain medicine of choice recommended for
circumcisions.
d. Analgesia in the form of a penile block is recommended.
e. The administration of sugar orally during the procedure will keep the neonate
preoccupied and happy.
87/ . You are asked to assist in the well-born nursery with neonatal care. Which of the following is a
part of routine care in a healthy infant?
a. Administration of ceftriaxone cream to the eyes for prophylaxis for gonorrhea and
chlamydia
b. Administration of vitamin A to prevent bleeding problems
21
c. Administration of hepatitis B vaccination for routine immunization
d. Cool-water bath to remove vernix
e. Placement of a computer chip in left buttock for identification purposes
88/ . You are making rounds on a 29-year-old G1P1 who underwent an uncomplicated vaginal
delivery at term on the previous day. The patient is still very confused about whether she wants
to breast-feed. She is a very busy lawyer and is planning on going back to work in 4 weeks, and
she does not think that she has the time and dedication that breast-feeding requires. She asks
you what you think is best for her to do. Which of the following is an accurate statement
regarding breast-feeding?
a. Breast-feeding decreases the time to return of normal menstrual cycles.
b. Breast-feeding is associated with a decreased incidence of sudden infant death syndrome.
c. Breast-feeding is a poor source of nutrients for required infant growth.
d. Breast-feeding is associated with an increased incidence of childhood obesity.
e. Breast-feeding is associated with a decreased incidence of childhood attention deficit
disorder.
89/ . A 22-year-old G1P1 who is postpartum day 2 and is bottle-feeding complains that her breasts
are very engorged and tender. She wants you to give her something to make the engorgement go
away. Which of the following is recommended to relieve her symptoms?
a. Breast binder
b. Bromocriptine
c. Estrogen-containing contraceptive pills
d. Pump her breasts
e. Use oral antibiotics
90/ . A 36-year-old G1P1 comes to see you for a routine postpartum examination 6 weeks after an
uncomplicated vaginal delivery. She is currently nursing her baby without any major problems
and wants to continue to do so for at least 9 months. She is ready to resume sexual activity and
wants to know what her options are for birth control. She does not have any medical problems.
She is a nonsmoker and is not taking any medications except for her prenatal vitamins. Which
of the following methods may decrease her milk supply?
a. Intrauterine device
b. Progestin only pill
c. Depo-Provera
d. Combination oral contraceptives
e. Foam and condoms
91/ . A 30-year-old G3P3, who is 8 weeks postpartum and regularly breast-feeding calls you and is
very concerned because she is having pain with intercourse secondary to vaginal dryness.
Which of the following should you recommend to help her with this problem?
a. Instruct her to stop breast-feeding
b. Apply hydrocortisone cream to the perineum
c. Apply testosterone cream to the vulva and vagina
d. Apply estrogen cream to the vagina and vulva
e. Apply petroleum jelly to the perineum
92/ . A 25-year-old G1P1 comes to see you 6 weeks after an uncomplicated vaginal delivery for a
routine postpartum examination. She denies any problems and has been breast-feeding her
newborn without any difficulties since leaving the hospital. During the bimanual examination,
you note that her uterus is irregular, firm, nontender, and about a 15-week size. Which of the
following is the most likely etiology for this enlarged uterus?
a. Subinvolution of the uterus
22
b. The uterus is appropriate size for 6 weeks postpartum
c. Fibroid uterus
d. Adenomyosis
e. Endometritis
93/ . A 39-year-old G3P3 comes to see you on day 5 after a second repeat cesarean delivery. She is
concerned because her incision has become very red and tender and pus started draining from a
small opening in the incision this morning. She has been experiencing general malaise and
reports a fever of 38.8°C (102°F). Physical examination indicates that the Pfan- nenstiel
incision is indeed erythematous and is open about 1 cm at the left corner, and is draining a small
amount of purulent liquid. There is tenderness along the wound edges. Which of the following
is the best next step in the management of this patient?
a. Apply Steri-Strips to close the wound
b. Administer antifungal medication
c. Probe the fascia
d. Take the patient to the OR for debridement and closure of the skin
e. Reapproximate the wound edge under local analgesia
94/ . A 30-year-old G3P3 is postoperative day 4 after a repeat cesarean delivery. During the surgery
she received 2 units of packed red blood cells for a hemorrhage related to uterine atony. She is
to be discharged home today. She complains of some yellowish drainage from her incision and
redness that just started earlier in the day. She states that she feels feverish. She is breast-
feeding. Her past medical history is significant for type 2 diabetes mellitus and chronic
hypertension. She weighs 110 kg. Her vital signs are temperature 37.8°C (100.1°F), pulse 69
beats per minute, respiratory rate 18 breaths per minute, and blood pressure is 143/92 mm Hg.
Breast, lung, and cardiac examinations are normal. Her midline vertical skin incision is
erythematous and has a foul-smelling purulent discharge from the lower segment of the wound.
It is tender to touch. The uterine fundus is not tender. Which of the following is not a risk factor
for her condition?
a. Diabetes
b. Corticosteroid therapy
c. Preoperative antibiotic administration
d. Anemia
e. Obesity
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Gynecology- Preventive Care and Health Maintenance
95/ . You are following up on the results of routine testing of a 68-year-old G4P3 for her well-
woman examination. Her physical examination was normal for a postmenopausal woman. Her
Pap smear revealed parabasal cells, her mammogram was normal, lipid profile was normal, and
the urinalysis shows hematuria. Which of the following is the most appropriate next step in the
a. Colposcopy
b. Endometrial biopsy
c. Renal sonogram
d. Urine culture
e. No further treatment/evaluation is necessary if the patient is asymptomatic.
96/ . A 74-year-old woman presents to your office for well-woman examination. Her last Pap smear
and mammogram were 3 years ago. She has hypertension, high cholesterol, and osteoarthritis.
She stopped smoking 15 years ago, and denies alcohol use. Based on this patient’s history
which of the following medical conditions should be this patient’s biggest concern?
a. Alzheimer disease
b. Breast cancer
c. Cerebrovascular disease
d. Heart disease
e. Lung cancer
97/ . A 17-year-old G1P1 presents to your office for her yearly well- woman examination. She
had an uncomplicated vaginal delivery last year. She has been sexually active for the past 4
years and has had six different sexual partners. Her menses occurs every 28 days and lasts for 4
days. She denies any intermenstrual spotting, postcoital bleeding, or vaginal discharge. She
denies tobacco, alcohol, or illicit drug use. Which of the following are appropriate screening
tests for this patient?
a. Pap test
b. Pap test and gonorrhea and chlamydia cervical cultures
c. Pap test and herpes simplex cultures
d. Pap test and hemoglobin level assessment
e. Pap test and hepatitis C antibody
98/ . A 26-year-old woman presents to your office for her well-woman examination. She denies any
medical problems or prior surgeries. She states that her cycles are monthly. She is sexually
active and uses oral contraceptive pills for birth control. Her physical examination is normal.
As part of preventive health maintenance, you recommend breast self-examination and instruct
the patient how to do it. Which of the following is the best frequency and time to perform
breast self-examinations?
a. Monthly, in the week prior to the start of the menses
b. Monthly, in the week after cessation of menses
c. Monthly, during the menses
d. Every 3 months, in the week prior to the start of the menses
e. Every 6 months, in the week prior to the start of the menses
99/ . A married 41-year-old G5P3114 presents to your office for a routine examination. She reports
24
being healthy except for a history of migraine headaches. All her Pap smears have been normal.
She developed gestational diabetes in her last pregnancy. She drinks alcohol socially, and
admits to smoking occasionally. Her grandmother was diagnosed with ovarian cancer when she
was in her fifties. Her blood pressure is 140/90 mm Hg; height is 5 ft 5 in; weight is 150 lb.
Which of the following is the most common cause of death in women of this patient’s age?
a. HIV
b. Cardiac disease
c. Accidents
d. Suicide
e. Cancer
100/ . A 36-year-old G2P2 presents for her well-woman examination. She has had two spontaneous
vaginal deliveries without complications. Her largest child weighed 3500 g at birth. She uses
oral contraceptive pills and denies any history of an abnormal Pap smear. She does not smoke,
but drinks about four times per week. Her weight is 70 kg. Her vital signs are normal. After
placement of the speculum, you note a clear cyst approximately 2.5 cm in size on the lateral
wall of the vagina on the right side. The cyst is nontender and does not cause the patient any
dyspareunia or discomfort. Which of the following is the most likely diagnosis of this mass?
a. Bartholin duct cyst
b. Gartner duct cyst
c. Lipoma
d. Hematoma
e. Inclusion cyst
101/ . A 50-year-old G4P4 presents for her well-woman examination. She had one cesarean delivery
followed by three vaginal deliveries. Her menses stopped 1 year ago and she occasionally still
has a hot flash. She tells you that about 10 years ago she was treated with a laser conization for
carcinoma in situ of her cervix. Since that time, all of her Pap tests have been normal. What
recommendation should you make regarding how frequently she should undergo Pap smear
testing?
a. Every 3 months
b. Every 6 months
c. Every year
d. Every 2 years
e. Every 3 years
102/ . A 45-year-old G3P3 presents for her yearly examination. She last saw a doctor 7 years ago
after she had her last child. She had three vaginal deliveries, the last of which was complicated
by gestational diabetes and preeclampsia. She has not been sexually active in the past year. She
once had an abnormal Pap smear for which she underwent cryotherapy. She denies any medical
problems. Her family history is significant for coronary artery disease in her dad and a maternal
aunt who developed ovarian cancer at the age of 67. Which of the following is best screening
approach for this patient?
a. Pap smear
b. Pap smear and mammography
c. Pap smear, mammography, and cholesterol profile
d. Pap smear, mammography, cholesterol profile, and fasting blood sugar
e. Pap smear, mammography, cholesterol profile, fasting blood sugar, and serum CA-125
103/ . A 30-year-woman presents to your office with the fear of developing ovarian cancer. Her 70-
year-old grandmother recently died from ovarian cancer. You discuss with her the risks factors
25
and prevention for ovarian cancer. Which of the following can decrease a woman’s risk of
ovarian cancer?
a. Use of combination oral contraceptive therapy
b. Menopause after age 55
c. Nonsteroidal anti-inflammatory drugs
d. Nulliparity
e. Ovulation induction medications
104/ . A 42-year-old G4P3104 presents for her well-woman examination. She has had three vaginal
deliveries and one cesarean delivery for breech. She states her cycles are regular and denies any
sexually transmitted diseases. Currently she and her husband use condoms, but they hate the
hassle of a coital-dependent method. She is interested in a more effective contraception because
they do not want any more children. She reports occasional migraine headaches and had a
serious allergic reaction to anesthesia as a child when she underwent a tonsillectomy. She drinks
and smokes socially. She weighs 78 kg, and her blood pressure is 142/89 mm Hg. During her
office visit, you counsel the patient at length regarding birth control methods. Which of the
following is the most appropriate contraceptive method for this patient?
a. Intrauterine device
b. Bilateral tubal ligation
c. Combination oral contraceptives
d. Diaphragm
e. Transdermal patch
105/ . A 48-year-old G2P2 presents for her well-woman examination. She had two uneventful
vaginal deliveries. She had a vaginal hysterectomy for fibroids and menorrhagia. She denies any
medical problems, but has not seen a doctor in 6 years. Her family history is significant for
stroke, diabetes, and high blood pressure. On examination she is a pleasant female, stands 5 ft
3 in tall, and weighs 85 kg. Her blood pressure is 150/92 mm Hg, pulse 70 beats per minute,
respiratory rate 14 breaths per minute, and temperature 37°C (98.4°F). Her breast, lung,
cardiac, abdomen, and pelvic examinations are normal. The next appropriate step in the
management of this patient’s blood pressure is which of the following?
a. Beta-blocker
b. Calcium channel blocker
c. Diuretic
d. Diet, exercise, weight loss, and repeat blood pressure in 2 months
Benign and Malignant Disorders of the Breast and Pelvis
106/ . A 50-year-old woman is diagnosed with cervical cancer. Which lymph node group would be
the first involved in metastatic spread of this disease beyond the cervix and uterus?
a. Common iliac nodes
b. Parametrial nodes
c. External iliac nodes
d. Paracervical or ureteral nodes
e. Para-aortic nodes
107/ . A 54-year-old woman undergoes a laparotomy because of a pelvic mass. At exploratory
26
laparotomy, a unilateral ovarian neoplasm is discovered that is accompanied by a large omental
metastasis. Frozen section diagnosis confirms metastatic serous cystadenocarcinoma. Which of
the following is the most appropriate intraoperative course of action?
a. Excision of the omental metastasis and ovarian cystectomy
b. Omentectomy and ovarian cystectomy
c. Excision of the omental metastasis and unilateral oophorectomy
d. Omentectomy and bilateral salpingo-oophorectomy
e. Omentectomy, total abdominal hysterectomy, and bilateral salpingo-oophorectomy
108/ . A 58-year-old woman is seen for evaluation of a swelling in her right vulva. She has also
noted pain in this area when walking and during coitus. At the time of pelvic examination, a
mildly tender, fluctuant mass is noted just outside the introitus in the right vulva in the region of
the Bartholin gland. Which of the following is the most appropriate treatment?
a. Marsupialization
b. Administration of antibiotics
c. Surgical excision
d. Incision and drainage
e. Observation
109/ . A 51-year-old woman is diagnosed with invasive cervical carcinoma by cone biopsy. Pelvic
examination and rectal-vaginal examination reveal the parametrium to be free of disease, but the
upper portion of the vagina is involved with tumor. Intravenous pyelography (IVP) and
sigmoidoscopy are negative, but a computed tomography (CT) scan of the abdomen and pelvis
shows grossly enlarged pelvic and periaortic nodes. This patient is classified at which of the
following stages?
a. IIa
b. IIb
c. IIIa
d. IIIb
e. IV
110/ . A 35-year-old G3P3 with a Pap smear showing high-grade squamous intraepithelial lesion of
the cervix (CIN III) has an inadequate colposcopy. Cone biopsy of the cervix shows squamous
cell cancer that has invaded only 1 mm beyond the basement membrane. There are no confluent
tongues of tumor, and there is no evidence of lymphatic or vascular invasion. The margins of
the cone biopsy specimen are free of disease.
How should you classify or stage this patient’s disease?
a. Carcinoma of low malignant potential
b. Microinvasive cancer, stage Ia1
c. Atypical squamous cells of undetermined significance
d. Carcinoma in situ
e. Invasive cancer, stage IIa
111/ . A 35-year-old G3P3 with a Pap smear showing high-grade squamous intraepithelial lesion of
the cervix (CIN III) has an inadequate colposcopy. Cone biopsy of the cervix shows squamous
cell cancer that has invaded only 1 mm beyond the basement membrane. There are no confluent
tongues of tumor, and there is no evidence of lymphatic or vascular invasion. The margins of
the cone biopsy specimen are free of disease.
The patient above now asks you for your advice on how to treat her cervical disease. Your
best recommendation is for the patient to undergo which of the following?
a. Treatment with external beam radiation
b. Implantation of radioactive cesium into the cervical canal c. Simple hysterectomy
27
d. Simple hysterectomy with pelvic lymphadenectomy
e. Radical hysterectomy
112/ . A pregnant 35-year-old patient is at highest risk for the concurrent development of which of
the following malignancies?
a. Cervix
b. Ovary
c. Breast
d. Vagina
e. Colon
113/ . A 22-year-old G3P0030 obese female comes to your office for a routine gynecologic
examination. She is single, but is currently sexually active. She has a history of five sexual
partners in the past, and became sexually active at age 15. She has had three first-trimester
voluntary pregnancy ter- minations. She uses Depo-Provera for birth control, and reports
occasionally using condoms as well. She has a history of genital warts, but denies any prior
history of abnormal Pap smears. The patient denies use of any illicit drugs, but admits to
smoking about one pack of cigarettes a day. Her physical examination is normal. However, 3
weeks later you receive the results of her Pap smear, which shows a high-grade squamous
intraepithelial lesion (HGSIL). Which of the following factors in this patient’s history does not
increase her risk for cervical dysplasia?
a. Young age at initiation of sexual activity
b. Multiple sexual partners
c. History of genital warts
d. Use of Depo-Provera
e. Smoking
114/ . A 57-year-old menopausal patient presents to your office for evaluation of postmenopausal
bleeding. She is morbidly obese and has chronic hypertension and adult onset diabetes. An
endometrial sampling done in the office shows complex endometrial hyperplasia with atypia,
and a pelvic ultrasound done at the hospital demonstrates multiple, large uterine fibroids. Which
of the following is the best treatment option for this patient?
a. Myomectomy
b. Total abdominal hysterectomy
c. Oral contraceptives
d. Uterine artery embolization
e. Oral progesterone
Infertility, Endocrinology, and Menstrual Dysfunction
115/ . You see five postmenopausal patients in the clinic. Each patient has one of the conditions
listed, and each patient wishes to begin hormone replacement therapy today. Which one of the
following patients would you start on therapy at the time of this visit?
a. Mild essential hypertension
b. Liver disease with abnormal liver function tests
c. Malignant melanoma
d. Undiagnosed genital tract bleeding
e. Treated stage III endometrial cancer
116/ . A mother brings her 12-year-old daughter in to your office for consultation. She is concerned
28
because most of the other girls in her daughter’s class have already started their period. She
thinks her daughter hasn’t shown any evidence of going into puberty yet. Knowing the usual
first sign of the onset of puberty, you should ask the mother which of the following questions?
a. Has her daughter had any acne?
b. Has her daughter started to develop breasts?
c. Does her daughter have any axillary or pubic hair?
d. Has her daughter started her growth spurt?
e. Has her daughter had any vaginal spotting?
117/ . A 55-year-old woman presents to your office for consultation regarding her symptoms of
menopause. She stopped having periods 8 months ago and is having severe hot flushes. The hot
flushes are causing her considerable stress. What should you tell her regarding the
psychological symptoms of the climacteric?
a. They are not related to her changing levels of estrogen and progesterone.
b. They commonly include insomnia, irritability, frustration, and malaise.
c. They are related to a drop in gonadotropin levels.
d. They are not affected by environmental factors.
e. They are primarily a reaction to the cessation of menstrual flow.
118/ . While evaluating a 30-year-old woman for infertility, you diagnose a bicornuate uterus. You
explain that additional testing is necessary because of the woman’s increased risk of congenital
anomalies in which organ system?
a. Skeletal
b. Hematopoietic
c. Urinary
d. Central nervous
e. Tracheoesophageal
119/ . A 39-year-old G3P3 complains of severe, progressive secondary dysmenorrhea and
menorrhagia. Pelvic examination demonstrates a tender, diffusely enlarged uterus with no
adnexal tenderness. Results of endometrial biopsy are normal. Which of the following is the
most likely diagnosis?
a. Endometriosis
b. Endometritis
c. Adenomyosis
d. Uterine sarcoma
e. Leiomyoma
120/ . A 28-year-old G3P0 has a history of severe menstrual cramps, prolonged, heavy periods,
chronic pelvic pain, and painful intercourse. All of her pregnancies were spontaneous abortions
in the first trimester. A hysterosalpingogram (HSG) she just had as part of the evaluation for
recurrent abortion showed a large uterine septum. You have recommended surgical repair of the
uterus. Of the patient’s symptoms, which is most likely to be corrected by resection of the
uterine septum?
a. Habitual abortion
b. Dysmenorrhea
c. Menometrorrhagia
d. Dyspareunia
e. Chronic pelvic pain
121/ . During the evaluation of infertility in a 25-year-old female, a hysterosalpingogram showed
29
evidence of Asherman syndrome. Which one of the following symptoms would you expect this
patient to have?
a. Hypomenorrhea
b. Oligomenorrhea
c. Menorrhagia
d. Metrorrhagia
e. Dysmenorrhea
122/ . A couple presents for evaluation of primary infertility. The evaluation of the woman is
completely normal. The husband is found to have a left varicocele. If the husband’s varicocele
is the cause of the couple’s infertility, what would you expect to see when evaluating the
husband’s semen analysis?
a. Decreased sperm count with an increase in the number of abnormal forms
b. Decreased sperm count with an increase in motility
c. Increased sperm count with an increase in the number of abnormal forms
d. Increased sperm count with absent motility
e. Azoospermia
123/ . A 25-year-old woman presents to your office for evaluation of primary infertility. She has
regular periods every 28 days. She has done testing at home with an ovulation kit, which
suggests she is ovulating. A hysterosalpingogram demonstrates patency of both fallopian tubes.
A progesterone level drawn in the mid–luteal phase is lower than expected. A luteal phase
defect is suspected to be the cause of this patient’s infertility. Which of the following studies
performed in the second half of the menstrual cycle is helpful in making this diagnosis?
a. Serum estradiol levels
b. Urinary pregnanetriol levels
c. Endometrial biopsy
d. Serum follicle-stimulating hormone (FSH) levels
e. Serum luteinizing hormone (LH) levels
124/ . A 45-year-old woman who had two normal pregnancies 15 and 18 years ago presents with the
complaint of amenorrhea for 7 months. She expresses the desire to become pregnant again.
After exclusion of pregnancy, which of the following tests is next indicated in the evaluation of
this patient’s amenorrhea?
a. Hysterosalpingogram
b. Endometrial biopsy
c. Thyroid function tests
d. Testosterone and DHAS levels
e. LH and FSH levels
125/ . Which of the following pubertal events in girls is not estrogen dependent?
a. Menses
b. Vaginal cornification
c. Hair growth
d. Reaching adult height
e. Production of cervical mucus
126/ . You suspect that your infertility patient has an inadequate luteal phase. She should undergo
30
an endometrial biopsy on which day of her menstrual cycle?
a. Day 3
b. Day 8
c. Day 14
d. Day 21
e. Day 26
127/ . You have recommended a postcoital test for your patient as part of her evaluation for
infertility. She and her spouse should have sexual intercourse on which day of her menstrual
cycle as part of postcoital testing?
a. Day 3
b. Day 8
c. Day 14
d. Day 21
e. Day 26
128/ . You ask a patient to call your office during her next menstrual cycle to schedule a
hysterosalpingogram as part of her infertility evaluation. Which day of the menstrual cycle is
best for performing the hysterosalpingogram?
a. Day 3
b. Day 8
c. Day 14
d. Day 21
e. Day 26
129/ . You have recommended that your infertility patient return to your office during her next
menstrual cycle to have her serum progesterone level checked. Which is the best day of the
menstrual cycle to check her progesterone level if you are trying to confirm ovulation?
a. Day 3
b. Day 8
c. Day 14
d. Day 21
e. Day 26
Pelvic Relaxation and Urology

130/ . An 86-year-old woman presents to your office for her well-woman examination. She has no
complaints. On pelvic examination performed in the supine and upright positions, the patient
has second-degree prolapse of the uterus. Which of the following is the best next step in the
a. Reassurance
b. Placement of a pessary
c. Vaginal hysterectomy
d. Le Fort procedure
e. Anterior colporrhaphy
131/ . An 81-year-old woman presents to your office complaining that her uterus fell out 2 months
ago. She has multiple medical problems, including chronic hypertension, congestive heart
failure, and osteoporosis. She is limited to sitting in a wheelchair because of her health
problems. Her fallen uterus causes significant pain. On physical examination, the patient is frail
and requires assistance with getting on the examination table. She has complete procidentia of
the uterus. Which of the following is the most appropriate next step in the management of this
31
patient?
a. Reassurance
b. Placement of a pessary
c. Vaginal hysterectomy
d. Le Fort procedure
e. Anterior colporrhaphy
132/ . A 78-year-old woman with chronic obstructive pulmonary disease, chronic hypertension, and
history of myocardial infarction requiring angioplasty presents to your office for evaluation of
something hanging out of her vagina. She had a hysterectomy for benign indications at age 48.
For the past few months, she has been experiencing the sensation of pelvic pressure. Last month
she felt a bulge at the vaginal opening. Two weeks ago something fell out of the vagina. On
pelvic examination, the patient has total eversion of the vagina. There is a superficial ulceration
at the vaginal apex. Which of the following is the best next step in the management of this
patient?
a. Biopsy of the vaginal ulceration
b. Schedule abdominal sacral colpopexy
c. Place a pessary
d. Prescribe oral estrogen
e. Prescribe topical vaginal estrogen cream
133/ . A 28-year-old woman presents to your office with symptoms of a urinary tract infection.
This is her second infection in 2 months. You treated the last infection with Bactrim DS for 3
days. Her symptoms never really improved. Now she has worsening lower abdominal
discomfort, dysuria, and frequency. She has had no fever or flank pain. Physical examination
shows only mild suprapubic tenderness. Which of the following is the best next step in the
evaluation of this patient?
a. Urine culture
b. Intravenous pyelogram
c. Cystoscopy
d. Wet smear
e. CT scan of the abdomen with contrast
Human Sexuality and Contraception
134/ . A 28-year-old G3P3 presents to your office for contraceptive counseling. She denies any
medical problems or sexually transmitted diseases. You counsel her on the risks and benefits of
all contraceptive methods. Which of the following is the most common form of contraception
used by reproductive-age women in the United States?
a. Pills
b. Condom
c. Diaphragm
d. Intrauterine device (IUD)
e. Permanent sterilization
135/ . A 20-year-old woman presents to your office for her well-woman examination. She has
32
recently become sexually active and desires an effective contraceptive method. She has no
medical problems, but family history is significant for breast cancer in a maternal aunt at the
age of 42. She is worried about getting cancer from taking birth control pills. You discuss with
her the risks and benefits of contraceptive pills. You tell her that which of the following
neoplasms has been associated with the use of oral contraceptives?
a. Breast cancer
b. Ovarian cancer
c. Endometrial cancer
d. Hepatic cancer
e. Hepatic adenoma
136/ . An intrauterine pregnancy of approximately 10 weeks gestation is confirmed in a 30-year-old
G5P4 woman with an IUD in place. The patient expresses a strong desire for the pregnancy to
be continued. On examination, the string of the IUD is noted to be protruding from the
cervical os. Which of the following is the most appropriate course of action?
a. Leave the IUD in place without any other treatment.
b. Leave the IUD in place and continue prophylactic antibiotics throughout pregnancy.
c. Remove the IUD immediately.
d. Terminate the pregnancy because of the high risk of infection.
e. Perform a laparoscopy to rule out a heterotopic ectopic pregnancy.
137/ . A 19-year-old woman presents for voluntary termination of pregnancy 6 weeks after her
expected (missed) menses. She previously had regular menses every 28 days. Pregnancy is
confirmed by β-human chorionic gonadotropin (β-hCG), and ultrasound confirms expected
gestational age. Which of the following techniques for termination of pregnancy would be safe
and effective in this patient at this time?
a. Dilation and evacuation (D&E)
b. Hypertonic saline infusion
c. Suction dilation and curettage (D&C)
d. 15-methyl α-prostaglandin injection
e. Hysterotomy
138/ . A 22-year-old nulliparous woman has recently become sexually active. She consults you
because of painful coitus, with the pain located at the vaginal introitus. It is accompanied by
painful involuntary contraction of the pelvic muscles. Other than confirmation of these findings,
the pelvic examination is normal. Which of the following is the most common cause of this
condition?
a. Endometriosis
b. Psychogenic causes
c. Bartholin gland abscess
d. Vulvar atrophy
e. Ovarian cyst
139/ . Five patients present for contraceptive counseling, each requesting that an IUD be inserted.
Which of the following is a recognized contraindication to the insertion of an IUD?
a. Pelvic inflammatory disease
b. Previous pregnancy with an IUD
c. Dysfunctional uterine bleeding
d. Cervical conization
33
e. Chorioamnionitis in previous pregnancy
140/ . A couple presents to your office to discuss permanent sterilization. They have three children
and are sure they do not want any more. You discuss the risk and benefits of surgical
sterilization. Which of the following statements is true regarding surgical sterilizations?
a. They cannot be performed immediately postpartum.
b. They have become the second most common method of contraception for white couples
between 20 and 40 years of age in the United States.
c. They can be considered effective immediately in females (bilateral tubal ligation).
d. They can be considered effective immediately in males (vasectomy).
e. Tubal ligation should be performed in the secretory phase of the menstrual cycle.
141/ . A couple presents to your office to discuss sterilization. They are very happy with their four
children and do not want any more. You discuss with them the pros and cons of both female and
male sterilization. The 34-year- old male undergoes a vasectomy. Which of the following is the
most frequent immediate complication of this procedure?
a. Infection
b. Impotence
c. Hematoma
d. Spontaneous reanastomosis
e. Sperm granulomas
142/ . A woman with multiple sexual partners
For above female patient seeking contraception, select the method that is medically
contraindicated for that patient.
a. Oral contraceptives
b. IUD
c. Condoms
d. Laparoscopic tubal ligation
e. Diaphragm
143/ . A woman with a history of deep vein thrombosis
b. IUD
c. Condoms
e. Diaphragm
144/ . A woman with moderate cystocele
b. IUD
c. Condoms
e. Diaphragm
145/ . A woman with severely reduced functional capacity as a result of chronic obstructive lung
disease.
34
b. IUD
c. Condoms
e. Diaphragm
146/ . A woman with a known latex allergy.
b. IUD
c. Condoms
e. Diaphragm
147/ . Nausea during first cycle of pills

For above situation involving oral contraceptives, select the most appropriate response.
a. Stop pills and resume after 7 days.
b. Continue pills as usual.
c. Continue pills and use an additional form of contraception.
d. Take an additional pill.
e. Stop pills and seek a medical examination.
148/ . Pill forgotten for 1 day

149/ . Pill forgotten for 3 continuous days
150/ . Light bleeding at midcycle during first month on pill
35
Sexual Abuse and Domestic Violence
151/ . A 20-year-old woman presents to your office with the complaint of abdominal pain. Through
further questioning, the woman reveals that she was sexually assaulted at a party 3 weeks ago
by a male friend whom she recently started dating. She states that she has not revealed this to
anyone else and has not informed the police because she was drinking. Her abdominal and
pelvic examinations are normal. Which of the following is the best management to offer this
patient?
a. Counsel patient to sue male friend.
b. Provide an antidepressant.
c. Provide emergency contraception.
d. Test for and treat sexually transmitted infections.
e. Order CT of the abdomen and pelvis.
152/ . You are called to the emergency department to evaluate an 18-year- old woman for a vulvar
laceration. She is accompanied by her mother and father. The father explains that the injury was
caused by a fall onto the sup- port bar on her bicycle. You interview the woman alone and find
out that her father has been sexually assaulting her. Which of the following statements best
describes injuries related to sexual assault?
a. Most injuries are considered major and require surgical correction.
b. Most injuries require hospitalization.
c. More than 50% of victims will have an injury.
d. Most injuries occur after the assault has taken place.
e. Vaginal and vulvar lacerations are common in virginal victims.
153/ . You are an intern working the night shift in the emergency department. During the evaluation
of a sexual assault victim, your attending physician asks you to order the appropriate laboratory
tests. Which of the following tests should be ordered?
a. HIV, HBsAg, Pap smear, RPR, and urine culture
b. HIV, HBsAg, Pap smear, RPR, and urine pregnancy test
c. Chlamydia and gonorrhea cultures, complete blood count, HIV, HBsAg, Pap smear, and
RPR
d. Chlamydia and gonorrhea cultures, HIV, HBsAg, Pap smear, RPR, and urine pregnancy
test
e. Chlamydia and gonorrhea cultures, HIV, HBsAg, RPR, urine culture, and urine
pregnancy test
154/ . You are evaluating a 19-year-old woman for a sexual assault. She denies any medical
problems or allergies to medications. Her pregnancy test is negative. Which of the following
antibiotic prophylaxes do you recommend for sexually transmitted infections?
a. No antibiotic prophylaxis is indicated
b. Flagyl 500 mg PO twice daily for 7 days
c. Rocephin 250 mg IM
d. Doxycycline 100 mg PO twice daily for 7 days plus Rocephin 250 mg IM
e. Erythromycin 500 mg PO twice daily for 7 days
36
155/ . After your evaluation and treatment of a rape victim has been com- pleted, you discharge the
patient to home. When is the best time to schedule a follow-up appointment for the patient?
a. 24 to 48 hours
b. 1 week
c. 6 weeks
d. 12 weeks
e. There is no need for the patient to have any additional follow-up as long as she feels
well.
37

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MCQ FOR OBSTETRIC-GYNECOLOGY

Part A- Selected 155 MCQs/ 37pp

Maternal-Fetal Physiology and Placentation

Antepartum Care and Fetal Surveillance

Medical and Surgical Complications of Pregnancy

Normal and Abnormal Labor and Delivery

57/ . A 23-year-old G1 at 38 weeks gestation presents in active labor at

The Puerperium, Lactation, and Immediate Care of the Newborn

Benign and Malignant Disorders of the Breast and Pelvis

107/ . A 54-year-old woman undergoes a laparotomy because of a pelvic mass. At exploratory

Pelvic Relaxation and Urology

Human Sexuality and Contraception

147/ . Nausea during first cycle of pills

148/ . Pill forgotten for 1 day

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