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OMSB Obstetrics and Gynecology (OEOG) study materials
OMSB Obstetrics and Gynecology (OEOG) study resources

OMSB Obstetrics and Gynecology (OEOG) practice questions

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Question 1Obstetrics

A 28-year-old woman at 39 weeks gestation has a blood pressure of 158/112 mmHg on two occasions four hours apart, with 3+ proteinuria. She has a severe frontal headache. Which is the most appropriate immediate management step?

  1. Perform an immediate cesarean delivery without stabilization
  2. Discharge home with weekly blood pressure checks
  3. Administer intravenous magnesium sulfate and antihypertensive therapy, then plan delivery Correct answer.
  4. Start oral antibiotics and reassess in 48 hours

Explanation

Severe preeclampsia (sustained systolic ≥160 or diastolic ≥110 mmHg with symptoms) requires seizure prophylaxis with magnesium sulfate and antihypertensive treatment, followed by delivery after maternal stabilization. Delivery is the definitive treatment, but abrupt surgery without controlling blood pressure and starting magnesium increases maternal risk.

Question 2Obstetrics

Which finding is the most reliable single indicator of ovulation in a woman with regular menstrual cycles?

  1. Mid-cycle lower abdominal pain
  2. Cervical mucus that becomes thin and stretchy
  3. A biphasic basal body temperature chart
  4. A serum progesterone level of 25 nmol/L on day 21 Correct answer.

Explanation

A mid-luteal serum progesterone above the laboratory's ovulatory threshold confirms that a corpus luteum formed and ovulation occurred. The other findings are supportive but indirect and can occur without ovulation.

Question 3Obstetrics

A 32-year-old woman at 34 weeks has a singleton pregnancy with the fetus in breech presentation. She is otherwise well and the fetus is growing normally. What is the most appropriate management?

  1. Perform immediate cesarean delivery
  2. Offer external cephalic version at 37 weeks Correct answer.
  3. Reassure her that breech presentation will not affect delivery mode
  4. Schedule elective cesarean at 36 weeks

Explanation

External cephalic version is offered at around 37 weeks for a persistent breech at term, after excluding contraindications. Many breech presentations before 36 weeks turn spontaneously, so early intervention is not appropriate.

Question 4Obstetrics

Which of the following is the most common cause of primary postpartum hemorrhage?

  1. Uterine atony Correct answer.
  2. Retained placenta
  3. Genital tract laceration
  4. Coagulopathy

Explanation

Uterine atony accounts for roughly 70-80% of primary postpartum hemorrhage and is managed initially with uterine massage and uterotonics. The other causes are the remaining elements of the 'four Ts'.

Question 5Obstetrics

A woman at 10 weeks gestation has a closed cervix, mild lower abdominal cramping, and a small amount of vaginal bleeding. Ultrasound shows an intrauterine gestational sac with fetal cardiac activity. What is the diagnosis?

  1. Inevitable miscarriage
  2. Missed miscarriage
  3. Complete miscarriage
  4. Threatened miscarriage Correct answer.

Explanation

A threatened miscarriage is defined by vaginal bleeding in early pregnancy with a closed cervix and a viable intrauterine pregnancy on ultrasound. Management is conservative with follow-up.

Question 6Obstetrics

Which screening test is recommended at 24-28 weeks for all pregnant women to detect gestational diabetes?

  1. Random plasma glucose
  2. Fasting plasma glucose alone
  3. HbA1c measurement
  4. A 75 g oral glucose tolerance test Correct answer.

Explanation

A 75 g two-hour oral glucose tolerance test at 24-28 weeks is the standard approach for universal screening for gestational diabetes. It assesses fasting, one-hour, and two-hour values against pregnancy-specific thresholds.

Question 7Obstetrics

Which vaccine is routinely recommended during every pregnancy, regardless of prior vaccination history, to protect the newborn?

  1. Varicella
  2. Tetanus-diphtheria-acellular pertussis Correct answer.
  3. Measles-mumps-rubella
  4. Human papillomavirus

Explanation

Tdap is recommended in each pregnancy, ideally at 27-36 weeks, to provide passive pertussis antibody to the neonate. Live vaccines such as MMR and varicella are contraindicated in pregnancy.

Question 8Obstetrics

A woman at 38 weeks has a singleton pregnancy with a fetus in cephalic presentation. Which fetal heart rate pattern is considered a normal reassuring finding?

  1. Recurrent late decelerations
  2. Baseline 140 bpm with moderate variability and accelerations Correct answer.
  3. Baseline 100 bpm with absent variability
  4. Baseline 175 bpm with minimal variability

Explanation

A baseline between 110 and 160 bpm with moderate variability and accelerations is reassuring. Bradycardia, tachycardia, minimal variability, and recurrent decelerations are non-reassuring.

Question 9Obstetrics

A 30-year-old woman at 28 weeks has a blood pressure of 150/95 mmHg and 1+ proteinuria on two occasions. She has no symptoms. Which is the most appropriate initial management?

  1. Reassure her and repeat blood pressure at 36 weeks
  2. Start antihypertensive therapy and arrange close outpatient or inpatient monitoring with fetal assessment Correct answer.
  3. Admit for immediate delivery
  4. Give a single dose of antenatal corticosteroids and discharge

Explanation

Preeclampsia without severe features at 28 weeks is managed with blood pressure control, monitoring, and fetal surveillance to prolong pregnancy while watching for progression. Immediate delivery is reserved for severe features or fetal compromise.

Question 10Obstetrics

A woman at 26 weeks reports reduced fetal movements. Cardiotocography shows a normal baseline with accelerations. What is the most appropriate next step?

  1. Repeat the CTG in four weeks
  2. Reassure and discharge without further assessment
  3. Schedule induction of labor
  4. Arrange ultrasound assessment of fetal growth, amniotic fluid, and umbilical artery Doppler Correct answer.

Explanation

Reduced fetal movements warrant a CTG and, if normal, ultrasound assessment of growth, amniotic fluid volume, and umbilical artery Doppler to exclude placental insufficiency. Reassurance alone can miss a compromised fetus.

Question 11Obstetrics

A 24-year-old woman at 12 weeks is RhD negative and unsensitized. She has vaginal bleeding. What is the most appropriate management?

  1. Give anti-D immunoglobulin only after delivery
  2. Withhold anti-D until 28 weeks
  3. Give anti-D immunoglobulin and perform an indirect Coombs test Correct answer.
  4. Give anti-D immunoglobulin only if the fetus is RhD positive

Explanation

Any potentially sensitizing event such as bleeding in an RhD-negative woman warrants anti-D immunoglobulin plus an indirect Coombs test to confirm she is not already sensitized. Timing of routine prophylaxis does not replace cover for sensitizing events.

Question 12Obstetrics

A woman at 41 weeks with a singleton cephalic pregnancy and a Bishop score of 4 requests induction. Which method is most appropriate for cervical ripening?

  1. Elective cesarean delivery
  2. Intravenous oxytocin without cervical preparation
  3. Vaginal prostaglandin or a mechanical balloon catheter Correct answer.
  4. Immediate amniotomy alone

Explanation

An unfavorable cervix (low Bishop score) requires cervical ripening with vaginal prostaglandin or a mechanical balloon before oxytocin or amniotomy. Amniotomy alone is ineffective when the cervix is unripe.

Question 13Obstetrics

A woman at 33 weeks has a blood pressure of 165/115 mmHg with headache and visual disturbance. Which antihypertensive is most appropriate for acute control?

  1. Intravenous labetalol or hydralazine with magnesium sulfate Correct answer.
  2. Sublingual nifedipine as the only agent
  3. Oral methyldopa for immediate effect
  4. Oral labetalol as a single dose

Explanation

Severe hypertension in pregnancy requires rapid parenteral control with agents such as intravenous labetalol or hydralazine, plus magnesium sulfate for seizure prophylaxis. Oral agents are too slow for acute severe hypertension.

Question 14Obstetrics

A 35-year-old woman at 36 weeks has a fetus with an estimated weight below the 10th centile and an elevated umbilical artery pulsatility index. What is the most appropriate management?

  1. Reassure and repeat growth scan at 40 weeks
  2. Arrange close fetal surveillance with Doppler and plan delivery based on deterioration Correct answer.
  3. Perform immediate cesarean delivery
  4. Start maternal bed rest and low-dose aspirin

Explanation

Fetal growth restriction with abnormal umbilical artery Doppler indicates placental insufficiency and requires close surveillance with delivery timed according to Doppler findings and gestational age. Immediate delivery at 36 weeks may be needed if Doppler is severely abnormal, but the general plan is surveillance and planned delivery.

Question 15Obstetrics

A woman at 30 weeks presents with a painful, tense uterus, vaginal bleeding, and fetal heart rate showing frequent contractions. Ultrasound shows a retroplacental hematoma. What is the most likely diagnosis?

  1. Placenta previa
  2. Placental abruption Correct answer.
  3. Vasa previa
  4. Uterine rupture

Explanation

Painful bleeding with a tense uterus and a retroplacental hematoma on ultrasound is characteristic of placental abruption. Placenta previa typically causes painless bleeding with a soft uterus.

Question 16Obstetrics

A woman at 28 weeks has a cervix dilated to 3 cm with bulging membranes. Which intervention is most likely to improve neonatal outcome?

  1. Cerclage placement with bulging membranes
  2. Immediate delivery
  3. Prophylactic antibiotics alone
  4. Antenatal corticosteroids and tocolysis with close monitoring Correct answer.

Explanation

For threatened preterm birth at 28 weeks, antenatal corticosteroids reduce neonatal respiratory distress and mortality, and tocolysis may allow time for steroid effect. Cerclage is contraindicated with bulging membranes.

Question 17Obstetrics

A woman at 39 weeks has a prolonged second stage with arrest of descent. Examination shows the fetal head at station 0 with caput and molding, and the fetal heart rate shows recurrent late decelerations. What is the most appropriate management?

  1. Cesarean delivery Correct answer.
  2. Operative vaginal delivery with forceps or vacuum
  3. Augment with oxytocin
  4. Continue pushing for another two hours

Explanation

A prolonged second stage with arrest of descent, significant caput and molding, and non-reassuring fetal status is an indication for cesarean delivery. Operative vaginal delivery is not appropriate at station 0 with suspected cephalopelvic disproportion.

Question 18Obstetrics

A woman at 34 weeks has a singleton pregnancy and ruptured membranes but no contractions. She is afebrile with a normal fetal heart rate. What is the most appropriate management?

  1. Tocolysis for 48 hours without antibiotics
  2. Expectant management with antibiotics and corticosteroids, planning delivery around 37 weeks Correct answer.
  3. Discharge home with instructions to return if contractions start
  4. Immediate induction of labor

Explanation

Preterm prelabor rupture of membranes at 34 weeks is managed expectantly with antibiotics and corticosteroids, with delivery planned around 37 weeks if the mother and fetus remain stable. Immediate delivery is reserved for infection, abruption, or fetal compromise.

Question 19Obstetrics

A woman in the second stage of labor develops a sudden severe headache, hypertension, and a seizure. What is the most appropriate initial drug?

  1. Intravenous labetalol alone
  2. Intravenous magnesium sulfate Correct answer.
  3. Oral phenytoin
  4. Intravenous diazepam

Explanation

Eclampsia is treated with intravenous magnesium sulfate for seizure control, along with antihypertensive therapy and delivery after stabilization. Magnesium is superior to other anticonvulsants in this setting.

Question 20Obstetrics

A woman at 20 weeks has a fundal height of 24 cm and a history of a previous cesarean. Ultrasound shows the placenta covering the internal os with loss of the normal myometrial interface. What is the most likely diagnosis?

  1. Placenta previa without accreta
  2. Low-lying placenta
  3. Placenta accreta spectrum Correct answer.
  4. Vasa previa

Explanation

Placenta previa with loss of the normal myometrial interface and prior cesarean delivery suggests placenta accreta spectrum. This requires specialist antenatal planning and delivery at a center with expertise.

Question 21Obstetrics

A woman at 37 weeks has a fetus with a nuchal cord noted on ultrasound. Which statement is most accurate?

  1. Induction of labor is contraindicated
  2. Fetal monitoring can be omitted
  3. Cesarean delivery is always required
  4. Most nuchal cords are benign and do not require a change in delivery mode Correct answer.

Explanation

A nuchal cord is common and usually benign; it does not by itself mandate cesarean delivery or alter the mode of delivery. Continuous fetal monitoring during labor remains appropriate.

Question 22Obstetrics

A woman at 32 weeks has a blood pressure of 155/105 mmHg, 4+ proteinuria, and elevated liver enzymes with a platelet count of 90,000. What is the most likely diagnosis?

  1. HELLP syndrome without preeclampsia
  2. Preeclampsia with severe features Correct answer.
  3. Gestational hypertension
  4. Chronic hypertension

Explanation

Preeclampsia with severe features is diagnosed when severe hypertension or symptoms or laboratory abnormalities such as thrombocytopenia and elevated liver enzymes are present. HELLP is a variant of severe preeclampsia.

Question 23Obstetrics

A woman at 36 weeks has a fetus with an estimated weight of 4.6 kg and a history of shoulder dystocia in a previous delivery. What is the most appropriate counseling?

  1. No additional counseling is needed
  2. Vaginal delivery is contraindicated in all cases
  3. Induction of labor at 37 weeks will prevent shoulder dystocia
  4. Elective cesarean delivery should be offered Correct answer.

Explanation

A suspected macrosomic fetus with a prior shoulder dystocia warrants counseling about elective cesarean delivery because of the increased recurrence risk. Induction does not reliably prevent shoulder dystocia.

Question 24Obstetrics

A woman at 18 weeks has a fetus with an abdominal wall defect and elevated maternal serum alpha-fetoprotein. Which finding best distinguishes gastroschisis from omphalocele?

  1. Gastroschisis is covered by a membrane
  2. Omphalocele is lateral to the umbilical cord insertion
  3. Omphalocele is always associated with a normal karyotype
  4. Gastroschisis is lateral to the umbilical cord insertion without a covering membrane Correct answer.

Explanation

Gastroschisis herniates lateral to the umbilical cord insertion and lacks a covering membrane, whereas omphalocele is central and covered by peritoneum and amnion. Omphalocele has a higher association with chromosomal anomalies.

Question 25Obstetrics

A woman at 38 weeks has a fetus with a suspected congenital diaphragmatic hernia. Which finding on ultrasound is most consistent with this diagnosis?

  1. Cystic structure in the posterior fossa
  2. Bilateral renal agenesis
  3. Echogenic bowel in the abdomen
  4. Stomach bubble in the fetal thorax with mediastinal shift Correct answer.

Explanation

A left-sided congenital diaphragmatic hernia typically shows the stomach and bowel in the thorax with mediastinal shift and cardiac displacement. This requires delivery at a center with neonatal surgical and ECMO capability.

Question 26Obstetrics

A woman at 39 weeks in active labor has a cervical dilatation of 6 cm that has not changed over the past 4 hours despite regular painful contractions. Membranes are intact and the fetal heart rate tracing is normal. Which finding best defines her condition as inadequate uterine activity rather than arrest of labor?

  1. Fetal head at station minus 3 with caput succedaneum
  2. Rupture of membranes with meconium-stained liquor
  3. Maternal request for epidural analgesia
  4. Contractions fewer than 3 in 10 minutes with softening of the cervix on repeat examination Correct answer.

Explanation

Arrest of labor is diagnosed when there is no cervical change over at least 4 hours of adequate contractions, or over 6 hours if contractions are inadequate. Adequate contractions are generally defined as at least 3 in 10 minutes with cervical change; fewer than 3 with no progress indicates hypotonic uterine dysfunction rather than true arrest.

Question 27Obstetrics

A woman at 34 weeks gestation is admitted with a confirmed major placenta previa and is currently not bleeding. Which management plan is most appropriate?

  1. Digital vaginal examination to assess cervical dilatation
  2. Membrane sweep at 38 weeks to reduce the risk of post-term pregnancy
  3. Antenatal corticosteroids with planned cesarean delivery around 36-37 weeks if she remains stable Correct answer.
  4. Immediate cesarean delivery at the time of diagnosis

Explanation

For a stable woman with major placenta previa and no active hemorrhage, expectant management with antenatal corticosteroids and planned cesarean delivery at around 36-37 weeks reduces neonatal morbidity while avoiding emergency hemorrhage. Vaginal examination and membrane sweeping are contraindicated because they can provoke catastrophic bleeding.

Question 28Obstetrics

A woman at 38 weeks has a fetus with a suspected congenital pulmonary airway malformation. Which ultrasound feature most strongly suggests hydrops requiring urgent evaluation?

  1. Polyhydramnios with a normal fetal heart
  2. A single small echogenic lung lesion without mediastinal shift
  3. A cystic lesion measuring 2 cm with no cardiac displacement
  4. Fetal ascites, pleural effusion, and skin edema Correct answer.

Explanation

Hydrops fetalis is defined by abnormal fluid accumulation in at least two fetal compartments, such as ascites, pleural effusion, pericardial effusion, and skin edema. In a fetus with a lung malformation, hydrops signals severe compromise and prompts consideration of urgent intervention or delivery planning.

Question 29Obstetrics

A woman at 32 weeks presents with a confirmed deep vein thrombosis of the left popliteal vein. Which anticoagulant is preferred for treatment during pregnancy?

  1. Direct oral anticoagulant rivaroxaban
  2. Warfarin
  3. Low molecular weight heparin Correct answer.
  4. Aspirin

Explanation

Low molecular weight heparin is the preferred anticoagulant in pregnancy because it does not cross the placenta and has a predictable dose response. Warfarin crosses the placenta and is associated with embryopathy, and direct oral anticoagulants are generally avoided in pregnancy.

Question 30Obstetrics

A woman at 28 weeks has a singleton pregnancy and a history of a previous preterm birth at 30 weeks. Which intervention has the strongest evidence for reducing the risk of recurrent preterm birth?

  1. Elective cervical cerclage at 12 weeks
  2. Weekly oral antibiotics until delivery
  3. Routine bed rest for the remainder of pregnancy
  4. Vaginal progesterone supplementation Correct answer.

Explanation

Vaginal progesterone is recommended for women with a singleton pregnancy and a prior spontaneous preterm birth, as it reduces the rate of recurrent preterm delivery. Cerclage is reserved for specific cervical shortening or history indications, and antibiotics and bed rest are not proven preventive strategies.

Question 31Obstetrics

A woman in the third stage of labor has ongoing heavy vaginal bleeding after delivery of the placenta. The uterus is soft and boggy on palpation. Which initial step is most appropriate?

  1. Uterine artery embolization
  2. Bimanual uterine massage with administration of a uterotonic agent Correct answer.
  3. Insertion of a Bakri balloon without pharmacologic therapy
  4. Immediate laparotomy

Explanation

A soft, boggy uterus after delivery indicates uterine atony, the most common cause of postpartum hemorrhage. Initial management is uterine massage combined with a uterotonic such as oxytocin, followed by escalation to other measures if bleeding persists.

Question 32Obstetrics

A woman at 36 weeks has a fetus with an estimated weight below the 10th centile, and Doppler shows an elevated umbilical artery pulsatility index. Which statement best reflects the clinical significance of this finding?

  1. It confirms a chromosomal abnormality requiring immediate amniocentesis
  2. It is a normal finding in late pregnancy that needs no follow-up
  3. It reliably excludes uteroplacental insufficiency
  4. It indicates increased placental vascular resistance and a higher risk of fetal compromise Correct answer.

Explanation

An elevated umbilical artery pulsatility index reflects increased resistance in the placental circulation, which is associated with fetal growth restriction and adverse perinatal outcomes. It warrants closer surveillance rather than being a normal variant or a definitive diagnosis of aneuploidy.

Question 33Obstetrics

A woman at 30 weeks presents with a painful, tense uterus, vaginal bleeding, and a fetal heart rate showing frequent contractions. Which diagnosis is most likely?

  1. Vasa previa
  2. Placenta previa
  3. Placental abruption Correct answer.
  4. Uterine rupture

Explanation

Painful bleeding with a tense, tender uterus and fetal heart rate abnormalities is the classic presentation of placental abruption. Placenta previa typically causes painless bleeding, and vasa previa causes painless bleeding with fetal exsanguination, whereas uterine rupture usually occurs in labor after prior uterine surgery.

Question 34Obstetrics

A woman at 20 weeks has a fundal height of 24 cm and a history of a previous cesarean delivery. Ultrasound shows the placenta covering the internal os with loss of the normal retroplacental clear zone and increased vascularity at the bladder interface. Which diagnosis is most likely?

  1. Placenta previa alone
  2. Gestational trophoblastic disease
  3. Placenta accreta spectrum Correct answer.
  4. Uterine dehiscence

Explanation

Placenta previa with loss of the retroplacental clear zone, irregular bladder interface, and increased vascularity strongly suggests placenta accreta spectrum, especially with prior cesarean delivery. These features indicate abnormal trophoblast invasion rather than simple previa.

Question 35Gynecology

A 24-year-old woman has a 3 cm simple ovarian cyst with no septations, no solid areas, and normal CA-125. What is the most appropriate management?

  1. Observation with follow-up ultrasound Correct answer.
  2. Immediate laparotomy and oophorectomy
  3. Aspiration of the cyst in the clinic
  4. Chemotherapy with paclitaxel and carboplatin

Explanation

A simple cyst under 5 cm with no solid components, thin walls, and normal tumor markers in a premenopausal woman is almost certainly benign and usually resolves spontaneously. International guidance recommends conservative follow-up with ultrasound rather than surgery. Aspiration is not advised because recurrence is common and cytology is unreliable.

Question 36Gynecology

Which organism is most commonly implicated in pelvic inflammatory disease in young sexually active women?

  1. Gardnerella vaginalis
  2. Candida albicans
  3. Trichomonas vaginalis
  4. Chlamydia trachomatis Correct answer.

Explanation

Chlamydia trachomatis, often together with Neisseria gonorrhoeae, is the leading cause of acute pelvic inflammatory disease in sexually active young women. Untreated infection ascends from the cervix to the endometrium and fallopian tubes. Candida, Gardnerella, and Trichomonas cause vaginitis rather than ascending pelvic infection.

Question 37Gynecology

A 52-year-old woman reports hot flushes, night sweats, and vaginal dryness after 14 months of amenorrhea. Which finding best confirms the diagnosis of natural menopause?

  1. FSH above 30 IU/L with low estradiol Correct answer.
  2. A single elevated LH measurement
  3. Endometrial thickness of 4 mm on ultrasound
  4. Persistently elevated prolactin

Explanation

Menopause is diagnosed clinically after 12 months of amenorrhea in a woman over 45 with typical vasomotor symptoms. Biochemically, follicle depletion produces an elevated FSH (typically above 30 IU/L) with low estradiol. A single LH value or endometrial thickness does not establish the diagnosis.

Question 38Gynecology

Which contraceptive method is contraindicated in a woman with a history of migraine with aura?

  1. Copper intrauterine device
  2. Levonorgestrel intrauterine system
  3. Combined oral contraceptive pill Correct answer.
  4. Progestogen-only implant

Explanation

Estrogen-containing contraceptives increase ischemic stroke risk in women who have migraine with aura, so combined hormonal methods are classified as contraindicated. Progestogen-only and intrauterine methods do not carry this restriction. The copper IUD is hormone-free and safe in this setting.

Question 39Gynecology

Which finding on cervical cytology is reported under the Bethesda system as a high-grade squamous intraepithelial lesion?

  1. Severe dysplasia with markedly enlarged nuclei and high nuclear-to-cytoplasmic ratio Correct answer.
  2. Reactive endocervical cells with prominent nucleoli
  3. Fungal hyphae with acute inflammatory cells
  4. Koilocytes with perinuclear halos and mild nuclear atypia

Explanation

High-grade squamous intraepithelial lesion (HSIL) corresponds to moderate to severe dysplasia (CIN 2-3) with markedly enlarged, hyperchromatic nuclei and a high nuclear-to-cytoplasmic ratio. Koilocytic change with perinuclear halos indicates low-grade LSIL. Reactive and inflammatory changes are benign categories.

Question 40Gynecology

A woman at 34 weeks' gestation presents with a firm, tender uterus, vaginal bleeding, and fetal distress. Which diagnosis is most likely?

  1. Vasa previa
  2. Placenta previa
  3. Placental abruption Correct answer.
  4. Uterine rupture

Explanation

Painful vaginal bleeding with a tense, tender uterus and fetal compromise in the third trimester is the classic picture of placental abruption. Placenta previa typically causes painless bleeding with a soft uterus. Vasa previa causes fetal bleeding with rupture of membranes, and uterine rupture usually follows prior uterine surgery.

Question 41Gynecology

Which is the most common cause of postmenopausal bleeding that requires exclusion before assuming atrophy?

  1. Endometrial carcinoma Correct answer.
  2. Endometrial polyp
  3. Cervical ectropion
  4. Atrophic vaginitis

Explanation

Postmenopausal bleeding must always prompt evaluation for endometrial carcinoma, which is the most important diagnosis to exclude. Atrophy and polyps are common benign causes, but cancer must be ruled out with endometrial sampling and transvaginal ultrasound. Cervical ectropion does not cause postmenopausal bleeding.

Question 42Gynecology

Which statement correctly describes the mechanism of action of the copper intrauterine device?

  1. It thickens cervical mucus through progestogenic effect
  2. It creates a spermicidal inflammatory environment in the uterine cavity Correct answer.
  3. It suppresses ovulation by inhibiting the LH surge
  4. It prevents implantation by lowering progesterone receptor expression

Explanation

The copper IUD releases copper ions that provoke a sterile inflammatory reaction in the endometrium, which is toxic to sperm and impairs fertilization. It does not suppress ovulation or act through progestogenic effects. Ovulation continues normally in users of the copper device.

Question 43Gynecology

A 30-year-old woman with irregular menses and hirsutism has a raised LH-to-FSH ratio and multiple small ovarian follicles on ultrasound. Which diagnosis best fits?

  1. Premature ovarian insufficiency
  2. Congenital adrenal hyperplasia
  3. Polycystic ovary syndrome Correct answer.
  4. Hyperprolactinemia

Explanation

The combination of oligo-ovulation, clinical or biochemical hyperandrogenism, and polycystic ovarian morphology on ultrasound fulfills the Rotterdam criteria for polycystic ovary syndrome. The elevated LH-to-FSH ratio is a supportive biochemical feature. Premature ovarian insufficiency, congenital adrenal hyperplasia, and hyperprolactinemia are alternative causes that should be excluded.

Question 44Gynecology

A 28-year-old woman has a 7 cm complex ovarian mass with thick septations and a solid component. Which next step is most appropriate?

  1. Repeat ultrasound in 12 months
  2. Trial of combined oral contraceptives for 3 months
  3. Referral to gynecologic oncology for surgical evaluation Correct answer.
  4. Outpatient cyst aspiration

Explanation

A complex adnexal mass with thick septations and solid components is suspicious for malignancy and warrants surgical evaluation by a gynecologic oncologist. Benign-appearing simple cysts can be observed, but complex features require prompt intervention. Oral contraceptives and aspiration have no role in the management of a suspicious mass.

Question 45Gynecology

Which finding on transvaginal ultrasound is most suggestive of an ectopic pregnancy in a woman with a positive pregnancy test and no intrauterine sac?

  1. Fluid in the posterior cul-de-sac only
  2. A thin endometrial stripe of 3 mm
  3. A simple ovarian cyst of 3 cm
  4. An adnexal mass separate from the ovary with a gestational sac Correct answer.

Explanation

An adnexal mass separate from the ovary that contains a gestational sac, with or without a yolk sac or embryo, is highly specific for ectopic pregnancy. Free pelvic fluid and a thin endometrium are nonspecific findings that can occur in early intrauterine pregnancy or miscarriage. A simple ovarian cyst is unrelated.

Question 46Gynecology

A 45-year-old woman has heavy menstrual bleeding with a 2 cm submucosal fibroid. Which treatment offers the most definitive correction of the bleeding while preserving the uterus?

  1. Levonorgestrel intrauterine system
  2. GnRH agonist for 6 months
  3. Hysteroscopic myomectomy Correct answer.
  4. Uterine artery embolization

Explanation

Hysteroscopic myomectomy directly resects a submucosal fibroid and provides definitive control of heavy bleeding while preserving fertility and the uterus. The levonorgestrel system and GnRH agonists reduce bleeding temporarily but do not remove the fibroid. Uterine artery embolization is effective but less targeted for a small submucosal lesion and carries a risk of impaired fertility.

Question 47Gynecology

A 26-year-old woman presents with a 4 cm Bartholin cyst that is fluctuant and tender. Which management is most appropriate?

  1. Excision of the gland under general anesthesia
  2. Oral antibiotics alone
  3. Observation until spontaneous resolution
  4. Incision and drainage with placement of a Word catheter Correct answer.

Explanation

An acutely infected or abscessed Bartholin cyst is treated by incision and drainage, usually with placement of a Word catheter to maintain drainage and reduce recurrence. Antibiotics alone are insufficient for a fluctuant abscess. Excision is reserved for recurrent cysts and is not first-line in acute infection.

Question 48Gynecology

Which vaccine is recommended for the primary prevention of cervical cancer and is given before sexual debut for maximal benefit?

  1. Quadrivalent or nonavalent HPV vaccine Correct answer.
  2. Pneumococcal conjugate vaccine
  3. Hepatitis B vaccine
  4. Herpes simplex virus vaccine

Explanation

Prophylactic HPV vaccines targeting oncogenic types 16 and 18 prevent most cervical cancers and are most effective when given before exposure to the virus. Hepatitis B, HSV, and pneumococcal vaccines do not prevent cervical neoplasia. Vaccination does not eliminate the need for cervical screening.

Question 49Gynecology

A 33-year-old woman with a history of deep infiltrating endometriosis reports severe dysmenorrhea and dyspareunia. Which medication provides symptomatic relief by inducing hypoestrogenism?

  1. GnRH agonist Correct answer.
  2. Combined oral contraceptive
  3. Nonsteroidal anti-inflammatory drug
  4. Tranexamic acid

Explanation

GnRH agonists produce a reversible hypoestrogenic state that suppresses endometriotic implants and relieves pain. Combined oral contraceptives and NSAIDs are useful first-line options but do not act through hypoestrogenism. Tranexamic acid reduces menstrual bleeding rather than endometriosis-related pain.

Question 50Gynecology

A 29-year-old woman with primary infertility has regular cycles and a normal pelvic examination. Which initial investigation is most appropriate?

  1. Endometrial biopsy
  2. Diagnostic laparoscopy
  3. Semen analysis of the partner Correct answer.
  4. Hysterosalpingography on day 3 of the cycle

Explanation

Infertility evaluation begins with a semen analysis because male factor contributes to a substantial proportion of cases and the test is inexpensive and non-invasive. Hysterosalpingography assesses tubal patency but is not the first test. Laparoscopy and endometrial biopsy are reserved for specific indications.