Obstetrics & gynecology - clerkship
exam review with answers
40 y.o. female presents with AMENORRHEA, MORNING NAUSEA and VOMITING,
FATIGUE, and POLYURIA. Her LAST MENSTRUAL PERIOD was 6 WEEKS AGO, and
her BREASTS ARE FULL AND TENDER. She uses the rhythm method for
contraception. What is the most likely diagnosis? - ✔️✔️correct answer-PREGNANCY
***Pregnancy is suggested in a patient with AMENORRHEA, ENLARGEMENT of the
UTERUS, and a (+) urinary beta-hCG
23 y.o. OBESE female presents with AMENORRHEA FOR 6 MONTHS, FACIAL HAIR,
and INFERTILITY for the past 3 YEARS. What is the most likely diagnosis? -
✔️✔️correct answer-PCOS
35 y.o. female presents with AMENORRHEA, GALACTORRHEA, VISUAL FIELD
DEFECTS, and HEADACHES for the PAST 6 MONTHS. What is the most likely
diagnosis? - ✔️✔️correct answer-Amenorrhea secondary to PROLACTINOMA
51 y.o. female presents with AMENORRHEA FOR THE PAST 12 MONTHS
accompanied by HOT FLASHES, NIGHT SWEATS, EMOTIONAL LABILITY, and
DYSPAREUNIA. What is the most likely diagnosis? - ✔️✔️correct answer-Menopause
35 y.o. female presents with AMENORRHEA, COLD INTOLERANCE, COARSE HAIR,
WEIGHT LOSS, and FATIGUE. She has a HISTORY OF ABRUPTIO PLACENTAE
followed by HYPOVOLEMIC SHOCK and FAILURE OF LACTATION 2 YEARS AGO.
What is the most likely diagnosis? - ✔️✔️correct answer-Sheehan Syndrome
(postpartum hypopituitarism)
,= Excessive postpartum blood loss leading to infarction
of the pituitary gland
18 y.o. female presents with AMENORRHEA for the past 4 MONTHS. She is 5 feet, 6
inches tall and weighs 90 pounds. She has a history of VIGOROUS EXERCISE and
COLD INTOLERANCE. What is the most likely diagnosis? - ✔️✔️correct answer-
Anorexia nervosa
29 y.o. female presents with AMENORRHEA for the past 6 MONTHS. She has a history
of occasional PALPITATIONS and DIZZINESS. She lost her fiance in a car accident.
What is the most likely diagnosis? - ✔️✔️correct answer-Anxiety-induced Amenorrhea
17 y.o. female presents with PROLONGED, EXCESSIVE MENSTRUAL BLEEDING
occurring IRREGULARLY within the past 6 MONTHS. What is the most likely
diagnosis? - ✔️✔️correct answer-Dysfunctional Uterine Bleeding
61 y.o. OBESE female presents with PROFUSE VAGINAL BLEEDING for the PAST
MONTH. Her LMP was 10 YEARS AGO. She has a HISTORY OF HYPERTENSION
and DIABETES MELLITUS. She is NULLIPAROUS. What is the most likely diagnosis? -
✔️✔️correct answer-Endometrial Cancer
45 y.o. G5P5 female presents with POSTCOITAL BLEEDING. She is a CIGARETTE
SMOKER and TAKES OCPs. What is the most likely diagnosis? - ✔️✔️correct answer-
Cervical Cancer
28 y.o. female who is 8 WEEKS PREGNANT presents with LOWER ABDOMINAL PAIN
and VAGINAL BLEEDING. What is the most likely diagnosis? - ✔️✔️correct answer-
Spontaneous Abortion
32 y.o. female presents with SUDDEN ONSET of LEFT LOWER ABDOMINAL PAIN
that radiates to the scapula and back and is associated with VAGINAL BLEEDING. Her
LMP was 5 WEEKS AGO. She has a history of PID and UNPROTECTED
INTERCOURSE. What is the most likely diagnosis? - ✔️✔️correct answer-Ectopic
Pregnancy
***If RUPTURED, can be HYPOTENSIVE with PERITONEAL IRRITATION (eg,
rebound tenderness)
Risk Factors:
(1) Previous Ectopic pregnancies (STRONGEST RISK FACTOR)
(2) PID
(3) IUD
,28 y.o. female presents with a THIN, GRAY-WHITE, FOUL-SMELLING VAGINAL
DISCHARGE. What is the most likely diagnosis? - ✔️✔️correct answer-Bacterial
Vaginosis
Tx: Metronidazole 500mg PO bid x 7 days
30 y.o. female presents with a THICK, WHITE, COTTAGE CHEESE-LIKE, ODORLESS
VAGINAL DISCHARGE and VAGINAL ITCHING. What is the most likely diagnosis? -
✔️✔️correct answer-Vaginitis-candidal
*pH≤4.5
*KOH wetmount reveals hyphae and spores
RISK FACTORS: DM, Broad-spectrum antibiotic use, Pregnancy, Corticosteroids
Tx: Fluconazole 150mg PO in a single dose
35 y.o. female presents with a MALODOROUS, PROFUSE, FROTHY, GREENISH
VAGINAL DISCHARGE with INTENSE VAGINAL ITCHING and DISCOMFORT. What
is the most likely diagnosis? - ✔️✔️correct answer-Vaginitis-trichomonal
***Petechiae on vagina and cervix ("strawberry cervix")
Tx: Metronidazole 2g PO single dose
***Symptomatic pregnant women should be treated with 2g Metronidazole once
***Treat even if asymptomatic!
***Treat partner(s)
54 y.o. female complains of DYSPAREUNIA and POST-COITAL SPOTTING. Her LMP
was 9 months ago. She has HOT FLASHES. What is the most likely diagnosis? -
✔️✔️correct answer-Atrophic Vaginitis
37 y.o. female presents with DYSPAREUNIA, INABILITY TO CONCEIVE, and
DYSMENORRHEA. What is the most likely diagnosis? - ✔️✔️correct answer-
Endometriosis
Naegele's rule - ✔️✔️correct answer-LMP - 3 Months + 7 Days = Estimated day of
delivery
Goodell's Sign - ✔️✔️correct answer-One of the FIRST SIGNS of pregnancy that is
seen on physical exam is the GOODELL SIGN, SOFTENING OF THE CERVIX that is
felt first at 4-6 WEEKS.
What is the BEST INITIAL TEST when suspecting pregnancy? - ✔️✔️correct answer-
beta-HCG
(+) in SERUM 9 days POST-CONCEPTION
(+) in URINE 28 days AFTER FIRST DAY OF LMP
, PLASMA LEVELS DOUBLE every 1-2 days, peak at 8-10 weeks, then fall to a plateau
until delivery.
Beta-HCG > 1500 or 5 weeks = Gestational Sac on ultrasound
A 17 y.o. woman presents for a routine prenatal checkup at 12 weeks. Which of the
following is the MOST ACCURATE method to establish gestational age?
A) Ultrasound
B) Beta-HCG
C) Pelvic Exam
D) Fundal Height
E) LMP - ✔️✔️correct answer-A. ULTRASOUND is the MOST ACCURATE way of
establishing gestational age at 11 to 14 weeks.
A 20 y.o. woman presents to the ER for VAGINAL BLEEDING and LOWER
ABDOMINAL PAIN for 1 day. She states that she is 15 weeks pregnant. Vital signs
include temperature 37°C, HR 100 bpm, BP 110/75 mm Hg, and RR 12 per minute. On
pelvic exam, there is BLOOD PRESENT IN THE VAULT. U/S shows INTRAUTERINE
BLEEDING, PRODUCTS OF CONCEPTION, and a DILATED CERVIX. Which of the
following is the MOST LIKELY DIAGNOSIS in this patient?
A) Complete abortion
B) Incomplete abortion
C) Inevitable abortion
D) Threatened abortion
E) Septic abortion - ✔️✔️correct answer-C. An INEVITABLE ABORTION is
characterized by UTERINE BLEEDING with CERVICAL DILATION and CRAMPY
ABDOMINAL PAIN and NO TISSUE EXPULSION.
Review:
Complete Abortion - EXPULSION OF ALL PRODUCTS OF CONCEPTION (POC)
FROM THE UTERUS. Pain ceases, but spotting may persist. CLOSED OS. U/S shows
an empty uterus. Treat with SERIAL TESTING of hCG LEVEL to make sure that it goes
down to ZERO.
Incomplete Abortion - PASSAGE OF SOME POC THROUGH THE CERVIX.
Bleeding/mild cramping. Visible tissue on exam. OPEN OS. U/S shows retained fetal
tissue
Threatened Abortion - PRODUCTS OF CONCEPTION INTACT. Intrauterine
BLEEDING, NO dilation of cervix. CLOSED OS + intact membranes + fetal cardiac
motion on ultrasound. Treat with bed rest and pelvic rest
Septic Abortion - Infection of the uterus and the surrounding areas. HYPOTENSION,
HYPOTHERMIA, ↑ WBC count.
***Tx: D&C and IV ANTIBIOTICS, such as LEVOFLOXACIN and METRONIDAZOLE
Missed Abortion - Fetal death with NO expulsion of tissue (in some cases not for
several weeks). Treat with D&C if <14 weeks of gestation, attempted delivery if more
than 14 weeks of gestation.
exam review with answers
40 y.o. female presents with AMENORRHEA, MORNING NAUSEA and VOMITING,
FATIGUE, and POLYURIA. Her LAST MENSTRUAL PERIOD was 6 WEEKS AGO, and
her BREASTS ARE FULL AND TENDER. She uses the rhythm method for
contraception. What is the most likely diagnosis? - ✔️✔️correct answer-PREGNANCY
***Pregnancy is suggested in a patient with AMENORRHEA, ENLARGEMENT of the
UTERUS, and a (+) urinary beta-hCG
23 y.o. OBESE female presents with AMENORRHEA FOR 6 MONTHS, FACIAL HAIR,
and INFERTILITY for the past 3 YEARS. What is the most likely diagnosis? -
✔️✔️correct answer-PCOS
35 y.o. female presents with AMENORRHEA, GALACTORRHEA, VISUAL FIELD
DEFECTS, and HEADACHES for the PAST 6 MONTHS. What is the most likely
diagnosis? - ✔️✔️correct answer-Amenorrhea secondary to PROLACTINOMA
51 y.o. female presents with AMENORRHEA FOR THE PAST 12 MONTHS
accompanied by HOT FLASHES, NIGHT SWEATS, EMOTIONAL LABILITY, and
DYSPAREUNIA. What is the most likely diagnosis? - ✔️✔️correct answer-Menopause
35 y.o. female presents with AMENORRHEA, COLD INTOLERANCE, COARSE HAIR,
WEIGHT LOSS, and FATIGUE. She has a HISTORY OF ABRUPTIO PLACENTAE
followed by HYPOVOLEMIC SHOCK and FAILURE OF LACTATION 2 YEARS AGO.
What is the most likely diagnosis? - ✔️✔️correct answer-Sheehan Syndrome
(postpartum hypopituitarism)
,= Excessive postpartum blood loss leading to infarction
of the pituitary gland
18 y.o. female presents with AMENORRHEA for the past 4 MONTHS. She is 5 feet, 6
inches tall and weighs 90 pounds. She has a history of VIGOROUS EXERCISE and
COLD INTOLERANCE. What is the most likely diagnosis? - ✔️✔️correct answer-
Anorexia nervosa
29 y.o. female presents with AMENORRHEA for the past 6 MONTHS. She has a history
of occasional PALPITATIONS and DIZZINESS. She lost her fiance in a car accident.
What is the most likely diagnosis? - ✔️✔️correct answer-Anxiety-induced Amenorrhea
17 y.o. female presents with PROLONGED, EXCESSIVE MENSTRUAL BLEEDING
occurring IRREGULARLY within the past 6 MONTHS. What is the most likely
diagnosis? - ✔️✔️correct answer-Dysfunctional Uterine Bleeding
61 y.o. OBESE female presents with PROFUSE VAGINAL BLEEDING for the PAST
MONTH. Her LMP was 10 YEARS AGO. She has a HISTORY OF HYPERTENSION
and DIABETES MELLITUS. She is NULLIPAROUS. What is the most likely diagnosis? -
✔️✔️correct answer-Endometrial Cancer
45 y.o. G5P5 female presents with POSTCOITAL BLEEDING. She is a CIGARETTE
SMOKER and TAKES OCPs. What is the most likely diagnosis? - ✔️✔️correct answer-
Cervical Cancer
28 y.o. female who is 8 WEEKS PREGNANT presents with LOWER ABDOMINAL PAIN
and VAGINAL BLEEDING. What is the most likely diagnosis? - ✔️✔️correct answer-
Spontaneous Abortion
32 y.o. female presents with SUDDEN ONSET of LEFT LOWER ABDOMINAL PAIN
that radiates to the scapula and back and is associated with VAGINAL BLEEDING. Her
LMP was 5 WEEKS AGO. She has a history of PID and UNPROTECTED
INTERCOURSE. What is the most likely diagnosis? - ✔️✔️correct answer-Ectopic
Pregnancy
***If RUPTURED, can be HYPOTENSIVE with PERITONEAL IRRITATION (eg,
rebound tenderness)
Risk Factors:
(1) Previous Ectopic pregnancies (STRONGEST RISK FACTOR)
(2) PID
(3) IUD
,28 y.o. female presents with a THIN, GRAY-WHITE, FOUL-SMELLING VAGINAL
DISCHARGE. What is the most likely diagnosis? - ✔️✔️correct answer-Bacterial
Vaginosis
Tx: Metronidazole 500mg PO bid x 7 days
30 y.o. female presents with a THICK, WHITE, COTTAGE CHEESE-LIKE, ODORLESS
VAGINAL DISCHARGE and VAGINAL ITCHING. What is the most likely diagnosis? -
✔️✔️correct answer-Vaginitis-candidal
*pH≤4.5
*KOH wetmount reveals hyphae and spores
RISK FACTORS: DM, Broad-spectrum antibiotic use, Pregnancy, Corticosteroids
Tx: Fluconazole 150mg PO in a single dose
35 y.o. female presents with a MALODOROUS, PROFUSE, FROTHY, GREENISH
VAGINAL DISCHARGE with INTENSE VAGINAL ITCHING and DISCOMFORT. What
is the most likely diagnosis? - ✔️✔️correct answer-Vaginitis-trichomonal
***Petechiae on vagina and cervix ("strawberry cervix")
Tx: Metronidazole 2g PO single dose
***Symptomatic pregnant women should be treated with 2g Metronidazole once
***Treat even if asymptomatic!
***Treat partner(s)
54 y.o. female complains of DYSPAREUNIA and POST-COITAL SPOTTING. Her LMP
was 9 months ago. She has HOT FLASHES. What is the most likely diagnosis? -
✔️✔️correct answer-Atrophic Vaginitis
37 y.o. female presents with DYSPAREUNIA, INABILITY TO CONCEIVE, and
DYSMENORRHEA. What is the most likely diagnosis? - ✔️✔️correct answer-
Endometriosis
Naegele's rule - ✔️✔️correct answer-LMP - 3 Months + 7 Days = Estimated day of
delivery
Goodell's Sign - ✔️✔️correct answer-One of the FIRST SIGNS of pregnancy that is
seen on physical exam is the GOODELL SIGN, SOFTENING OF THE CERVIX that is
felt first at 4-6 WEEKS.
What is the BEST INITIAL TEST when suspecting pregnancy? - ✔️✔️correct answer-
beta-HCG
(+) in SERUM 9 days POST-CONCEPTION
(+) in URINE 28 days AFTER FIRST DAY OF LMP
, PLASMA LEVELS DOUBLE every 1-2 days, peak at 8-10 weeks, then fall to a plateau
until delivery.
Beta-HCG > 1500 or 5 weeks = Gestational Sac on ultrasound
A 17 y.o. woman presents for a routine prenatal checkup at 12 weeks. Which of the
following is the MOST ACCURATE method to establish gestational age?
A) Ultrasound
B) Beta-HCG
C) Pelvic Exam
D) Fundal Height
E) LMP - ✔️✔️correct answer-A. ULTRASOUND is the MOST ACCURATE way of
establishing gestational age at 11 to 14 weeks.
A 20 y.o. woman presents to the ER for VAGINAL BLEEDING and LOWER
ABDOMINAL PAIN for 1 day. She states that she is 15 weeks pregnant. Vital signs
include temperature 37°C, HR 100 bpm, BP 110/75 mm Hg, and RR 12 per minute. On
pelvic exam, there is BLOOD PRESENT IN THE VAULT. U/S shows INTRAUTERINE
BLEEDING, PRODUCTS OF CONCEPTION, and a DILATED CERVIX. Which of the
following is the MOST LIKELY DIAGNOSIS in this patient?
A) Complete abortion
B) Incomplete abortion
C) Inevitable abortion
D) Threatened abortion
E) Septic abortion - ✔️✔️correct answer-C. An INEVITABLE ABORTION is
characterized by UTERINE BLEEDING with CERVICAL DILATION and CRAMPY
ABDOMINAL PAIN and NO TISSUE EXPULSION.
Review:
Complete Abortion - EXPULSION OF ALL PRODUCTS OF CONCEPTION (POC)
FROM THE UTERUS. Pain ceases, but spotting may persist. CLOSED OS. U/S shows
an empty uterus. Treat with SERIAL TESTING of hCG LEVEL to make sure that it goes
down to ZERO.
Incomplete Abortion - PASSAGE OF SOME POC THROUGH THE CERVIX.
Bleeding/mild cramping. Visible tissue on exam. OPEN OS. U/S shows retained fetal
tissue
Threatened Abortion - PRODUCTS OF CONCEPTION INTACT. Intrauterine
BLEEDING, NO dilation of cervix. CLOSED OS + intact membranes + fetal cardiac
motion on ultrasound. Treat with bed rest and pelvic rest
Septic Abortion - Infection of the uterus and the surrounding areas. HYPOTENSION,
HYPOTHERMIA, ↑ WBC count.
***Tx: D&C and IV ANTIBIOTICS, such as LEVOFLOXACIN and METRONIDAZOLE
Missed Abortion - Fetal death with NO expulsion of tissue (in some cases not for
several weeks). Treat with D&C if <14 weeks of gestation, attempted delivery if more
than 14 weeks of gestation.
