ACOG OB/GYN In-Training Form 164
Exam With Actual 120 Questions &
Verified Answers,Plus
Rationales/Expert Verified For
Guaranteed Pass Graded A+/
2025/2026 /Latest Update/Instant
Download Pdf
1. A 28-year-old woman presents with secondary amenorrhea for 6 months. She has
normal BMI and no galactorrhea. Which test is most appropriate first?
A) TSH
B) Prolactin
C) FSH and LH
D) Pelvic ultrasound
B) Prolactin
Rationale: Prolactin should be checked first in secondary amenorrhea, especially if
galactorrhea is present. Elevated prolactin can suppress ovulation.
2. A 32-year-old G2P1 at 20 weeks’ gestation presents with painless vaginal bleeding.
What is the most likely diagnosis?
A) Placenta previa
B) Placental abruption
C) Vasa previa
D) Cervical insufficiency
A) Placenta previa
Rationale: Painless bleeding in the second trimester is characteristic of placenta previa.
Ultrasound confirms placental location.
3. The recommended screening test for gestational diabetes at 24–28 weeks is:
A) 50-g glucose challenge test
B) 1-hour 100-g oral glucose tolerance test
, C) Fasting plasma glucose
D) Hemoglobin A1C
A) 50-g glucose challenge test
Rationale: The 50-g non-fasting glucose challenge test is the initial screening. If abnormal,
a 3-hour OGTT is performed.
4. Which of the following is the most effective contraception for a woman postpartum
who is breastfeeding?
A) Combined oral contraceptives
B) Progestin-only pills
C) Copper IUD
D) Barrier methods
B) Progestin-only pills
Rationale: Progestin-only methods do not interfere with lactation and are safe for
postpartum women.
5. A 45-year-old woman has postmenopausal bleeding. Which is the initial test of
choice?
A) Endometrial biopsy
B) Transvaginal ultrasound
C) Hysterosalpingogram
D) MRI pelvis
B) Transvaginal ultrasound
Rationale: TVUS is first-line to assess endometrial thickness. Biopsy is indicated if thickness
>4 mm or if imaging is suspicious.
6. A patient presents with a 3-cm ovarian cyst, asymptomatic, premenopausal.
Management is:
A) Immediate surgery
B) Repeat ultrasound in 6–12 weeks
C) Chemotherapy
D) MRI pelvis
B) Repeat ultrasound in 6–12 weeks
Rationale: Simple cysts <5 cm in premenopausal women are often functional and can be
monitored with follow-up imaging.
7. A 26-year-old presents with acute pelvic pain, nausea, and vomiting. Ultrasound
shows an adnexal mass with absent Doppler flow. Most likely diagnosis:
A) Ectopic pregnancy
B) Ovarian torsion
, C) Appendicitis
D) Pelvic inflammatory disease
B) Ovarian torsion
Rationale: Sudden onset pelvic pain with an adnexal mass and absent blood flow is classic
for ovarian torsion.
8. What is the most common cause of postpartum hemorrhage?
A) Retained placenta
B) Uterine atony
C) Coagulopathy
D) Trauma
B) Uterine atony
Rationale: Uterine atony accounts for ~70–80% of postpartum hemorrhage cases. Initial
management includes uterotonics and massage.
9. The most common site for ectopic pregnancy is:
A) Ovary
B) Fallopian tube
C) Abdominal cavity
D) Cervix
B) Fallopian tube
Rationale: Approximately 95% of ectopic pregnancies occur in the fallopian tube,
particularly the ampullary portion.
10. A patient with a history of deep vein thrombosis is 32 weeks pregnant. Which
anticoagulant is preferred?
A) Warfarin
B) Heparin
C) DOACs
D) Aspirin
B) Heparin
Rationale: LMWH or unfractionated heparin is preferred during pregnancy as it does not
cross the placenta, unlike warfarin.
11. The most common cause of infertility in women is:
A) Ovulatory dysfunction
B) Tubal blockage
C) Endometriosis
D) Uterine fibroids
A) Ovulatory dysfunction
Rationale: Ovulatory disorders, including PCOS, are the leading cause of female infertility.
Exam With Actual 120 Questions &
Verified Answers,Plus
Rationales/Expert Verified For
Guaranteed Pass Graded A+/
2025/2026 /Latest Update/Instant
Download Pdf
1. A 28-year-old woman presents with secondary amenorrhea for 6 months. She has
normal BMI and no galactorrhea. Which test is most appropriate first?
A) TSH
B) Prolactin
C) FSH and LH
D) Pelvic ultrasound
B) Prolactin
Rationale: Prolactin should be checked first in secondary amenorrhea, especially if
galactorrhea is present. Elevated prolactin can suppress ovulation.
2. A 32-year-old G2P1 at 20 weeks’ gestation presents with painless vaginal bleeding.
What is the most likely diagnosis?
A) Placenta previa
B) Placental abruption
C) Vasa previa
D) Cervical insufficiency
A) Placenta previa
Rationale: Painless bleeding in the second trimester is characteristic of placenta previa.
Ultrasound confirms placental location.
3. The recommended screening test for gestational diabetes at 24–28 weeks is:
A) 50-g glucose challenge test
B) 1-hour 100-g oral glucose tolerance test
, C) Fasting plasma glucose
D) Hemoglobin A1C
A) 50-g glucose challenge test
Rationale: The 50-g non-fasting glucose challenge test is the initial screening. If abnormal,
a 3-hour OGTT is performed.
4. Which of the following is the most effective contraception for a woman postpartum
who is breastfeeding?
A) Combined oral contraceptives
B) Progestin-only pills
C) Copper IUD
D) Barrier methods
B) Progestin-only pills
Rationale: Progestin-only methods do not interfere with lactation and are safe for
postpartum women.
5. A 45-year-old woman has postmenopausal bleeding. Which is the initial test of
choice?
A) Endometrial biopsy
B) Transvaginal ultrasound
C) Hysterosalpingogram
D) MRI pelvis
B) Transvaginal ultrasound
Rationale: TVUS is first-line to assess endometrial thickness. Biopsy is indicated if thickness
>4 mm or if imaging is suspicious.
6. A patient presents with a 3-cm ovarian cyst, asymptomatic, premenopausal.
Management is:
A) Immediate surgery
B) Repeat ultrasound in 6–12 weeks
C) Chemotherapy
D) MRI pelvis
B) Repeat ultrasound in 6–12 weeks
Rationale: Simple cysts <5 cm in premenopausal women are often functional and can be
monitored with follow-up imaging.
7. A 26-year-old presents with acute pelvic pain, nausea, and vomiting. Ultrasound
shows an adnexal mass with absent Doppler flow. Most likely diagnosis:
A) Ectopic pregnancy
B) Ovarian torsion
, C) Appendicitis
D) Pelvic inflammatory disease
B) Ovarian torsion
Rationale: Sudden onset pelvic pain with an adnexal mass and absent blood flow is classic
for ovarian torsion.
8. What is the most common cause of postpartum hemorrhage?
A) Retained placenta
B) Uterine atony
C) Coagulopathy
D) Trauma
B) Uterine atony
Rationale: Uterine atony accounts for ~70–80% of postpartum hemorrhage cases. Initial
management includes uterotonics and massage.
9. The most common site for ectopic pregnancy is:
A) Ovary
B) Fallopian tube
C) Abdominal cavity
D) Cervix
B) Fallopian tube
Rationale: Approximately 95% of ectopic pregnancies occur in the fallopian tube,
particularly the ampullary portion.
10. A patient with a history of deep vein thrombosis is 32 weeks pregnant. Which
anticoagulant is preferred?
A) Warfarin
B) Heparin
C) DOACs
D) Aspirin
B) Heparin
Rationale: LMWH or unfractionated heparin is preferred during pregnancy as it does not
cross the placenta, unlike warfarin.
11. The most common cause of infertility in women is:
A) Ovulatory dysfunction
B) Tubal blockage
C) Endometriosis
D) Uterine fibroids
A) Ovulatory dysfunction
Rationale: Ovulatory disorders, including PCOS, are the leading cause of female infertility.
