OB/GYN: ACOG GYNECOLOGY
UPDATED ACTUAL Questions and
CORRECT Answers
A 24-year-old G1P1 woman comes to the office requesting contraception. Her past medical
history is unremarkable, except for a family history of ovarian cancer. She denies alcohol,
smoking and recreational drug use. She is in a monogamous relationship. She wants to decrease
her risk of gynecological cancer. Of the following, what is the best method of contraception for
this patient?
A. Female condoms
B. Male condoms
C. Copper containing intrauterine device
D. Progesterone containing intrauterine device
E. Combined oral contraceptives - CORRECT ANSWER - E. Oral contraceptives will
decrease a woman's risk of developing ovarian and endometrial cancer. The earlier, higher dose
oral contraceptive pills have been linked to a slight increase in breast cancer, but not the most
recent lower dose pills. Women who use oral contraceptive pills have a slightly higher risk of
developing cervical intraepithelial neoplasia, but their risk of developing PID, endometriosis,
benign breast changes and ectopic pregnancy are reduced. Both hypertension and
thromboembolic disorders can be a potential side effect from using oral contraceptive pills.
Condoms and intrauterine devices will not lower her risk of ovarian cancer.
A 35-year-old G3P3 woman comes to the office because she desires contraception. Her past
medical history is significant for Wilson's disease, chronic hypertension and anemia secondary to
menorrhagia. She is currently on no medications. Her vital signs reveal a blood pressure of
144/96. Which of the following contraceptives is the best option for this patient?
A. Progestin-only pill
B. Low dose combination contraceptive
C. Continuous oral contraceptive
D. Copper containing intrauterine device
, E. Levonorgestrel intrauterine device - CORRECT ANSWER - E. The levonorgestrel
intrauterine device has lower failure rates within the first year of use than does the copper
containing intrauterine device. It causes more disruption in menstrual bleeding, especially during
the first few months of use, although the overall volume of bleeding is decreased long-term and
many women become amenorrheic. The levonorgestrel intrauterine device is protective against
endometrial cancer due to release of progestin in the endometrial cavity. She is not a candidate
for oral contraceptive pills because of her poorly controlled chronic hypertension. The progestin
only pills have a much higher failure rate than the progesterone intrauterine device. She is not a
candidate for the copper-containing intrauterine device because of her history of Wilson's
disease.
A 23-year-old G2P1 woman with six weeks amenorrhea presents with lower abdominal pain and
vaginal bleeding. Her temperature is 102.0°F (38.9°C) and the cervix is 1 cm dilated. Uterus is
eight-week size and tender. There are no adnexal masses. Urine pregnancy test is positive. What
is the most likely diagnosis?
A. Threatened abortion
B. Missed abortion
C. Normal pregnancy
D. Septic abortion
E. Ectopic Pregnancy - CORRECT ANSWER - D. The patient has a septic abortion. She
has fever and bleeding with a dilated cervix which are findings seen with septic abortion.
Threatened abortions clinically have vaginal bleeding, a positive pregnancy test and a cervical os
closed or uneffaced, while missed abortions have retention of a nonviable intrauterine pregnancy
for an extended period of time (i.e. dead fetus or blighted ovum). A normal pregnancy would
have a closed cervix. Ectopic pregnancy would likely present with bleeding, abdominal pain,
possibly have an adnexal mass, and the cervix would typically be closed.
How do you manage septic abortions? - CORRECT ANSWER - The management of
septic abortion includes broad-spectrum antibiotics and uterine evacuation. Single agent
antimicrobials do not provide adequate coverage for the array of organisms that may be involved
and therefore are not indicated. A laparoscopy can be indicated if ectopic pregnancy is suspected,
but it is unlikely in this case. Medical termination is not the best option since prompt evacuation
of the uterus is indicated in this case.
A 29-year-old G3P0 woman presents for evaluation and treatment of pregnancy loss. Her past
medical history is remarkable for three early (<14 weeks gestation) pregnancy losses. Parental
, karyotype was normal. Which of the following is the most appropriate next step in the
management of this patient?
A. Place a prophylactic cerclage with her next pregnancy
B. Obtain serial cervical length with her next pregnancy
C. Recommend 17-hydroxyprogesterone with her next pregnancy
D. Check for Factor V Leiden mutation
E. Check antiphospholipid antibodies - CORRECT ANSWER - E. Antiphosphospholipid
antibodies are associated with recurrent pregnancy loss. The workup for antiphospholipid
syndrome includes assessment of anticardiolipin and beta-2 glycoprotein antibody status, PTT,
and Russell viper venom time. There are multiple etiologies for recurrent pregnancy loss, which
is defined as > two consecutive or > three spontaneous losses before 20 weeks gestation.
Etiologies include anatomic causes, endocrine abnormalities such as hyper or hypothyroidism
and luteal phase deficiency, parental chromosomal anomalies, immune factors such as lupus
anticoagulant and idiopathic factors. Her history is not consistent with cervical insufficiency
which is diagnosed typically in the second trimester by history, physical exam and other
diagnostic tests, such as ultrasound. Serial cervical lengths or placement of a cerclage are not
indicated in this patient. Treatment with 17-hydroxyprogesterone is indicated in patients with a
history of prior preterm birth. Factor V Leiden mutation has not been associated with recurrent
pregnancy loss. It can be associated with thrombotic events.
A 29-year-old G3P0 woman presents for evaluation and treatment of pregnancy loss. Her past
medical history is remarkable for three early (<16 weeks gestation) pregnancy losses and a deep
vein thrombosis two years ago. Her work up includes: prolonged dilute Russell viper venom test;
elevated anticardiolipin antibodies; normal thyroid function; normal prolactin; and normal MRI
of the pelvis. She wishes to get pregnant soon. In addition to aspirin, which of the following
treatments is appropriate for this patient?
A. No additional treatment
B. Corticosteroid
C. Heparin
D. 17-OH progesterone
E. Bromocriptine - CORRECT ANSWER - C. The prolonged dilute Russell viper venom
time leads one to suspect that the etiology of recurrent pregnancy loss is due to antiphospholipid
antibody syndrome. The treatment is aspirin plus heparin. There is roughly a 75% success rate
with combination therapy versus aspirin alone. There is conflicting evidence regarding steroid
use for treatment. 17-OH progesterone is used for the prevention of preterm delivery and not
recurrent pregnancy loss.
UPDATED ACTUAL Questions and
CORRECT Answers
A 24-year-old G1P1 woman comes to the office requesting contraception. Her past medical
history is unremarkable, except for a family history of ovarian cancer. She denies alcohol,
smoking and recreational drug use. She is in a monogamous relationship. She wants to decrease
her risk of gynecological cancer. Of the following, what is the best method of contraception for
this patient?
A. Female condoms
B. Male condoms
C. Copper containing intrauterine device
D. Progesterone containing intrauterine device
E. Combined oral contraceptives - CORRECT ANSWER - E. Oral contraceptives will
decrease a woman's risk of developing ovarian and endometrial cancer. The earlier, higher dose
oral contraceptive pills have been linked to a slight increase in breast cancer, but not the most
recent lower dose pills. Women who use oral contraceptive pills have a slightly higher risk of
developing cervical intraepithelial neoplasia, but their risk of developing PID, endometriosis,
benign breast changes and ectopic pregnancy are reduced. Both hypertension and
thromboembolic disorders can be a potential side effect from using oral contraceptive pills.
Condoms and intrauterine devices will not lower her risk of ovarian cancer.
A 35-year-old G3P3 woman comes to the office because she desires contraception. Her past
medical history is significant for Wilson's disease, chronic hypertension and anemia secondary to
menorrhagia. She is currently on no medications. Her vital signs reveal a blood pressure of
144/96. Which of the following contraceptives is the best option for this patient?
A. Progestin-only pill
B. Low dose combination contraceptive
C. Continuous oral contraceptive
D. Copper containing intrauterine device
, E. Levonorgestrel intrauterine device - CORRECT ANSWER - E. The levonorgestrel
intrauterine device has lower failure rates within the first year of use than does the copper
containing intrauterine device. It causes more disruption in menstrual bleeding, especially during
the first few months of use, although the overall volume of bleeding is decreased long-term and
many women become amenorrheic. The levonorgestrel intrauterine device is protective against
endometrial cancer due to release of progestin in the endometrial cavity. She is not a candidate
for oral contraceptive pills because of her poorly controlled chronic hypertension. The progestin
only pills have a much higher failure rate than the progesterone intrauterine device. She is not a
candidate for the copper-containing intrauterine device because of her history of Wilson's
disease.
A 23-year-old G2P1 woman with six weeks amenorrhea presents with lower abdominal pain and
vaginal bleeding. Her temperature is 102.0°F (38.9°C) and the cervix is 1 cm dilated. Uterus is
eight-week size and tender. There are no adnexal masses. Urine pregnancy test is positive. What
is the most likely diagnosis?
A. Threatened abortion
B. Missed abortion
C. Normal pregnancy
D. Septic abortion
E. Ectopic Pregnancy - CORRECT ANSWER - D. The patient has a septic abortion. She
has fever and bleeding with a dilated cervix which are findings seen with septic abortion.
Threatened abortions clinically have vaginal bleeding, a positive pregnancy test and a cervical os
closed or uneffaced, while missed abortions have retention of a nonviable intrauterine pregnancy
for an extended period of time (i.e. dead fetus or blighted ovum). A normal pregnancy would
have a closed cervix. Ectopic pregnancy would likely present with bleeding, abdominal pain,
possibly have an adnexal mass, and the cervix would typically be closed.
How do you manage septic abortions? - CORRECT ANSWER - The management of
septic abortion includes broad-spectrum antibiotics and uterine evacuation. Single agent
antimicrobials do not provide adequate coverage for the array of organisms that may be involved
and therefore are not indicated. A laparoscopy can be indicated if ectopic pregnancy is suspected,
but it is unlikely in this case. Medical termination is not the best option since prompt evacuation
of the uterus is indicated in this case.
A 29-year-old G3P0 woman presents for evaluation and treatment of pregnancy loss. Her past
medical history is remarkable for three early (<14 weeks gestation) pregnancy losses. Parental
, karyotype was normal. Which of the following is the most appropriate next step in the
management of this patient?
A. Place a prophylactic cerclage with her next pregnancy
B. Obtain serial cervical length with her next pregnancy
C. Recommend 17-hydroxyprogesterone with her next pregnancy
D. Check for Factor V Leiden mutation
E. Check antiphospholipid antibodies - CORRECT ANSWER - E. Antiphosphospholipid
antibodies are associated with recurrent pregnancy loss. The workup for antiphospholipid
syndrome includes assessment of anticardiolipin and beta-2 glycoprotein antibody status, PTT,
and Russell viper venom time. There are multiple etiologies for recurrent pregnancy loss, which
is defined as > two consecutive or > three spontaneous losses before 20 weeks gestation.
Etiologies include anatomic causes, endocrine abnormalities such as hyper or hypothyroidism
and luteal phase deficiency, parental chromosomal anomalies, immune factors such as lupus
anticoagulant and idiopathic factors. Her history is not consistent with cervical insufficiency
which is diagnosed typically in the second trimester by history, physical exam and other
diagnostic tests, such as ultrasound. Serial cervical lengths or placement of a cerclage are not
indicated in this patient. Treatment with 17-hydroxyprogesterone is indicated in patients with a
history of prior preterm birth. Factor V Leiden mutation has not been associated with recurrent
pregnancy loss. It can be associated with thrombotic events.
A 29-year-old G3P0 woman presents for evaluation and treatment of pregnancy loss. Her past
medical history is remarkable for three early (<16 weeks gestation) pregnancy losses and a deep
vein thrombosis two years ago. Her work up includes: prolonged dilute Russell viper venom test;
elevated anticardiolipin antibodies; normal thyroid function; normal prolactin; and normal MRI
of the pelvis. She wishes to get pregnant soon. In addition to aspirin, which of the following
treatments is appropriate for this patient?
A. No additional treatment
B. Corticosteroid
C. Heparin
D. 17-OH progesterone
E. Bromocriptine - CORRECT ANSWER - C. The prolonged dilute Russell viper venom
time leads one to suspect that the etiology of recurrent pregnancy loss is due to antiphospholipid
antibody syndrome. The treatment is aspirin plus heparin. There is roughly a 75% success rate
with combination therapy versus aspirin alone. There is conflicting evidence regarding steroid
use for treatment. 17-OH progesterone is used for the prevention of preterm delivery and not
recurrent pregnancy loss.
