Family Medicine EOR OBGYN Exam (2026/2027) |
QUESTIONS AND VERIFIED ANSWERS
Physician Assistant (PA) Family Medicine End of Rotation (EOR) Obstetrics & Gynecology
Examination | Core Domains: Routine Prenatal Care & Screening, Intrapartum & Postpartum
Care, Common Gynecologic Infections (STIs, PID, BV), Contraception Counseling &
Management, Menstrual Disorders (AUB, Dysmenorrhea, PMS/PMDD), Breast Health &
Screening, Menopause Management & HRT, Pelvic Pain & Endometriosis, and Well-Woman
Care & Cancer Screening (Pap, HPV, Mammography) | Physician Assistant Education Focus |
Specialty-Specific EOR Exam Format
Exam Structure
The Family Medicine EOR OBGYN exam for the 2026/2027 academic cycle is an 85-question,
multiple-choice question (MCQ) examination.
Introduction
This Family Medicine EOR OBGYN exam guide for the 2026/2027 cycle prepares Physician
Assistant students for the obstetrics and gynecology-focused End of Rotation examination. The
content assesses comprehensive women's health care across the lifespan, emphasizing
evidence-based screening, management of common conditions, patient education, and the
integration of OBGYN services within the family medicine scope of practice.
Answer Format
All correct answers and clinical management strategies must be presented in bold and green,
followed by detailed rationales that reference current ACOG guidelines, USPSTF screening
recommendations, appropriate antibiotic regimens for infections, contraceptive eligibility
criteria (US MEC), and clear thresholds for obstetric or gynecologic referral.
Question 1: A 28-year-old woman at 10 weeks’ gestation presents for her first prenatal visit.
She has no medical problems. According to ACOG, which of the following is recommended as
part of routine first-trimester screening?
(A) Glucose challenge test
(B) Group B streptococcus culture
(C) Cell-free DNA screening for aneuploidy
(D) Quad screen
,(E) Anatomy ultrasound
Correct Answer: (C) Cell-free DNA screening for aneuploidy
Rationale: Cell-free DNA (cfDNA) screening, also known as non-invasive prenatal testing
(NIPT), can be performed as early as 10 weeks and screens for trisomies 21, 18, and 13, as well as
sex chromosome abnormalities. It is recommended for all pregnant individuals, especially those
at increased risk. Glucose challenge test is done at 24–28 weeks. Group B strep culture is
performed at 36–37 weeks. Quad screen is a second-trimester serum screen (15–22 weeks).
Anatomy ultrasound is typically done at 18–22 weeks. First-trimester labs also include CBC,
blood type/Rh, rubella immunity, HIV, syphilis, hepatitis B, and urinalysis.
Question 2: A 32-year-old woman presents with vaginal discharge that is thin, gray, and has a
fishy odor, especially after intercourse. Wet mount shows clue cells and a vaginal pH of 5.2.
Which of the following is the most appropriate treatment?
(A) Fluconazole 150 mg PO single dose
(B) Metronidazole 500 mg PO twice daily for 7 days
(C) Ceftriaxone 250 mg IM plus azithromycin 1 g PO
(D) Acyclovir 400 mg PO three times daily for 7 days
(E) Clindamycin cream nightly for 7 days
Correct Answer: (B) Metronidazole 500 mg PO twice daily for 7 days
Rationale: This patient has bacterial vaginosis (BV), diagnosed by Amsel criteria (≥3 of: thin
gray discharge, pH >4.5, positive whiff test, clue cells on wet mount). First-line treatment is oral
metronidazole 500 mg twice daily for 7 days or metronidazole gel intravaginally. Clindamycin
cream (E) is an alternative but less preferred due to higher recurrence rates. Fluconazole treats
candidiasis. Ceftriaxone/azithromycin is for chlamydia/gonorrhea. Acyclovir is for HSV. Male
partners do not require treatment.
Question 3: A 25-year-old woman requests contraception. She has a history of migraine with
aura. According to the U.S. Medical Eligibility Criteria (US MEC), which of the following is
contraindicated?
,(A) Progestin-only pill
(B) Levonorgestrel IUD
(C) Combined oral contraceptive pill
(D) Depot medroxyprogesterone acetate (DMPA)
(E) Etonogestrel implant
Correct Answer: (C) Combined oral contraceptive pill
Rationale: Combined hormonal contraceptives (CHCs) are Category 4 (unacceptable health
risk) in women with migraine with aura due to significantly increased risk of ischemic stroke.
Progestin-only methods (pills, implant, DMPA, IUDs) are safe (Category 1 or 2). The
levonorgestrel IUD and etonogestrel implant are highly effective, long-acting reversible
contraceptives (LARCs) and ideal choices. Always confirm aura characteristics—true aura
includes visual, sensory, or speech symptoms that develop gradually and last 5–60 minutes.
Question 4: A 48-year-old woman presents with heavy menstrual bleeding for the past 6
months, soaking a pad every 2 hours. Pelvic ultrasound shows a 2 cm endometrial stripe and no
fibroids. Her hemoglobin is 9.8 g/dL. Which of the following is the most appropriate next step?
(A) Start combined oral contraceptives
(B) Perform endometrial biopsy
(C) Prescribe tranexamic acid
(D) Order thyroid function tests
(E) Reassure and observe
, Correct Answer: (B) Perform endometrial biopsy
Rationale: Per ACOG, endometrial biopsy is indicated in women ≥45 years with abnormal
uterine bleeding (AUB), or in younger women with risk factors for endometrial
hyperplasia/cancer (e.g., obesity, PCOS, unopposed estrogen exposure). Heavy bleeding causing
anemia warrants evaluation. While tranexamic acid and hormonal therapy (e.g., LNG-IUD) are
treatment options, structural and histologic causes must be ruled out first. An endometrial
thickness >4 mm in postmenopausal women is concerning, but in perimenopausal women, even
thinner linings can harbor pathology if bleeding is abnormal.
Question 5: A 30-year-old woman at 38 weeks’ gestation presents in active labor. She develops
sudden-onset severe abdominal pain, vaginal bleeding, and fetal bradycardia. Uterus is rigid and
tender. What is the most likely diagnosis?
(A) Placenta previa
(B) Uterine rupture
(C) Placental abruption
(D) Vasa previa
(E) Cervical laceration
Correct Answer: (C) Placental abruption
Rationale: Placental abruption is premature separation of the placenta after 20 weeks,
presenting with painful vaginal bleeding, uterine tenderness/rigidity, and fetal distress. Risk
factors include hypertension, trauma, smoking, and cocaine use. Placenta previa causes painless
bleeding. Uterine rupture may occur in women with prior cesarean and presents with loss of
contractions, abdominal pain, and fetal distress—but uterus is not typically rigid. Vasa previa
causes painless bleeding with fetal exsanguination. Immediate delivery is often required for
abruption with fetal compromise.
Question 6: According to USPSTF guidelines, at what age should average-risk women begin
cervical cancer screening with Pap smear?
QUESTIONS AND VERIFIED ANSWERS
Physician Assistant (PA) Family Medicine End of Rotation (EOR) Obstetrics & Gynecology
Examination | Core Domains: Routine Prenatal Care & Screening, Intrapartum & Postpartum
Care, Common Gynecologic Infections (STIs, PID, BV), Contraception Counseling &
Management, Menstrual Disorders (AUB, Dysmenorrhea, PMS/PMDD), Breast Health &
Screening, Menopause Management & HRT, Pelvic Pain & Endometriosis, and Well-Woman
Care & Cancer Screening (Pap, HPV, Mammography) | Physician Assistant Education Focus |
Specialty-Specific EOR Exam Format
Exam Structure
The Family Medicine EOR OBGYN exam for the 2026/2027 academic cycle is an 85-question,
multiple-choice question (MCQ) examination.
Introduction
This Family Medicine EOR OBGYN exam guide for the 2026/2027 cycle prepares Physician
Assistant students for the obstetrics and gynecology-focused End of Rotation examination. The
content assesses comprehensive women's health care across the lifespan, emphasizing
evidence-based screening, management of common conditions, patient education, and the
integration of OBGYN services within the family medicine scope of practice.
Answer Format
All correct answers and clinical management strategies must be presented in bold and green,
followed by detailed rationales that reference current ACOG guidelines, USPSTF screening
recommendations, appropriate antibiotic regimens for infections, contraceptive eligibility
criteria (US MEC), and clear thresholds for obstetric or gynecologic referral.
Question 1: A 28-year-old woman at 10 weeks’ gestation presents for her first prenatal visit.
She has no medical problems. According to ACOG, which of the following is recommended as
part of routine first-trimester screening?
(A) Glucose challenge test
(B) Group B streptococcus culture
(C) Cell-free DNA screening for aneuploidy
(D) Quad screen
,(E) Anatomy ultrasound
Correct Answer: (C) Cell-free DNA screening for aneuploidy
Rationale: Cell-free DNA (cfDNA) screening, also known as non-invasive prenatal testing
(NIPT), can be performed as early as 10 weeks and screens for trisomies 21, 18, and 13, as well as
sex chromosome abnormalities. It is recommended for all pregnant individuals, especially those
at increased risk. Glucose challenge test is done at 24–28 weeks. Group B strep culture is
performed at 36–37 weeks. Quad screen is a second-trimester serum screen (15–22 weeks).
Anatomy ultrasound is typically done at 18–22 weeks. First-trimester labs also include CBC,
blood type/Rh, rubella immunity, HIV, syphilis, hepatitis B, and urinalysis.
Question 2: A 32-year-old woman presents with vaginal discharge that is thin, gray, and has a
fishy odor, especially after intercourse. Wet mount shows clue cells and a vaginal pH of 5.2.
Which of the following is the most appropriate treatment?
(A) Fluconazole 150 mg PO single dose
(B) Metronidazole 500 mg PO twice daily for 7 days
(C) Ceftriaxone 250 mg IM plus azithromycin 1 g PO
(D) Acyclovir 400 mg PO three times daily for 7 days
(E) Clindamycin cream nightly for 7 days
Correct Answer: (B) Metronidazole 500 mg PO twice daily for 7 days
Rationale: This patient has bacterial vaginosis (BV), diagnosed by Amsel criteria (≥3 of: thin
gray discharge, pH >4.5, positive whiff test, clue cells on wet mount). First-line treatment is oral
metronidazole 500 mg twice daily for 7 days or metronidazole gel intravaginally. Clindamycin
cream (E) is an alternative but less preferred due to higher recurrence rates. Fluconazole treats
candidiasis. Ceftriaxone/azithromycin is for chlamydia/gonorrhea. Acyclovir is for HSV. Male
partners do not require treatment.
Question 3: A 25-year-old woman requests contraception. She has a history of migraine with
aura. According to the U.S. Medical Eligibility Criteria (US MEC), which of the following is
contraindicated?
,(A) Progestin-only pill
(B) Levonorgestrel IUD
(C) Combined oral contraceptive pill
(D) Depot medroxyprogesterone acetate (DMPA)
(E) Etonogestrel implant
Correct Answer: (C) Combined oral contraceptive pill
Rationale: Combined hormonal contraceptives (CHCs) are Category 4 (unacceptable health
risk) in women with migraine with aura due to significantly increased risk of ischemic stroke.
Progestin-only methods (pills, implant, DMPA, IUDs) are safe (Category 1 or 2). The
levonorgestrel IUD and etonogestrel implant are highly effective, long-acting reversible
contraceptives (LARCs) and ideal choices. Always confirm aura characteristics—true aura
includes visual, sensory, or speech symptoms that develop gradually and last 5–60 minutes.
Question 4: A 48-year-old woman presents with heavy menstrual bleeding for the past 6
months, soaking a pad every 2 hours. Pelvic ultrasound shows a 2 cm endometrial stripe and no
fibroids. Her hemoglobin is 9.8 g/dL. Which of the following is the most appropriate next step?
(A) Start combined oral contraceptives
(B) Perform endometrial biopsy
(C) Prescribe tranexamic acid
(D) Order thyroid function tests
(E) Reassure and observe
, Correct Answer: (B) Perform endometrial biopsy
Rationale: Per ACOG, endometrial biopsy is indicated in women ≥45 years with abnormal
uterine bleeding (AUB), or in younger women with risk factors for endometrial
hyperplasia/cancer (e.g., obesity, PCOS, unopposed estrogen exposure). Heavy bleeding causing
anemia warrants evaluation. While tranexamic acid and hormonal therapy (e.g., LNG-IUD) are
treatment options, structural and histologic causes must be ruled out first. An endometrial
thickness >4 mm in postmenopausal women is concerning, but in perimenopausal women, even
thinner linings can harbor pathology if bleeding is abnormal.
Question 5: A 30-year-old woman at 38 weeks’ gestation presents in active labor. She develops
sudden-onset severe abdominal pain, vaginal bleeding, and fetal bradycardia. Uterus is rigid and
tender. What is the most likely diagnosis?
(A) Placenta previa
(B) Uterine rupture
(C) Placental abruption
(D) Vasa previa
(E) Cervical laceration
Correct Answer: (C) Placental abruption
Rationale: Placental abruption is premature separation of the placenta after 20 weeks,
presenting with painful vaginal bleeding, uterine tenderness/rigidity, and fetal distress. Risk
factors include hypertension, trauma, smoking, and cocaine use. Placenta previa causes painless
bleeding. Uterine rupture may occur in women with prior cesarean and presents with loss of
contractions, abdominal pain, and fetal distress—but uterus is not typically rigid. Vasa previa
causes painless bleeding with fetal exsanguination. Immediate delivery is often required for
abruption with fetal compromise.
Question 6: According to USPSTF guidelines, at what age should average-risk women begin
cervical cancer screening with Pap smear?
