UWISE OBGYN BUNDLED EXAMS
COMPREHENSIVE STUDY GUIDE 2026
FULL QUESTIONS AND SOLUTIONS
⩥ A 32-year-old G3P3 woman comes to the office to discuss permanent
sterilization. She has a history of hypertension and asthma (on
corticosteroids). She has been married for 10 years. Vital signs show:
blood pressure 140/90; weight 280 pounds; height 5 feet 9 inches; and
BMI 41.4kg/m2. You discuss with her risks and benefits of
contraception. Which of the following would be the best form of
permanent sterilization to recommend for this patient?
A. Laparoscopic bilateral tubal ligation
B. Mini laparotomy tubal ligation
C. Exploratory laparotomy with bilateral salpingectomy
D. Total abdominal hysterectomy
E. Vasectomy for her husband. Answer: E. Both vasectomy and tubal
ligation are 99.8% effective. Vasectomies are performed as an outpatient
procedure under local anesthesia, while tubal ligations are typically
performed in the operating room under regional or general anesthesia;
therefore carrying slightly more risk to the woman, assuming both are
healthy. She is morbidly obese, so the risk of anesthesia and surgery are
increased. In addition, she has chronic medical problems that put her at
increased risk of having complications from surgery.
,⩥ 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. 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 37-year-old G0 woman presents with a one-week history of a mildly
painful vulvar ulcer. She reports no fevers, malaise or other systemic
,symptoms. She recently started use of a topical steroid ointment for a
vulvar contact dermatitis. She is married and has no prior history of
sexually transmitted infections. She reports no travel outside the United
States by her husband or herself. Her last Pap smear, six months ago,
was normal. A vulvar herpes culture later returns positive for herpes
simplex virus type 2. A Rapid Plasma Reagin (RPR) is nonreactive, and
HIV testing is negative. Which of the following is the most likely
diagnosis in this patient?
A. Primary HSV episode
B. Recurrent HSV-1 episode
C. Recurrent HSV-2 episode
D. Atypical HSV episode
E. Contact dermatitis. Answer: C. Two serotypes of HSV have been
identified: HSV-1 and HSV-2. Most cases of recurrent genital herpes are
caused by HSV-2. Up to 30% of first-episode cases of genital herpes are
caused by HSV-1, but recurrences are much less frequent for genital
HSV-1 infection than genital HSV-2 infection. Genital HSV infections
are classified as initial primary, initial nonprimary, recurrent and
asymptomatic. Initial, or first-episode primary genital herpes is a true
primary infection (i.e. no history of previous genital herpetic lesions, and
seronegative for HSV antibodies). Systemic symptoms of a primary
infection include fever, headache, malaise and myalgias, and usually
precede the onset of genital lesions. Vulvar lesions begin as tender
grouped vesicles that progress into exquisitely tender, superficial, small
ulcerations on an erythematous base. Initial, nonprimary genital herpes
is the first recognized episode of genital herpes in individuals who are
seropositive for HSV antibodies. Prior HSV-1 infection confers partial
, immunity to HSV-2 infection and thereby lessens the severity of type 2
infection. The severity and duration of symptoms are intermediate
between primary and recurrent disease, with individuals experiencing
less pain, fewer lesions, more rapid resolution of clinical lesions and
shorter duration of viral shedding. Systemic symptoms are rare.
Recurrent episodes involve reactivation of latent genital infection, most
commonly with HSV-2, and are marked by episodic prodromal
symptoms and outbreaks of lesions at varying intervals and of variable
severity. Clinical diagnosis of genital herpes should be confirmed by
viral culture, antigen detection or serologic tests. Treatment consists of
antiviral therapy with acyclovir, famciclovir or valacyclovir.
⩥ A 74-year-old G0 woman complains of vulvar pain. She reports that
the pain is present every day and she has had it for the past year. It now
limits her ability to exercise, and she is no longer able to have sexual
relations with her partner. On exam, her BMI is 32; blood pressure is
100/60; and heart rate is 77. Her vulva has an ulcerated lesion near the
left labial edge. Which of the following is the next best step in the
management of this patient?
A. Estrogen cream
B. Clobetasol cream
C. Vulva biopsy
D. Laser vaporization of the lesion
E. Vulvectomy. Answer: C. This patient has a vulvar lesion causing her
pain. The next step is to perform a biopsy to evaluate for vulvar cancer.
Estrogen cream and clobetasol (a high potency steroid) are treatments
COMPREHENSIVE STUDY GUIDE 2026
FULL QUESTIONS AND SOLUTIONS
⩥ A 32-year-old G3P3 woman comes to the office to discuss permanent
sterilization. She has a history of hypertension and asthma (on
corticosteroids). She has been married for 10 years. Vital signs show:
blood pressure 140/90; weight 280 pounds; height 5 feet 9 inches; and
BMI 41.4kg/m2. You discuss with her risks and benefits of
contraception. Which of the following would be the best form of
permanent sterilization to recommend for this patient?
A. Laparoscopic bilateral tubal ligation
B. Mini laparotomy tubal ligation
C. Exploratory laparotomy with bilateral salpingectomy
D. Total abdominal hysterectomy
E. Vasectomy for her husband. Answer: E. Both vasectomy and tubal
ligation are 99.8% effective. Vasectomies are performed as an outpatient
procedure under local anesthesia, while tubal ligations are typically
performed in the operating room under regional or general anesthesia;
therefore carrying slightly more risk to the woman, assuming both are
healthy. She is morbidly obese, so the risk of anesthesia and surgery are
increased. In addition, she has chronic medical problems that put her at
increased risk of having complications from surgery.
,⩥ 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. 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 37-year-old G0 woman presents with a one-week history of a mildly
painful vulvar ulcer. She reports no fevers, malaise or other systemic
,symptoms. She recently started use of a topical steroid ointment for a
vulvar contact dermatitis. She is married and has no prior history of
sexually transmitted infections. She reports no travel outside the United
States by her husband or herself. Her last Pap smear, six months ago,
was normal. A vulvar herpes culture later returns positive for herpes
simplex virus type 2. A Rapid Plasma Reagin (RPR) is nonreactive, and
HIV testing is negative. Which of the following is the most likely
diagnosis in this patient?
A. Primary HSV episode
B. Recurrent HSV-1 episode
C. Recurrent HSV-2 episode
D. Atypical HSV episode
E. Contact dermatitis. Answer: C. Two serotypes of HSV have been
identified: HSV-1 and HSV-2. Most cases of recurrent genital herpes are
caused by HSV-2. Up to 30% of first-episode cases of genital herpes are
caused by HSV-1, but recurrences are much less frequent for genital
HSV-1 infection than genital HSV-2 infection. Genital HSV infections
are classified as initial primary, initial nonprimary, recurrent and
asymptomatic. Initial, or first-episode primary genital herpes is a true
primary infection (i.e. no history of previous genital herpetic lesions, and
seronegative for HSV antibodies). Systemic symptoms of a primary
infection include fever, headache, malaise and myalgias, and usually
precede the onset of genital lesions. Vulvar lesions begin as tender
grouped vesicles that progress into exquisitely tender, superficial, small
ulcerations on an erythematous base. Initial, nonprimary genital herpes
is the first recognized episode of genital herpes in individuals who are
seropositive for HSV antibodies. Prior HSV-1 infection confers partial
, immunity to HSV-2 infection and thereby lessens the severity of type 2
infection. The severity and duration of symptoms are intermediate
between primary and recurrent disease, with individuals experiencing
less pain, fewer lesions, more rapid resolution of clinical lesions and
shorter duration of viral shedding. Systemic symptoms are rare.
Recurrent episodes involve reactivation of latent genital infection, most
commonly with HSV-2, and are marked by episodic prodromal
symptoms and outbreaks of lesions at varying intervals and of variable
severity. Clinical diagnosis of genital herpes should be confirmed by
viral culture, antigen detection or serologic tests. Treatment consists of
antiviral therapy with acyclovir, famciclovir or valacyclovir.
⩥ A 74-year-old G0 woman complains of vulvar pain. She reports that
the pain is present every day and she has had it for the past year. It now
limits her ability to exercise, and she is no longer able to have sexual
relations with her partner. On exam, her BMI is 32; blood pressure is
100/60; and heart rate is 77. Her vulva has an ulcerated lesion near the
left labial edge. Which of the following is the next best step in the
management of this patient?
A. Estrogen cream
B. Clobetasol cream
C. Vulva biopsy
D. Laser vaporization of the lesion
E. Vulvectomy. Answer: C. This patient has a vulvar lesion causing her
pain. The next step is to perform a biopsy to evaluate for vulvar cancer.
Estrogen cream and clobetasol (a high potency steroid) are treatments
