OBGYN all practice Exam questions and
answers Graded A+
You have three patients: a 40 year old with a PMHx of breast cancer, a 35 year old
taking lithium, and a 42 year old with PAH. Which one should you recommend
against pregnancy?
pt with PAH
You have a 32 week pregnant patient with a UTI. Your coworker suggests
prescribing nitrofurantoin or TMP/SMZ. Are these appropriate?
no - nitrofurantoin is fine in first tri but not second/third
avoid TMP/SMZ in third tri
penicillins, cephalosporins, and erythromycin are safe
You have a pregnant woman asking for safe options to relieve her back pain.
What can you suggest?
acetaminophen (category B)
avoid NSAIDs + aspirin!
You are counseling a newly pregnant patient about expected weight gain and
diet. She asks how much is appropriate to gain. Her BMI is 20. What should you
tell her?
25-35 lbs
A patient presents complaining of amenorrhea. Her last period was 10 weeks ago.
After confirming she is pregnant, she asks what prenatals she needs to take. What
should you suggest?
2 flintstones is fine (w iron)
folic acid won't help anymore - she's past 10 weeks, neural tube is formed
A pregnant woman presents with AMS and headache after a car accident. You
want to order a head CT but your coworker says not to because she's pregnant.
What should you do?
,order it! more important to save mom
just try to keep exposure under 5 rads
A patient with irregular menses presents with a positive home pregnant test. She
believes her last period was sometime in the last 2 months, but cannot be sure.
You cannot palpate her uterus abdominally. How can you most accurately assess
her due date?
crown rump length on ultrasound during first tri
(would be at least 12 weeks if you could palpate uterus)
A 30 year old woman presents with increased urinary frequency. There is no
bacteriuria. You order more tests, which show a low creatinine and high GFR. She
has no other symptoms. Other labs show low serum albumin, high lipids and alk
phos. What could explain this?
pregnancy!
You order prenatal genetic screening at 10 weeks, and it comes back positive for
trisomy 13. Your patient expresses that she wishes to terminate the pregnancy if
this is truly the case. She is now 12 weeks along. What are your next steps?
can do CVS now, or wait until 14 weeks to do amniocentesis
confirm with either option before terminating
Mom has O- blood but baby has O+ blood. How do you manage this?
Rhogam at 28 weeks and at delivery (plus if there is any bleeding during
pregnancy)
Your patient is 20 weeks pregnant. What should be done at her visit?
anatomy US
weight, BP, urine dip, fetal doppler, ensure mom is feeling movement
A 32 week pregnant woman presents to the ED complaining of contractions every
3 minutes. They have been the same intensity for the past 3 hours. She feels
better when laying down. Cervical exam looks normal. What is going on?
Braxton-Hicks contractions
,A 16 week pregnant woman presents complaining of painless vaginal bleeding. On
exam, you note bulging membranes coming from the cervix. US shows a
shortened cervix. How can you manage this?
can try cerclage, but warn pt this has poor prognosis
(dx: incompetent cervix)
A 10 week pregnant woman presents complaining of bleeding an cramping. US
shows intrauterine pregnancy, but no fetal heart activity. How should you manage
this?
D+C with IV sedation
(dx: spontaneous abortion)
A 30 week pregnant woman presents complaining of a large volume of painless
vaginal bleeding. It started after she had sex. What should you do?
2 large bore IVs, type and cross 2 units, monitor fetal heart + contractions, give
mom O2, left lateral position
(dx: placenta previa)
A 36 week pregnant woman presents complaining of painless vaginal bleeding.
She reports that she felt a large gush of fluid and believes her water broke. But
then she started bleeding. Fetal doppler reveals a low heart rate. What is going
on?
vasa previa + PPROM
A woman presents to the ER after vaginal delivery 3 days ago with heavy vaginal
bleeding and intense cramping. She has a low grade fever. What should you do?
catheterize bladder, 2 large bore IVs, massage fundus, manually remove clot from
uterus, apply pressure to uterine arteries
then give pitocin, hemobate, methergine, or misoprostol
(dx: uterine atony)
A 30 week pregnant woman presents with contractions for the past hour that are
now 1 minute apart. Her membranes ruptured half an hour ago. She has a history
of delivery of two previous pregnancies and 34 and 32 weeks. FFN is positive.
What should you do?
, give magnesium sulfate and steroids, high threat of preterm delivery
A 35 week pregnant woman presents with severe abdominal pain that is constant
and came on suddenly. Her abdomen is hard, BP is 80/40 and HR is 125. She
admits to cocaine use. What should you be concerned about complication-wise?
DIC, maternal and fetal death, shock
(dx: abruption)
A 40 week pregnant woman who has been in labor for 48 hours now has a 100F
fever, elevated WBCs, and HR 120. Amniotic fluid is malodorous. What is going
on?
chorioamnionitis
A 37 week pregnant woman comes in concerned because her underwear is wet.
She cannot tell if it is urine or if her water broke. What would you examine the
fluid for under microsopy?
ferning
A woman in active labor who has not had prenatal care presents to the hospital.
On exam, you can see the fetus' buttocks exiting the cervix. What do you do?
breech delivery:
mom in knee-chest position
do not pull baby out! let her push!
flex baby's head once shoulders delivered, hold baby parallel to floor
You are performing a vaginal delivery and note that the baby's shoulder is
impacted behind the symphysis pubis. What complications are you worried about
for the baby?
Erb's palsy or broken clavicle
(dx: shoulder dystocia)
You are considering inducing a woman with preeclampsia. She is currently 38
weeks. What must you assess first?
answers Graded A+
You have three patients: a 40 year old with a PMHx of breast cancer, a 35 year old
taking lithium, and a 42 year old with PAH. Which one should you recommend
against pregnancy?
pt with PAH
You have a 32 week pregnant patient with a UTI. Your coworker suggests
prescribing nitrofurantoin or TMP/SMZ. Are these appropriate?
no - nitrofurantoin is fine in first tri but not second/third
avoid TMP/SMZ in third tri
penicillins, cephalosporins, and erythromycin are safe
You have a pregnant woman asking for safe options to relieve her back pain.
What can you suggest?
acetaminophen (category B)
avoid NSAIDs + aspirin!
You are counseling a newly pregnant patient about expected weight gain and
diet. She asks how much is appropriate to gain. Her BMI is 20. What should you
tell her?
25-35 lbs
A patient presents complaining of amenorrhea. Her last period was 10 weeks ago.
After confirming she is pregnant, she asks what prenatals she needs to take. What
should you suggest?
2 flintstones is fine (w iron)
folic acid won't help anymore - she's past 10 weeks, neural tube is formed
A pregnant woman presents with AMS and headache after a car accident. You
want to order a head CT but your coworker says not to because she's pregnant.
What should you do?
,order it! more important to save mom
just try to keep exposure under 5 rads
A patient with irregular menses presents with a positive home pregnant test. She
believes her last period was sometime in the last 2 months, but cannot be sure.
You cannot palpate her uterus abdominally. How can you most accurately assess
her due date?
crown rump length on ultrasound during first tri
(would be at least 12 weeks if you could palpate uterus)
A 30 year old woman presents with increased urinary frequency. There is no
bacteriuria. You order more tests, which show a low creatinine and high GFR. She
has no other symptoms. Other labs show low serum albumin, high lipids and alk
phos. What could explain this?
pregnancy!
You order prenatal genetic screening at 10 weeks, and it comes back positive for
trisomy 13. Your patient expresses that she wishes to terminate the pregnancy if
this is truly the case. She is now 12 weeks along. What are your next steps?
can do CVS now, or wait until 14 weeks to do amniocentesis
confirm with either option before terminating
Mom has O- blood but baby has O+ blood. How do you manage this?
Rhogam at 28 weeks and at delivery (plus if there is any bleeding during
pregnancy)
Your patient is 20 weeks pregnant. What should be done at her visit?
anatomy US
weight, BP, urine dip, fetal doppler, ensure mom is feeling movement
A 32 week pregnant woman presents to the ED complaining of contractions every
3 minutes. They have been the same intensity for the past 3 hours. She feels
better when laying down. Cervical exam looks normal. What is going on?
Braxton-Hicks contractions
,A 16 week pregnant woman presents complaining of painless vaginal bleeding. On
exam, you note bulging membranes coming from the cervix. US shows a
shortened cervix. How can you manage this?
can try cerclage, but warn pt this has poor prognosis
(dx: incompetent cervix)
A 10 week pregnant woman presents complaining of bleeding an cramping. US
shows intrauterine pregnancy, but no fetal heart activity. How should you manage
this?
D+C with IV sedation
(dx: spontaneous abortion)
A 30 week pregnant woman presents complaining of a large volume of painless
vaginal bleeding. It started after she had sex. What should you do?
2 large bore IVs, type and cross 2 units, monitor fetal heart + contractions, give
mom O2, left lateral position
(dx: placenta previa)
A 36 week pregnant woman presents complaining of painless vaginal bleeding.
She reports that she felt a large gush of fluid and believes her water broke. But
then she started bleeding. Fetal doppler reveals a low heart rate. What is going
on?
vasa previa + PPROM
A woman presents to the ER after vaginal delivery 3 days ago with heavy vaginal
bleeding and intense cramping. She has a low grade fever. What should you do?
catheterize bladder, 2 large bore IVs, massage fundus, manually remove clot from
uterus, apply pressure to uterine arteries
then give pitocin, hemobate, methergine, or misoprostol
(dx: uterine atony)
A 30 week pregnant woman presents with contractions for the past hour that are
now 1 minute apart. Her membranes ruptured half an hour ago. She has a history
of delivery of two previous pregnancies and 34 and 32 weeks. FFN is positive.
What should you do?
, give magnesium sulfate and steroids, high threat of preterm delivery
A 35 week pregnant woman presents with severe abdominal pain that is constant
and came on suddenly. Her abdomen is hard, BP is 80/40 and HR is 125. She
admits to cocaine use. What should you be concerned about complication-wise?
DIC, maternal and fetal death, shock
(dx: abruption)
A 40 week pregnant woman who has been in labor for 48 hours now has a 100F
fever, elevated WBCs, and HR 120. Amniotic fluid is malodorous. What is going
on?
chorioamnionitis
A 37 week pregnant woman comes in concerned because her underwear is wet.
She cannot tell if it is urine or if her water broke. What would you examine the
fluid for under microsopy?
ferning
A woman in active labor who has not had prenatal care presents to the hospital.
On exam, you can see the fetus' buttocks exiting the cervix. What do you do?
breech delivery:
mom in knee-chest position
do not pull baby out! let her push!
flex baby's head once shoulders delivered, hold baby parallel to floor
You are performing a vaginal delivery and note that the baby's shoulder is
impacted behind the symphysis pubis. What complications are you worried about
for the baby?
Erb's palsy or broken clavicle
(dx: shoulder dystocia)
You are considering inducing a woman with preeclampsia. She is currently 38
weeks. What must you assess first?
