Structured cases and ACOG readings Verified Exam Questions and
Answers Latest update 2026/2027
Question:
1. Risk reducing BSO (5)
Answer:
1. Explore entire abdomen
2. Pelvic washings
3. Examine course of ureter
4. Dissect IP 2 cm lateral to ovary
5. Inform pathology
Question:
2. Salpingectomy counseling
Answer:
1. Ensure it is her wish, not being imposed
2. Other forms of contraception (LARCs, vasectomy)
3. Surgical risks
4. Menstrual hx; will not help bleeding
Question:
3. AUB medical treatments
Answer:
1. cOCP
2. Progestins (oral, Depo Provera, LNG IUD)
3. Tranexamic acid
4. GnRH modulators (suppress LH and FSH)
a. Lupron: GnRH modulator (agonist); Norethrindrone add back therapy to help
reduce bone loss and hot flashes
b. Elagolix, Rolugolix, Linzagolix: GnRH antagonists (need add back, esp if higher
doses for fibroid treatment)
Question:
4. PID antibiotics
Answer:
Ceftriaxone 1g q24 hrs Doxycycline 100 mg BID Flagyl 500 mg BID Home on Doxy/Flagyl for total
of 14 days IR if no improvement in about 24 hrs Laparoscopy if concern for rupture
,Question:
5. Layers abdominal wall
Internal oblique
Answer:
Skin Fat (camper's fascia) Scarpa's fascia (membranous) External oblique Transverse abdominal
Transversalis fascia Preperitoneal fat Peritoneum
Question:
6. Causes of AUB (PALM-COEIN)
Answer:
Structural- Polyps Adenomyosis Leiomyoma Malignancy/ Hyperplasia Coagulopathy Ovulatory
dysfuction Endometrial Iatrogenic Not yet classified
Question:
7. Acute AUB medical treatment
Answer:
1. IV Estrogen 25 mg q 4-6 hrs for 24 hrs
2. Medroxprogesterone acetate 20 mg TID for 7 days
3. cOCP 35 micorgrams estradiol TID x7 days
4. Tranexamic acid 1.3 g TID x 5 days
Question:
8. When to evaluate for underlying bleeding disorder with AUB
Answer:
1. Heavy menses since menarche
2. ONE of the following: PPH, surgery related bleeding, bleeding with dental work
3. TWO or more: Epistaxis or bruising twice monthly, frequent gum bleeds, FH
bleeding disorders
Question:
9. Fetal risks VAVD Scalp lacerations
Answer:
Cephalohematoma Subgaleal hematoma (30-40/1000) Intracranial hemorrhage (1/860) Retinal
hemorrhage (38%) Hyperbilirubinemia Facial nerve palsies
Question:
10. Trisomy 21 phenotypes
Answer:
Flattened face and occiput, small brachycephalic head, epicanthal folds, flat nasal bridge, small mouth
and ears, and up-slanting palpebral fissure, hypotonia, short stature, protruding tongue
, Question:
11. Vaginal breech delivery maneuvers
Answer:
1. No traction; maternal ettort only until fetus delivered at least to level of umbilicus
2. Pinard's maneuver for the legs (pressure in popliteal fossa for them to bend at
knees)
3. Wrap in towel. Continue maternal forces until delivery to level of scapula.
4. Lovset's maneuver for arms (longitudinal force on anterior surface of humerus,
sweep hand over chest and slide out). Rotate 180 degrees for other arm.
5. Wrap arms in towel. Ensure back is anterior.
6. Deliver head: Suprapubic pressure and McRobert's
- Bracht maneuver to lift body up
- Mauriceau-Smellie-Veit (second and fourth finger on fetal maxilla to flex head)
- Piper's (LEFT blade first to fetal right ear; should sit/kneel; fetal body ABOVE
blades)
- Terbutaline or NG to relax uterus if head entrapment (but would not fix BONY
problem)
- Duhrssen's (2, 6, 10 - for very preterm fetus)
- Theoretical symphysiotomy
Question:
12. Contraindications for vaginal breech
Answer:
- Prior C/S
- Gestational age <37 wks
- Induction of labor
- No skilled statt available
- Footing or incomplete breech
- EFW <2500 g or >4000 g
- FGR
- Fetal anomaly on US
- Head is hyperextended
- Inadequate pelvis
- AFI <3 cm max vertical pocket
Answers Latest update 2026/2027
Question:
1. Risk reducing BSO (5)
Answer:
1. Explore entire abdomen
2. Pelvic washings
3. Examine course of ureter
4. Dissect IP 2 cm lateral to ovary
5. Inform pathology
Question:
2. Salpingectomy counseling
Answer:
1. Ensure it is her wish, not being imposed
2. Other forms of contraception (LARCs, vasectomy)
3. Surgical risks
4. Menstrual hx; will not help bleeding
Question:
3. AUB medical treatments
Answer:
1. cOCP
2. Progestins (oral, Depo Provera, LNG IUD)
3. Tranexamic acid
4. GnRH modulators (suppress LH and FSH)
a. Lupron: GnRH modulator (agonist); Norethrindrone add back therapy to help
reduce bone loss and hot flashes
b. Elagolix, Rolugolix, Linzagolix: GnRH antagonists (need add back, esp if higher
doses for fibroid treatment)
Question:
4. PID antibiotics
Answer:
Ceftriaxone 1g q24 hrs Doxycycline 100 mg BID Flagyl 500 mg BID Home on Doxy/Flagyl for total
of 14 days IR if no improvement in about 24 hrs Laparoscopy if concern for rupture
,Question:
5. Layers abdominal wall
Internal oblique
Answer:
Skin Fat (camper's fascia) Scarpa's fascia (membranous) External oblique Transverse abdominal
Transversalis fascia Preperitoneal fat Peritoneum
Question:
6. Causes of AUB (PALM-COEIN)
Answer:
Structural- Polyps Adenomyosis Leiomyoma Malignancy/ Hyperplasia Coagulopathy Ovulatory
dysfuction Endometrial Iatrogenic Not yet classified
Question:
7. Acute AUB medical treatment
Answer:
1. IV Estrogen 25 mg q 4-6 hrs for 24 hrs
2. Medroxprogesterone acetate 20 mg TID for 7 days
3. cOCP 35 micorgrams estradiol TID x7 days
4. Tranexamic acid 1.3 g TID x 5 days
Question:
8. When to evaluate for underlying bleeding disorder with AUB
Answer:
1. Heavy menses since menarche
2. ONE of the following: PPH, surgery related bleeding, bleeding with dental work
3. TWO or more: Epistaxis or bruising twice monthly, frequent gum bleeds, FH
bleeding disorders
Question:
9. Fetal risks VAVD Scalp lacerations
Answer:
Cephalohematoma Subgaleal hematoma (30-40/1000) Intracranial hemorrhage (1/860) Retinal
hemorrhage (38%) Hyperbilirubinemia Facial nerve palsies
Question:
10. Trisomy 21 phenotypes
Answer:
Flattened face and occiput, small brachycephalic head, epicanthal folds, flat nasal bridge, small mouth
and ears, and up-slanting palpebral fissure, hypotonia, short stature, protruding tongue
, Question:
11. Vaginal breech delivery maneuvers
Answer:
1. No traction; maternal ettort only until fetus delivered at least to level of umbilicus
2. Pinard's maneuver for the legs (pressure in popliteal fossa for them to bend at
knees)
3. Wrap in towel. Continue maternal forces until delivery to level of scapula.
4. Lovset's maneuver for arms (longitudinal force on anterior surface of humerus,
sweep hand over chest and slide out). Rotate 180 degrees for other arm.
5. Wrap arms in towel. Ensure back is anterior.
6. Deliver head: Suprapubic pressure and McRobert's
- Bracht maneuver to lift body up
- Mauriceau-Smellie-Veit (second and fourth finger on fetal maxilla to flex head)
- Piper's (LEFT blade first to fetal right ear; should sit/kneel; fetal body ABOVE
blades)
- Terbutaline or NG to relax uterus if head entrapment (but would not fix BONY
problem)
- Duhrssen's (2, 6, 10 - for very preterm fetus)
- Theoretical symphysiotomy
Question:
12. Contraindications for vaginal breech
Answer:
- Prior C/S
- Gestational age <37 wks
- Induction of labor
- No skilled statt available
- Footing or incomplete breech
- EFW <2500 g or >4000 g
- FGR
- Fetal anomaly on US
- Head is hyperextended
- Inadequate pelvis
- AFI <3 cm max vertical pocket
