OB/GYN: ACOG OBSTETRICS Verified Exam Questions and
Answers Latest update 2026/2027
Question:
A 28-year-old G2P2 woman returns today for follow up on her abnormal pap smear which reveals
atypical squamous cells of undetermined significance (ASCUS). Reflex HPV testing is positive for
high risk type. She has never had a prior abnormal pap smear, and has been following the
recommended screening guidelines. She is asymptomatic. Her pelvic exam reveals a normal cervix
with a small amount of cervical mucous. What is the next best step in the management of this patient?
A. Routine screening
B. Repeat Pap smear in one year
C. Repeat HPV testing in one year
D. Repeat co-testing with Pap and HPV in one year
E. Colposcopy
Answer:
E
Question:
A 17-year-old G0 high school student is brought in by her mother for her first gynecologic
examination. She began her menses at age 12 and has had regular periods for the past three years. Her
last menstrual period was one week ago. For privacy, you ask to examine the patient without her
mother. Further history is obtained in the examination room. She admits that she has been sexually
active with her boyfriend for the past three years. She uses condoms occasionally and is fearful about
possible pregnancy. She requests that her mother not be informed about her sexual activity. On
physical examination, she is anxious, but normally developed. Her pelvic examination reveals no
vulvar lesions, minimal non-malodorous discharge, and a nulliparous appearing cervix. The bimanual
examination reveals a normal size uterus, and her adnexa are non-tender and not enlarged. Urine
pregnancy test is negative. In addition to discussing
Answer:
D
Question:
A 25-year-old G0 woman is scheduled to discuss her recent abnormal Pap smear which showed
atypical squamous cells of undetermined significance (ASCUS). She has had one Pap smear at age 22
which was normal. Her only significant gynecologic history is genital warts that have not responded to
treatment with local application of trichloroacetic acid. She has had eight sexual partners. She uses
condoms and oral contraceptives. She has smoked a pack a day for the past two years. Which of the
following is the most appropriate next step in the management of this patient?
A. HPV typing
B. Repeat Pap smear in three years
C. Cone biopsy
D. Cryotherapy
,E. Loop Electrosurgical Excision Procedure (LEEP)
Answer:
A. HPV
typing
Question:
A 39-year-old G0 woman presents to the clinic reporting non-tender spots on her vulva for about a
week. No pruritus or pain is present. She also notes a brownish rash on the palms of her hands. She
admits to IV drug abuse. She was diagnosed as HIV-positive two years ago, but has not been
compliant with suggested treatment. On examination, three elevated plaques with rolled edges are
noted on the vulva. They are non-tender. A brown macular rash is noted on the palms of her hands and
the soles of her feet. What is the most appropriate next step in the management of this patient?
A. Obtain a treponemal-specific test
B. Biopsy of the lesion
C. Colposcopic evaluation of the vulvar lesions
D. Culture the base of the lesion
E. Initiate empiric treatment with doxycycline and ceftriaxone
Answer:
A. The diagnosis of syphilis is often established by serologic testing. Non-treponemal tests
(VDRL or RPR) are non-specific. In this patient with high suspicion for syphilis, specific testing with
treponemal antibody can confirm infection. The classic coiled spirochete is easily seen with dark-field
microscopy but availability is limited. A characteristic finding is a macular rash on the palms and soles
that are often described as copper penny lesions. Colposcopy would not be diagnostic, but certainly is
helpful to evaluate for any vulvar lesions thought to be dysplastic. Biopsies can be stained for
spirochetes and may show a necrotizing vasculitis, but certainly would not be the most expedient way
to make the diagnosis. Penicillin G is the preferred drug for treating all stages of syphilis. A
24-year-old G0 woman presents with multiple painful ulcers involving the vulva. The sores initially
were fluid filled, but are now open, weeping and crusted. She reports a fever and is having difficulty
voiding due to pain. She uses a vaginal ring for contraception. She has multiple sexual partners and
uses condoms for vaginal intercourse. She is distraught that she may have a sexually transmitted
infection. She is healthy and does not smoke or use drugs. On physical exam, she is in obvious
distress. Temperature is 100.2°F (37.9°C), pulse 100. Examination of the genital tract is limited due to
her discomfort. Multiple ulcers and erosions of variable size are
Question:
localized to the perineum, labia minora and vestibule. Swelling is diffuse. The lesions are eroded,
some with a purulent eschar. There is exquisite tenderness to touch. What further testing should be
offered to this patient?
A. RPR (rapid plasma regain)
B. HIV
Answer:
,E. This patient has classic primary herpes with painful
genital ulcerations, fever and dysuria. Given the presence of one sexually transmitted infection,
screening should be offered for other STIs. Resolution of the acute episode is required before a
speculum can be inserted to allow endocervical sampling for gonorrhea and chlamydia. If it was a
high-risk exposure, prophylactic empiric treatment could be offered to cover gonorrhea and
chlamydia. The patient should be counseled that primary herpes can be acquired despite condoms and
even by oral-genital inoculation. Hepatitis B vaccination should be offered to protect her against any
future exposures. She should be encouraged to discuss her diagnosis with all sexual partners and to
continue to reliably use latex condoms.
Question:
A 38-year-old G0 woman comes to the office because she noted a persistent yellow, frothy discharge
associated with mild external vulvar irritation. She denies any odor. She tried over the counter
anti-fungal medication without success. The discharge has been present for over three months,
gradually increasing in amount. Douching has resulted in temporary relief, but the symptoms always
recur. Pelvic examination reveals mild erythema at the introitus and a copious yellow frothy discharge
fills the vagina. The cervix has erythematous patches on the ectocervix. A sample of the discharge is
examined under the microscope. What is the most likely finding?
A. Strong amine fishy odor when KOH applied to sample
B. Marked polymorphonuclear cells with multi-nucleate giant cells
C. Motile ovoid protozoa with flagella
D. Budding yeast and pseudo-hyphae
E. Clue cells
Answer:
C. This patient most likely has trichomoniasis. The
erythematous patches on the cervix are characteristic of "strawberry cervicitis." Trichomonads are
unicellular protozoans, which are easily seen moving across the slide with flagella. The slide must be
examined immediately. The discharge is mixed with saline and placed on the slide with a cover slip.
Women with trichomonas vaginal infections may have a frothy, yellow-green vaginal discharge. Clue
cells are seen on a saline wet mount in women who have bacterial vaginosis. Clue cells are
characterized by adherent coccobacillary bacteria that obscure the edges of the cells. A drop of KOH
releases amines from the cells and a fishy odor is noted if bacterial vaginosis is present. Yeast vaginitis
is characterized by a thick white clumpy discharge which results in erythema, swelling and intense
pruritus. Multinucleate giant cells and inflammation may be herpes.
Question:
A 23-year-old G0 woman reports having a solitary, painful vulvar lesion that has been present for
three days. This lesion has occurred twice in the past. She states that herpes culture was done by her
doctor during her last outbreak and was negative. She is getting frustrated in that she does not know
her diagnosis. She has no significant previous medical history. She uses oral contraceptives and
condoms. She has had four sexual partners in her lifetime. On physical examination, a cluster of three
irregular erosions with a superficial crust is noted on the posterior fourchette. Urine pregnancy test is
negative. You suspect recurrent genital herpes. How do you explain the negative culture?
A. Cultures were taken too early
B. Oral contraceptives affect the growth of the virus
, C. The cultures were refrigerated prior to transport to the lab
D. Herpes cultures have a 10-20% false negative rate
E. The herpes virus cannot b
Answer:
D. Culture is the gold standard in
the diagnosis of herpes. They are highly specific, yet sensitivity is limited. It is best to culture the
lesion very early in the course. The blister is unroofed and the base is vigorously scraped. The herpes
virus can theoretically be isolated from both primary and recurrent infections. This patient very likely
presented too late in the course for a useful culture. Oral contraceptives do not affect the growth of
viruses. While serum antibody screening can be performed, it indicates lifetime exposure and would
not answer the question as to the etiology of the specific lesion. Alternatively, DNA studies such as
the polymerase chain reaction can be done, if available.
Question:
A 27-year-old G1 at 12 weeks gestation presents for first prenatal care visit. She is previously healthy
and takes no medications. An ultrasound is performed and a viable pregnancy is confirmed. At the end
of the visit, the patient discusses with you her desire to have a Cesarean section for delivery, as she
does not wish to go through the pain of labor. Her husband, an orthopedic surgeon, expresses concerns
as they desire to have at least three children and he is worried about potential complications with
repeated Cesarean sections. What is the most appropriate next step in the counseling of this patient?
a.Agree with her decision after proper counseling and perform a Cesarean section at 39 weeks
gestation
b.Agree with her decision after proper counseling and perform a Cesarean section at 41 weeks
gestation if she has not gone into labor by then
c.Advise her that it is not possible to plan a Cesarean section for del
Answer:
A. Elective cesarean section on demand has been getting more popular
among women for a variety of reasons. Although, it might sound unreasonable to undergo a Cesarean
section for being afraid of pain, the patient has the right to request it and the physician's duty is to
make sure she understands all the risks and potential complications associated with such a decision.
Her husband is appropriately concerned but it is up to her to make the decision regarding an elective
procedure.
Question:
A 25-year-old G3P2, who had recently undergone a primary Cesarean section, had her HIV status
revealed to her mother when a nurse left her chart open in the recovery room. She speaks to patient
relations and is thinking about seeking damages through legal avenues. When trying to explain the
concept of patient privacy, which of the following statements is correct?
a.Patient privacy is based on the ethical principle of justice
b.Patient privacy is protected by federal law, primarily with the Federal Emergency Medical
Treatment and Labor Act (EMTALA) statute
c.Patient privacy is the responsibility of physicians; physicians may be fined and/or assessed
criminal penalties for violating the privacy of a patient's protected health information
Answers Latest update 2026/2027
Question:
A 28-year-old G2P2 woman returns today for follow up on her abnormal pap smear which reveals
atypical squamous cells of undetermined significance (ASCUS). Reflex HPV testing is positive for
high risk type. She has never had a prior abnormal pap smear, and has been following the
recommended screening guidelines. She is asymptomatic. Her pelvic exam reveals a normal cervix
with a small amount of cervical mucous. What is the next best step in the management of this patient?
A. Routine screening
B. Repeat Pap smear in one year
C. Repeat HPV testing in one year
D. Repeat co-testing with Pap and HPV in one year
E. Colposcopy
Answer:
E
Question:
A 17-year-old G0 high school student is brought in by her mother for her first gynecologic
examination. She began her menses at age 12 and has had regular periods for the past three years. Her
last menstrual period was one week ago. For privacy, you ask to examine the patient without her
mother. Further history is obtained in the examination room. She admits that she has been sexually
active with her boyfriend for the past three years. She uses condoms occasionally and is fearful about
possible pregnancy. She requests that her mother not be informed about her sexual activity. On
physical examination, she is anxious, but normally developed. Her pelvic examination reveals no
vulvar lesions, minimal non-malodorous discharge, and a nulliparous appearing cervix. The bimanual
examination reveals a normal size uterus, and her adnexa are non-tender and not enlarged. Urine
pregnancy test is negative. In addition to discussing
Answer:
D
Question:
A 25-year-old G0 woman is scheduled to discuss her recent abnormal Pap smear which showed
atypical squamous cells of undetermined significance (ASCUS). She has had one Pap smear at age 22
which was normal. Her only significant gynecologic history is genital warts that have not responded to
treatment with local application of trichloroacetic acid. She has had eight sexual partners. She uses
condoms and oral contraceptives. She has smoked a pack a day for the past two years. Which of the
following is the most appropriate next step in the management of this patient?
A. HPV typing
B. Repeat Pap smear in three years
C. Cone biopsy
D. Cryotherapy
,E. Loop Electrosurgical Excision Procedure (LEEP)
Answer:
A. HPV
typing
Question:
A 39-year-old G0 woman presents to the clinic reporting non-tender spots on her vulva for about a
week. No pruritus or pain is present. She also notes a brownish rash on the palms of her hands. She
admits to IV drug abuse. She was diagnosed as HIV-positive two years ago, but has not been
compliant with suggested treatment. On examination, three elevated plaques with rolled edges are
noted on the vulva. They are non-tender. A brown macular rash is noted on the palms of her hands and
the soles of her feet. What is the most appropriate next step in the management of this patient?
A. Obtain a treponemal-specific test
B. Biopsy of the lesion
C. Colposcopic evaluation of the vulvar lesions
D. Culture the base of the lesion
E. Initiate empiric treatment with doxycycline and ceftriaxone
Answer:
A. The diagnosis of syphilis is often established by serologic testing. Non-treponemal tests
(VDRL or RPR) are non-specific. In this patient with high suspicion for syphilis, specific testing with
treponemal antibody can confirm infection. The classic coiled spirochete is easily seen with dark-field
microscopy but availability is limited. A characteristic finding is a macular rash on the palms and soles
that are often described as copper penny lesions. Colposcopy would not be diagnostic, but certainly is
helpful to evaluate for any vulvar lesions thought to be dysplastic. Biopsies can be stained for
spirochetes and may show a necrotizing vasculitis, but certainly would not be the most expedient way
to make the diagnosis. Penicillin G is the preferred drug for treating all stages of syphilis. A
24-year-old G0 woman presents with multiple painful ulcers involving the vulva. The sores initially
were fluid filled, but are now open, weeping and crusted. She reports a fever and is having difficulty
voiding due to pain. She uses a vaginal ring for contraception. She has multiple sexual partners and
uses condoms for vaginal intercourse. She is distraught that she may have a sexually transmitted
infection. She is healthy and does not smoke or use drugs. On physical exam, she is in obvious
distress. Temperature is 100.2°F (37.9°C), pulse 100. Examination of the genital tract is limited due to
her discomfort. Multiple ulcers and erosions of variable size are
Question:
localized to the perineum, labia minora and vestibule. Swelling is diffuse. The lesions are eroded,
some with a purulent eschar. There is exquisite tenderness to touch. What further testing should be
offered to this patient?
A. RPR (rapid plasma regain)
B. HIV
Answer:
,E. This patient has classic primary herpes with painful
genital ulcerations, fever and dysuria. Given the presence of one sexually transmitted infection,
screening should be offered for other STIs. Resolution of the acute episode is required before a
speculum can be inserted to allow endocervical sampling for gonorrhea and chlamydia. If it was a
high-risk exposure, prophylactic empiric treatment could be offered to cover gonorrhea and
chlamydia. The patient should be counseled that primary herpes can be acquired despite condoms and
even by oral-genital inoculation. Hepatitis B vaccination should be offered to protect her against any
future exposures. She should be encouraged to discuss her diagnosis with all sexual partners and to
continue to reliably use latex condoms.
Question:
A 38-year-old G0 woman comes to the office because she noted a persistent yellow, frothy discharge
associated with mild external vulvar irritation. She denies any odor. She tried over the counter
anti-fungal medication without success. The discharge has been present for over three months,
gradually increasing in amount. Douching has resulted in temporary relief, but the symptoms always
recur. Pelvic examination reveals mild erythema at the introitus and a copious yellow frothy discharge
fills the vagina. The cervix has erythematous patches on the ectocervix. A sample of the discharge is
examined under the microscope. What is the most likely finding?
A. Strong amine fishy odor when KOH applied to sample
B. Marked polymorphonuclear cells with multi-nucleate giant cells
C. Motile ovoid protozoa with flagella
D. Budding yeast and pseudo-hyphae
E. Clue cells
Answer:
C. This patient most likely has trichomoniasis. The
erythematous patches on the cervix are characteristic of "strawberry cervicitis." Trichomonads are
unicellular protozoans, which are easily seen moving across the slide with flagella. The slide must be
examined immediately. The discharge is mixed with saline and placed on the slide with a cover slip.
Women with trichomonas vaginal infections may have a frothy, yellow-green vaginal discharge. Clue
cells are seen on a saline wet mount in women who have bacterial vaginosis. Clue cells are
characterized by adherent coccobacillary bacteria that obscure the edges of the cells. A drop of KOH
releases amines from the cells and a fishy odor is noted if bacterial vaginosis is present. Yeast vaginitis
is characterized by a thick white clumpy discharge which results in erythema, swelling and intense
pruritus. Multinucleate giant cells and inflammation may be herpes.
Question:
A 23-year-old G0 woman reports having a solitary, painful vulvar lesion that has been present for
three days. This lesion has occurred twice in the past. She states that herpes culture was done by her
doctor during her last outbreak and was negative. She is getting frustrated in that she does not know
her diagnosis. She has no significant previous medical history. She uses oral contraceptives and
condoms. She has had four sexual partners in her lifetime. On physical examination, a cluster of three
irregular erosions with a superficial crust is noted on the posterior fourchette. Urine pregnancy test is
negative. You suspect recurrent genital herpes. How do you explain the negative culture?
A. Cultures were taken too early
B. Oral contraceptives affect the growth of the virus
, C. The cultures were refrigerated prior to transport to the lab
D. Herpes cultures have a 10-20% false negative rate
E. The herpes virus cannot b
Answer:
D. Culture is the gold standard in
the diagnosis of herpes. They are highly specific, yet sensitivity is limited. It is best to culture the
lesion very early in the course. The blister is unroofed and the base is vigorously scraped. The herpes
virus can theoretically be isolated from both primary and recurrent infections. This patient very likely
presented too late in the course for a useful culture. Oral contraceptives do not affect the growth of
viruses. While serum antibody screening can be performed, it indicates lifetime exposure and would
not answer the question as to the etiology of the specific lesion. Alternatively, DNA studies such as
the polymerase chain reaction can be done, if available.
Question:
A 27-year-old G1 at 12 weeks gestation presents for first prenatal care visit. She is previously healthy
and takes no medications. An ultrasound is performed and a viable pregnancy is confirmed. At the end
of the visit, the patient discusses with you her desire to have a Cesarean section for delivery, as she
does not wish to go through the pain of labor. Her husband, an orthopedic surgeon, expresses concerns
as they desire to have at least three children and he is worried about potential complications with
repeated Cesarean sections. What is the most appropriate next step in the counseling of this patient?
a.Agree with her decision after proper counseling and perform a Cesarean section at 39 weeks
gestation
b.Agree with her decision after proper counseling and perform a Cesarean section at 41 weeks
gestation if she has not gone into labor by then
c.Advise her that it is not possible to plan a Cesarean section for del
Answer:
A. Elective cesarean section on demand has been getting more popular
among women for a variety of reasons. Although, it might sound unreasonable to undergo a Cesarean
section for being afraid of pain, the patient has the right to request it and the physician's duty is to
make sure she understands all the risks and potential complications associated with such a decision.
Her husband is appropriately concerned but it is up to her to make the decision regarding an elective
procedure.
Question:
A 25-year-old G3P2, who had recently undergone a primary Cesarean section, had her HIV status
revealed to her mother when a nurse left her chart open in the recovery room. She speaks to patient
relations and is thinking about seeking damages through legal avenues. When trying to explain the
concept of patient privacy, which of the following statements is correct?
a.Patient privacy is based on the ethical principle of justice
b.Patient privacy is protected by federal law, primarily with the Federal Emergency Medical
Treatment and Labor Act (EMTALA) statute
c.Patient privacy is the responsibility of physicians; physicians may be fined and/or assessed
criminal penalties for violating the privacy of a patient's protected health information
