OB/GYN: ACOG GYNECOLOGY Verified Exam Questions and
Answers Latest update 2026/2027
Question:
A 24-year-old G1P1 woman comes to the office requesting contraception. Her past medical history is
unremarkable, except for a family history of ovarian cancer. She denies alcohol, smoking and
recreational drug use. She is in a monogamous relationship. She wants to decrease her risk of
gynecological cancer. Of the following, what is the best method of contraception for this patient?
A. Female condoms
B. Male condoms
C. Copper containing intrauterine device
D. Progesterone containing intrauterine device
E. Combined oral contraceptives
Answer:
E. Oral contraceptives will
decrease a woman's risk of developing ovarian and endometrial cancer. The earlier, higher dose oral
contraceptive pills have been linked to a slight increase in breast cancer, but not the most recent lower
dose pills. Women who use oral contraceptive pills have a slightly higher risk of developing cervical
intraepithelial neoplasia, but their risk of developing PID, endometriosis, benign breast changes and
ectopic pregnancy are reduced. Both hypertension and thromboembolic disorders can be a potential
side effect from using oral contraceptive pills. Condoms and intrauterine devices will not lower her
risk of ovarian cancer.
Question:
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.
Question:
A 23-year-old G2P1 woman with six weeks amenorrhea presents with lower abdominal pain and
vaginal bleeding. Her temperature is 102.0°F (38.9°C) and the cervix is 1 cm dilated. Uterus is
eight-week size and tender. There are no adnexal masses. Urine pregnancy test is positive. What is the
most likely diagnosis?
A. Threatened abortion
B. Missed abortion
C. Normal pregnancy
D. Septic abortion
E. Ectopic Pregnancy
Answer:
D. The patient has a septic abortion. She
has fever and bleeding with a dilated cervix which are findings seen with septic abortion. Threatened
abortions clinically have vaginal bleeding, a positive pregnancy test and a cervical os closed or
uneffaced, while missed abortions have retention of a nonviable intrauterine pregnancy for an
extended period of time (i.e. dead fetus or blighted ovum). A normal pregnancy would have a closed
cervix. Ectopic pregnancy would likely present with bleeding, abdominal pain, possibly have an
adnexal mass, and the cervix would typically be closed.
Question:
How do you manage septic abortions?
Answer:
The management of septic abortion includes broad-spectrum antibiotics and uterine evacuation. Single
agent antimicrobials do not provide adequate coverage for the array of organisms that may be involved
and therefore are not indicated. A laparoscopy can be indicated if ectopic pregnancy is suspected, but
it is unlikely in this case. Medical termination is not the best option since prompt evacuation of the
uterus is indicated in this case. A 29-year-old G3P0 woman presents for evaluation and treatment of
pregnancy loss. Her past medical history is remarkable for three early (<14 weeks gestation)
pregnancy losses. Parental
Question:
karyotype was normal. Which of the following is the most appropriate next step in the management of
this patient?
A. Place a prophylactic cerclage with her next pregnancy
B. Obtain serial cervical length with her next pregnancy
C. Recommend 17-hydroxyprogesterone with her next pregnancy
D. Check for Factor V Leiden mutation
E. Check antiphospholipid antibodies
Answer:
E. Antiphosphospholipid
antibodies are associated with recurrent pregnancy loss. The workup for antiphospholipid syndrome
, includes assessment of anticardiolipin and beta-2 glycoprotein antibody status, PTT, and Russell viper
venom time. There are multiple etiologies for recurrent pregnancy loss, which is defined as > two
consecutive or > three spontaneous losses before 20 weeks gestation. Etiologies include anatomic
causes, endocrine abnormalities such as hyper or hypothyroidism and luteal phase deficiency, parental
chromosomal anomalies, immune factors such as lupus anticoagulant and idiopathic factors. Her
history is not consistent with cervical insufficiency which is diagnosed typically in the second
trimester by history, physical exam and other diagnostic tests, such as ultrasound. Serial cervical
lengths or placement of a cerclage are not indicated in this patient. Treatment with
17-hydroxyprogesterone is indicated in patients with a history of prior preterm birth. Factor V Leiden
mutation has not been associated with recurrent pregnancy loss. It can be associated with thrombotic
events.
Question:
A 29-year-old G3P0 woman presents for evaluation and treatment of pregnancy loss. Her past medical
history is remarkable for three early (<16 weeks gestation) pregnancy losses and a deep vein
thrombosis two years ago. Her work up includes: prolonged dilute Russell viper venom test; elevated
anticardiolipin antibodies; normal thyroid function; normal prolactin; and normal MRI of the pelvis.
She wishes to get pregnant soon. In addition to aspirin, which of the following treatments is
appropriate for this patient?
A. No additional treatment
B. Corticosteroid
C. Heparin
D. 17-OH progesterone
E. Bromocriptine
Answer:
C. The prolonged dilute Russell viper venom
time leads one to suspect that the etiology of recurrent pregnancy loss is due to antiphospholipid
antibody syndrome. The treatment is aspirin plus heparin. There is roughly a 75% success rate with
combination therapy versus aspirin alone. There is conflicting evidence regarding steroid use for
treatment. 17-OH progesterone is used for the prevention of preterm delivery and not recurrent
pregnancy loss.
Question:
A 25-year-old G1 woman at six weeks gestation comes to the office because of undesired pregnancy.
You discuss with her the risks and benefits of surgical versus medical abortion using misoprostol and
mifepristone. Compared to surgical abortion, which of the following is increased in a woman
undergoing a medical abortion?
A. Post abortion pain
B. Lower failure rate
C. Long-term psychological sequelae
D. Blood loss
E. Future infertility
Answer:
Answers Latest update 2026/2027
Question:
A 24-year-old G1P1 woman comes to the office requesting contraception. Her past medical history is
unremarkable, except for a family history of ovarian cancer. She denies alcohol, smoking and
recreational drug use. She is in a monogamous relationship. She wants to decrease her risk of
gynecological cancer. Of the following, what is the best method of contraception for this patient?
A. Female condoms
B. Male condoms
C. Copper containing intrauterine device
D. Progesterone containing intrauterine device
E. Combined oral contraceptives
Answer:
E. Oral contraceptives will
decrease a woman's risk of developing ovarian and endometrial cancer. The earlier, higher dose oral
contraceptive pills have been linked to a slight increase in breast cancer, but not the most recent lower
dose pills. Women who use oral contraceptive pills have a slightly higher risk of developing cervical
intraepithelial neoplasia, but their risk of developing PID, endometriosis, benign breast changes and
ectopic pregnancy are reduced. Both hypertension and thromboembolic disorders can be a potential
side effect from using oral contraceptive pills. Condoms and intrauterine devices will not lower her
risk of ovarian cancer.
Question:
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.
Question:
A 23-year-old G2P1 woman with six weeks amenorrhea presents with lower abdominal pain and
vaginal bleeding. Her temperature is 102.0°F (38.9°C) and the cervix is 1 cm dilated. Uterus is
eight-week size and tender. There are no adnexal masses. Urine pregnancy test is positive. What is the
most likely diagnosis?
A. Threatened abortion
B. Missed abortion
C. Normal pregnancy
D. Septic abortion
E. Ectopic Pregnancy
Answer:
D. The patient has a septic abortion. She
has fever and bleeding with a dilated cervix which are findings seen with septic abortion. Threatened
abortions clinically have vaginal bleeding, a positive pregnancy test and a cervical os closed or
uneffaced, while missed abortions have retention of a nonviable intrauterine pregnancy for an
extended period of time (i.e. dead fetus or blighted ovum). A normal pregnancy would have a closed
cervix. Ectopic pregnancy would likely present with bleeding, abdominal pain, possibly have an
adnexal mass, and the cervix would typically be closed.
Question:
How do you manage septic abortions?
Answer:
The management of septic abortion includes broad-spectrum antibiotics and uterine evacuation. Single
agent antimicrobials do not provide adequate coverage for the array of organisms that may be involved
and therefore are not indicated. A laparoscopy can be indicated if ectopic pregnancy is suspected, but
it is unlikely in this case. Medical termination is not the best option since prompt evacuation of the
uterus is indicated in this case. A 29-year-old G3P0 woman presents for evaluation and treatment of
pregnancy loss. Her past medical history is remarkable for three early (<14 weeks gestation)
pregnancy losses. Parental
Question:
karyotype was normal. Which of the following is the most appropriate next step in the management of
this patient?
A. Place a prophylactic cerclage with her next pregnancy
B. Obtain serial cervical length with her next pregnancy
C. Recommend 17-hydroxyprogesterone with her next pregnancy
D. Check for Factor V Leiden mutation
E. Check antiphospholipid antibodies
Answer:
E. Antiphosphospholipid
antibodies are associated with recurrent pregnancy loss. The workup for antiphospholipid syndrome
, includes assessment of anticardiolipin and beta-2 glycoprotein antibody status, PTT, and Russell viper
venom time. There are multiple etiologies for recurrent pregnancy loss, which is defined as > two
consecutive or > three spontaneous losses before 20 weeks gestation. Etiologies include anatomic
causes, endocrine abnormalities such as hyper or hypothyroidism and luteal phase deficiency, parental
chromosomal anomalies, immune factors such as lupus anticoagulant and idiopathic factors. Her
history is not consistent with cervical insufficiency which is diagnosed typically in the second
trimester by history, physical exam and other diagnostic tests, such as ultrasound. Serial cervical
lengths or placement of a cerclage are not indicated in this patient. Treatment with
17-hydroxyprogesterone is indicated in patients with a history of prior preterm birth. Factor V Leiden
mutation has not been associated with recurrent pregnancy loss. It can be associated with thrombotic
events.
Question:
A 29-year-old G3P0 woman presents for evaluation and treatment of pregnancy loss. Her past medical
history is remarkable for three early (<16 weeks gestation) pregnancy losses and a deep vein
thrombosis two years ago. Her work up includes: prolonged dilute Russell viper venom test; elevated
anticardiolipin antibodies; normal thyroid function; normal prolactin; and normal MRI of the pelvis.
She wishes to get pregnant soon. In addition to aspirin, which of the following treatments is
appropriate for this patient?
A. No additional treatment
B. Corticosteroid
C. Heparin
D. 17-OH progesterone
E. Bromocriptine
Answer:
C. The prolonged dilute Russell viper venom
time leads one to suspect that the etiology of recurrent pregnancy loss is due to antiphospholipid
antibody syndrome. The treatment is aspirin plus heparin. There is roughly a 75% success rate with
combination therapy versus aspirin alone. There is conflicting evidence regarding steroid use for
treatment. 17-OH progesterone is used for the prevention of preterm delivery and not recurrent
pregnancy loss.
Question:
A 25-year-old G1 woman at six weeks gestation comes to the office because of undesired pregnancy.
You discuss with her the risks and benefits of surgical versus medical abortion using misoprostol and
mifepristone. Compared to surgical abortion, which of the following is increased in a woman
undergoing a medical abortion?
A. Post abortion pain
B. Lower failure rate
C. Long-term psychological sequelae
D. Blood loss
E. Future infertility
Answer:
