COMAT Obstetrics & Gynecology Exam V2 | COMAT
Obstetrics & Gynecology Exam V2
1. A 28-year-old G1P0 at 38 weeks gestation presents with spontaneous rupture of
membranes. Her blood pressure is 155/95 mmHg, and urinalysis shows 3+ proteinuria. On
physical exam, she has 2+ pitting edema and brisk patellar reflexes. Which of the following is
the most appropriate next step to prevent maternal seizures?
A. Administer intravenous hydralazine
B. Immediate Cesarean section
C. Administer intravenous magnesium sulfate
D. Administer intramuscular betamethasone
Correct Answer: C
Explanation: The patient presents with preeclampsia with severe features given her
elevated blood pressure and significant proteinuria near term. Magnesium sulfate is the
gold standard for seizure prophylaxis in patients with preeclampsia. Delivery is the
definitive treatment, but stabilizing the patient with magnesium sulfate is the immediate
priority to prevent eclampsia.
2. A 32-year-old female, G2P1, at 10 weeks gestation presents for her first prenatal visit. She
has a history of a previous pregnancy complicated by a fetal neural tube defect. What dose of
folic acid should be recommended for this patient?
A. 4.0 mg daily
,B. 1.0 mg daily
C. 0.4 mg daily
D. 5.0 mg daily
Correct Answer: A
Explanation: Women with a history of a previous child with a neural tube defect are at
significantly higher risk for recurrence. The CDC and ACOG recommend a higher dose of 4.0
mg of folic acid daily starting at least one month prior to conception and continuing
through the first trimester. This is ten times the dose recommended for low-risk women,
which is 0.4 mg daily.
3. A 24-year-old G1P0 at 39 weeks gestation is in active labor. The fetal heart rate tracing
shows late decelerations with 50% of contractions. What is the most likely cause of this
finding?
A. Uteroplacental insufficiency
B. Umbilical cord compression
C. Fetal head compression
D. Maternal hypotension
Correct Answer: A
Explanation: Late decelerations are characterized by a gradual decrease in fetal heart rate
that begins after the peak of the contraction and returns to baseline after the contraction
,ends. This pattern is a classic indicator of uteroplacental insufficiency, which results in
decreased oxygen delivery to the fetus. Management involves maternal repositioning,
oxygen, and potential preparation for delivery if the tracing remains Category III.
4. A 19-year-old female presents with a foul-smelling vaginal discharge. Examination reveals a
thin, grayish-white discharge and a ‘fishy’ odor when potassium hydroxide is added. Clue cells
are seen on microscopy. What is the most appropriate treatment?
A. Oral metronidazole
B. Intramuscular ceftriaxone
C. Oral fluconazole
D. Azithromycin
Correct Answer: A
Explanation: The clinical presentation describes Bacterial Vaginosis (BV), which is
diagnosed using Amsel’s criteria. The presence of clue cells and a positive whiff test are
highly suggestive of an overgrowth of anaerobic bacteria like Gardnerella vaginalis.
Metronidazole, either oral or vaginal, is the first-line treatment for symptomatic patients.
5. A 45-year-old G4P4 presents with heavy menstrual bleeding that has worsened over the
last six months. Pelvic exam reveals a non-tender, symmetrically enlarged uterus about the
size of 12 weeks gestation. What is the most likely diagnosis?
A. Endometriosis
B. Uterine leiomyomas
, C. Adenomyosis
D. Endometrial cancer
Correct Answer: C
Explanation: Adenomyosis is characterized by the presence of endometrial glands within
the myometrium, leading to a symmetrically enlarged, globular, and often ‘boggy’ uterus.
Patients typically present with dysmenorrhea and menorrhagia in their 40s or 50s. Uterine
leiomyomas usually present with an asymmetric or ‘lumpy’ uterus, which helps
differentiate them from adenomyosis.
6. A 22-year-old G1P0 at 30 weeks gestation presents after a motor vehicle accident. She is
Rh-negative. What is the most important test to determine the dose of Rho(D) immune
globulin required?
A. Kleihauer-Betke test
B. Apt test
C. Direct Coombs test
D. Fetal fibronectin
Correct Answer: A
Explanation: The Kleihauer-Betke (KB) test quantifies the amount of fetal hemoglobin in
the maternal circulation following potential feto-maternal hemorrhage. Since a standard
dose of Rho(D) immune globulin covers only 30 mL of fetal whole blood, trauma victims
who are Rh-negative require a KB test to ensure they receive an adequate dose to prevent
Obstetrics & Gynecology Exam V2
1. A 28-year-old G1P0 at 38 weeks gestation presents with spontaneous rupture of
membranes. Her blood pressure is 155/95 mmHg, and urinalysis shows 3+ proteinuria. On
physical exam, she has 2+ pitting edema and brisk patellar reflexes. Which of the following is
the most appropriate next step to prevent maternal seizures?
A. Administer intravenous hydralazine
B. Immediate Cesarean section
C. Administer intravenous magnesium sulfate
D. Administer intramuscular betamethasone
Correct Answer: C
Explanation: The patient presents with preeclampsia with severe features given her
elevated blood pressure and significant proteinuria near term. Magnesium sulfate is the
gold standard for seizure prophylaxis in patients with preeclampsia. Delivery is the
definitive treatment, but stabilizing the patient with magnesium sulfate is the immediate
priority to prevent eclampsia.
2. A 32-year-old female, G2P1, at 10 weeks gestation presents for her first prenatal visit. She
has a history of a previous pregnancy complicated by a fetal neural tube defect. What dose of
folic acid should be recommended for this patient?
A. 4.0 mg daily
,B. 1.0 mg daily
C. 0.4 mg daily
D. 5.0 mg daily
Correct Answer: A
Explanation: Women with a history of a previous child with a neural tube defect are at
significantly higher risk for recurrence. The CDC and ACOG recommend a higher dose of 4.0
mg of folic acid daily starting at least one month prior to conception and continuing
through the first trimester. This is ten times the dose recommended for low-risk women,
which is 0.4 mg daily.
3. A 24-year-old G1P0 at 39 weeks gestation is in active labor. The fetal heart rate tracing
shows late decelerations with 50% of contractions. What is the most likely cause of this
finding?
A. Uteroplacental insufficiency
B. Umbilical cord compression
C. Fetal head compression
D. Maternal hypotension
Correct Answer: A
Explanation: Late decelerations are characterized by a gradual decrease in fetal heart rate
that begins after the peak of the contraction and returns to baseline after the contraction
,ends. This pattern is a classic indicator of uteroplacental insufficiency, which results in
decreased oxygen delivery to the fetus. Management involves maternal repositioning,
oxygen, and potential preparation for delivery if the tracing remains Category III.
4. A 19-year-old female presents with a foul-smelling vaginal discharge. Examination reveals a
thin, grayish-white discharge and a ‘fishy’ odor when potassium hydroxide is added. Clue cells
are seen on microscopy. What is the most appropriate treatment?
A. Oral metronidazole
B. Intramuscular ceftriaxone
C. Oral fluconazole
D. Azithromycin
Correct Answer: A
Explanation: The clinical presentation describes Bacterial Vaginosis (BV), which is
diagnosed using Amsel’s criteria. The presence of clue cells and a positive whiff test are
highly suggestive of an overgrowth of anaerobic bacteria like Gardnerella vaginalis.
Metronidazole, either oral or vaginal, is the first-line treatment for symptomatic patients.
5. A 45-year-old G4P4 presents with heavy menstrual bleeding that has worsened over the
last six months. Pelvic exam reveals a non-tender, symmetrically enlarged uterus about the
size of 12 weeks gestation. What is the most likely diagnosis?
A. Endometriosis
B. Uterine leiomyomas
, C. Adenomyosis
D. Endometrial cancer
Correct Answer: C
Explanation: Adenomyosis is characterized by the presence of endometrial glands within
the myometrium, leading to a symmetrically enlarged, globular, and often ‘boggy’ uterus.
Patients typically present with dysmenorrhea and menorrhagia in their 40s or 50s. Uterine
leiomyomas usually present with an asymmetric or ‘lumpy’ uterus, which helps
differentiate them from adenomyosis.
6. A 22-year-old G1P0 at 30 weeks gestation presents after a motor vehicle accident. She is
Rh-negative. What is the most important test to determine the dose of Rho(D) immune
globulin required?
A. Kleihauer-Betke test
B. Apt test
C. Direct Coombs test
D. Fetal fibronectin
Correct Answer: A
Explanation: The Kleihauer-Betke (KB) test quantifies the amount of fetal hemoglobin in
the maternal circulation following potential feto-maternal hemorrhage. Since a standard
dose of Rho(D) immune globulin covers only 30 mL of fetal whole blood, trauma victims
who are Rh-negative require a KB test to ensure they receive an adequate dose to prevent
