COMAT Obstetrics & Gynecology Exam V1 | COMAT
Obstetrics & Gynecology Exam V1
1. A 28-year-old G1P0 at 36 weeks gestation presents with a blood pressure of 162/112
mmHg and 3+ proteinuria. She complains of a severe headache and blurry vision. What is the
most appropriate next step in management?
A. Immediate cesarean delivery
B. Bed rest and repeat blood pressure in 4 hours
C. Administration of magnesium sulfate and blood pressure control
D. Induction of labor at 37 weeks
Correct Answer: C
Explanation: This patient meets the criteria for preeclampsia with severe features (BP
>160/110 and neurologic symptoms). The immediate priority is the prevention of seizures
using magnesium sulfate and stabilizing the blood pressure with hydralazine or labetalol
before proceeding to delivery. Stabilization is critical to prevent maternal morbidity like
stroke or eclampsia.
2. A 19-year-old female presents for contraceptive counseling. She has a history of multiple
sexual partners and was treated for Pelvic Inflammatory Disease (PID) six months ago. She
currently has no symptoms and a negative pregnancy test. Which of the following is the most
appropriate long-acting reversible contraceptive (LARC)?
A. Copper IUD
,B. Levonorgestrel IUD
C. Etonogestrel implant
D. Depot medroxyprogesterone acetate
Correct Answer: C
Explanation: While IUDs are generally safe, a history of PID can be a concern for some
providers, but a current active infection is a contraindication. The etonogestrel implant is
highly effective, not dependent on pelvic anatomy, and avoids the theoretical risk of pelvic
infection exacerbation in patients with high-risk behaviors. It remains a top-tier LARC
recommendation for young, active patients.
3. A 45-year-old woman presents with heavy menstrual bleeding and an enlarged, irregularly
shaped uterus. An ultrasound confirms the presence of multiple intramural and subserosal
masses. What is the most likely diagnosis?
A. Adenomyosis
B. Endometrial hyperplasia
C. Uterine leiomyoma
D. Endometrial carcinoma
Correct Answer: C
Explanation: Uterine leiomyomas (fibroids) are benign smooth muscle tumors that
typically present as an irregularly enlarged uterus with heavy bleeding. Adenomyosis
,usually presents with a globally, symmetrically enlarged ‘boggy’ uterus. Leiomyomas are
the most common pelvic tumor in women and are the leading indication for hysterectomy.
4. A 24-year-old female presents with a thin, grayish-white vaginal discharge and a fishy odor
that is more noticeable after intercourse. Wet mount microscopy reveals clue cells. What is
the first-line treatment?
A. Metronidazole
B. Azithromycin
C. Fluconazole
D. Ceftriaxone
Correct Answer: A
Explanation: The clinical description is classic for Bacterial Vaginosis (BV), caused by a
shift in vaginal flora. Diagnosis is made using Amsel criteria: thin discharge, pH >4.5,
positive whiff test, and clue cells. Metronidazole (oral or vaginal) or clindamycin cream are
the standard treatments.
5. A 35-year-old G1P0 at 11 weeks gestation requests screening for chromosomal
abnormalities. She is concerned about the risk of Down Syndrome due to her age. Which of
the following is the most sensitive screening test available for this patient at this time?
A. First-trimester combined screening (PAPP-A, hCG, NT)
B. Quadruple screening
C. Amniocentesis
, D. Cell-free DNA screening (NIPT)
Correct Answer: D
Explanation: Cell-free DNA (NIPT) has the highest sensitivity and specificity for trisomy 21
among screening tests. It can be performed as early as 10 weeks gestation. While
amniocentesis is diagnostic, it is an invasive procedure, and NIPT is the preferred high-
sensitivity screening tool.
6. During a vaginal delivery, the fetal head is delivered, but the shoulders fail to emerge with
standard traction. The ‘turtle sign’ is noted. What is the first maneuver that should be
performed?
A. Zavanelli maneuver
B. McRoberts maneuver
C. Woods screw maneuver
D. Fundal pressure
Correct Answer: B
Explanation: Shoulder dystocia is an obstetric emergency. The McRoberts maneuver
(hyperflexion of the mother’s hips) should be the first step, often combined with
suprapubic pressure. Fundal pressure is strictly contraindicated as it can worsen the
impaction and cause uterine rupture.
Obstetrics & Gynecology Exam V1
1. A 28-year-old G1P0 at 36 weeks gestation presents with a blood pressure of 162/112
mmHg and 3+ proteinuria. She complains of a severe headache and blurry vision. What is the
most appropriate next step in management?
A. Immediate cesarean delivery
B. Bed rest and repeat blood pressure in 4 hours
C. Administration of magnesium sulfate and blood pressure control
D. Induction of labor at 37 weeks
Correct Answer: C
Explanation: This patient meets the criteria for preeclampsia with severe features (BP
>160/110 and neurologic symptoms). The immediate priority is the prevention of seizures
using magnesium sulfate and stabilizing the blood pressure with hydralazine or labetalol
before proceeding to delivery. Stabilization is critical to prevent maternal morbidity like
stroke or eclampsia.
2. A 19-year-old female presents for contraceptive counseling. She has a history of multiple
sexual partners and was treated for Pelvic Inflammatory Disease (PID) six months ago. She
currently has no symptoms and a negative pregnancy test. Which of the following is the most
appropriate long-acting reversible contraceptive (LARC)?
A. Copper IUD
,B. Levonorgestrel IUD
C. Etonogestrel implant
D. Depot medroxyprogesterone acetate
Correct Answer: C
Explanation: While IUDs are generally safe, a history of PID can be a concern for some
providers, but a current active infection is a contraindication. The etonogestrel implant is
highly effective, not dependent on pelvic anatomy, and avoids the theoretical risk of pelvic
infection exacerbation in patients with high-risk behaviors. It remains a top-tier LARC
recommendation for young, active patients.
3. A 45-year-old woman presents with heavy menstrual bleeding and an enlarged, irregularly
shaped uterus. An ultrasound confirms the presence of multiple intramural and subserosal
masses. What is the most likely diagnosis?
A. Adenomyosis
B. Endometrial hyperplasia
C. Uterine leiomyoma
D. Endometrial carcinoma
Correct Answer: C
Explanation: Uterine leiomyomas (fibroids) are benign smooth muscle tumors that
typically present as an irregularly enlarged uterus with heavy bleeding. Adenomyosis
,usually presents with a globally, symmetrically enlarged ‘boggy’ uterus. Leiomyomas are
the most common pelvic tumor in women and are the leading indication for hysterectomy.
4. A 24-year-old female presents with a thin, grayish-white vaginal discharge and a fishy odor
that is more noticeable after intercourse. Wet mount microscopy reveals clue cells. What is
the first-line treatment?
A. Metronidazole
B. Azithromycin
C. Fluconazole
D. Ceftriaxone
Correct Answer: A
Explanation: The clinical description is classic for Bacterial Vaginosis (BV), caused by a
shift in vaginal flora. Diagnosis is made using Amsel criteria: thin discharge, pH >4.5,
positive whiff test, and clue cells. Metronidazole (oral or vaginal) or clindamycin cream are
the standard treatments.
5. A 35-year-old G1P0 at 11 weeks gestation requests screening for chromosomal
abnormalities. She is concerned about the risk of Down Syndrome due to her age. Which of
the following is the most sensitive screening test available for this patient at this time?
A. First-trimester combined screening (PAPP-A, hCG, NT)
B. Quadruple screening
C. Amniocentesis
, D. Cell-free DNA screening (NIPT)
Correct Answer: D
Explanation: Cell-free DNA (NIPT) has the highest sensitivity and specificity for trisomy 21
among screening tests. It can be performed as early as 10 weeks gestation. While
amniocentesis is diagnostic, it is an invasive procedure, and NIPT is the preferred high-
sensitivity screening tool.
6. During a vaginal delivery, the fetal head is delivered, but the shoulders fail to emerge with
standard traction. The ‘turtle sign’ is noted. What is the first maneuver that should be
performed?
A. Zavanelli maneuver
B. McRoberts maneuver
C. Woods screw maneuver
D. Fundal pressure
Correct Answer: B
Explanation: Shoulder dystocia is an obstetric emergency. The McRoberts maneuver
(hyperflexion of the mother’s hips) should be the first step, often combined with
suprapubic pressure. Fundal pressure is strictly contraindicated as it can worsen the
impaction and cause uterine rupture.
