NBME SUBJECT EXAM – OBSTETRICS &
GYNECOLOGY EXAM | ALL QUESTIONS AND
ANSWERS | A+ GRADED | COMPREHENSIVE EXAM
GUIDE 2026/2027
1. A 24-year-old woman, gravida 1, para 0, at 8 weeks' gestation presents with vaginal
bleeding and mild lower abdominal cramping. Transvaginal ultrasonography shows an
intrauterine gestational sac with an embryo measuring 8 weeks and cardiac activity. The
cervical os is closed. Which is the most likely diagnosis?
A. Threatened abortion
B. Inevitable abortion
C. Incomplete abortion
D. Ectopic pregnancy
Answer: A
Rationale: Threatened abortion is characterized by vaginal bleeding before 20 weeks with a
closed cervical os and a viable intrauterine pregnancy.
2. A 29-year-old woman at 32 weeks' gestation develops sudden, painless, bright-red
vaginal bleeding. Her uterus is soft and nontender, and fetal heart rate monitoring is
initially reassuring. Which diagnosis is most likely?
A. Placental abruption
B. Uterine rupture
C. Placenta previa
D. Vasa previa
Answer: C
Rationale: Placenta previa classically causes painless third-trimester vaginal bleeding with a
nontender uterus.
3. A 35-year-old woman at 36 weeks' gestation presents with painful vaginal bleeding and
severe abdominal pain. The uterus is firm and tender, and fetal monitoring shows
recurrent late decelerations. Which condition is most likely?
,A. Placenta previa
B. Placental abruption
C. Cervical insufficiency
D. Bloody show
Answer: B
Rationale: Placental abruption causes painful bleeding, uterine tenderness or rigidity, and
may produce fetal distress due to impaired placental perfusion.
4. A 27-year-old woman with regular menstrual cycles presents with amenorrhea,
unilateral pelvic pain, and light vaginal bleeding. Her serum β-hCG concentration is
positive, and transvaginal ultrasonography does not show an intrauterine pregnancy.
Which diagnosis should be suspected most strongly?
A. Leiomyoma
B. Threatened abortion
C. Endometriosis
D. Ectopic pregnancy
Answer: D
Rationale: A positive pregnancy test with pelvic pain, bleeding, and no confirmed intrauterine
pregnancy raises strong concern for ectopic pregnancy.
5. A pregnant woman with an ectopic pregnancy suddenly develops severe abdominal pain,
shoulder pain, dizziness, and hypotension. Which complication is most likely responsible?
A. Rupture with intra-abdominal hemorrhage
B. Ovarian hyperstimulation
C. Septic abortion
D. Gestational trophoblastic disease
Answer: A
Rationale: Sudden pain, referred shoulder pain, and hemodynamic instability in ectopic
pregnancy strongly indicate tubal rupture and hemoperitoneum.
,6. A 31-year-old woman presents at 10 weeks' gestation with severe nausea and vomiting,
weight loss, dehydration, and ketonuria. Laboratory testing shows mild hypokalemia.
Which diagnosis is most likely?
A. Acute fatty liver of pregnancy
B. Hyperemesis gravidarum
C. HELLP syndrome
D. Preeclampsia
Answer: B
Rationale: Hyperemesis gravidarum causes severe persistent vomiting during early pregnancy
with dehydration, weight loss, electrolyte abnormalities, and ketonuria.
7. A 30-year-old pregnant woman at 28 weeks has a blood pressure of 148/94 mm Hg on
two separate measurements. She has no proteinuria, headache, visual changes, or
laboratory abnormalities. Which diagnosis is most appropriate?
A. Chronic hypertension
B. Preeclampsia with severe features
C. Gestational hypertension
D. Eclampsia
Answer: C
Rationale: New-onset hypertension after 20 weeks without proteinuria or evidence of end-
organ dysfunction is gestational hypertension.
8. A 34-year-old woman at 34 weeks' gestation has blood pressure of 162/112 mm Hg,
severe headache, and right upper-quadrant pain. Laboratory studies show elevated AST
and ALT and thrombocytopenia. Which diagnosis is most likely?
A. HELLP syndrome
B. Acute pancreatitis
C. Cholestasis of pregnancy
D. Gestational hypertension
Answer: A
Rationale: HELLP syndrome consists of hemolysis, elevated liver enzymes, and low platelet
count and is a severe hypertensive pregnancy complication.
, 9. A 26-year-old woman at 35 weeks' gestation has generalized tonic-clonic seizure activity.
Her blood pressure is 170/110 mm Hg. Which medication is most appropriate for
preventing recurrent seizures?
A. Diazepam
B. Phenytoin
C. Lorazepam
D. Magnesium sulfate
Answer: D
Rationale: Magnesium sulfate is the preferred medication for seizure prevention and
treatment in eclampsia.
10. A 37-year-old woman with preeclampsia develops severe persistent headache and visual
disturbances despite initial treatment. What is the most appropriate definitive
management?
A. Continued observation until 40 weeks
B. Delivery after maternal stabilization
C. Immediate cesarean delivery in every case
D. Bed rest alone
Answer: B
Rationale: Severe features of preeclampsia require delivery after appropriate maternal
stabilization because definitive treatment is termination of the pregnancy.
11. A 28-year-old woman at 30 weeks' gestation reports intense generalized itching,
particularly on her palms and soles. She has no rash. Laboratory testing shows elevated
serum bile acids. Which diagnosis is most likely?
A. Intrahepatic cholestasis of pregnancy
B. Preeclampsia
C. Pemphigoid gestationis
D. Atopic eruption of pregnancy
Answer: A
GYNECOLOGY EXAM | ALL QUESTIONS AND
ANSWERS | A+ GRADED | COMPREHENSIVE EXAM
GUIDE 2026/2027
1. A 24-year-old woman, gravida 1, para 0, at 8 weeks' gestation presents with vaginal
bleeding and mild lower abdominal cramping. Transvaginal ultrasonography shows an
intrauterine gestational sac with an embryo measuring 8 weeks and cardiac activity. The
cervical os is closed. Which is the most likely diagnosis?
A. Threatened abortion
B. Inevitable abortion
C. Incomplete abortion
D. Ectopic pregnancy
Answer: A
Rationale: Threatened abortion is characterized by vaginal bleeding before 20 weeks with a
closed cervical os and a viable intrauterine pregnancy.
2. A 29-year-old woman at 32 weeks' gestation develops sudden, painless, bright-red
vaginal bleeding. Her uterus is soft and nontender, and fetal heart rate monitoring is
initially reassuring. Which diagnosis is most likely?
A. Placental abruption
B. Uterine rupture
C. Placenta previa
D. Vasa previa
Answer: C
Rationale: Placenta previa classically causes painless third-trimester vaginal bleeding with a
nontender uterus.
3. A 35-year-old woman at 36 weeks' gestation presents with painful vaginal bleeding and
severe abdominal pain. The uterus is firm and tender, and fetal monitoring shows
recurrent late decelerations. Which condition is most likely?
,A. Placenta previa
B. Placental abruption
C. Cervical insufficiency
D. Bloody show
Answer: B
Rationale: Placental abruption causes painful bleeding, uterine tenderness or rigidity, and
may produce fetal distress due to impaired placental perfusion.
4. A 27-year-old woman with regular menstrual cycles presents with amenorrhea,
unilateral pelvic pain, and light vaginal bleeding. Her serum β-hCG concentration is
positive, and transvaginal ultrasonography does not show an intrauterine pregnancy.
Which diagnosis should be suspected most strongly?
A. Leiomyoma
B. Threatened abortion
C. Endometriosis
D. Ectopic pregnancy
Answer: D
Rationale: A positive pregnancy test with pelvic pain, bleeding, and no confirmed intrauterine
pregnancy raises strong concern for ectopic pregnancy.
5. A pregnant woman with an ectopic pregnancy suddenly develops severe abdominal pain,
shoulder pain, dizziness, and hypotension. Which complication is most likely responsible?
A. Rupture with intra-abdominal hemorrhage
B. Ovarian hyperstimulation
C. Septic abortion
D. Gestational trophoblastic disease
Answer: A
Rationale: Sudden pain, referred shoulder pain, and hemodynamic instability in ectopic
pregnancy strongly indicate tubal rupture and hemoperitoneum.
,6. A 31-year-old woman presents at 10 weeks' gestation with severe nausea and vomiting,
weight loss, dehydration, and ketonuria. Laboratory testing shows mild hypokalemia.
Which diagnosis is most likely?
A. Acute fatty liver of pregnancy
B. Hyperemesis gravidarum
C. HELLP syndrome
D. Preeclampsia
Answer: B
Rationale: Hyperemesis gravidarum causes severe persistent vomiting during early pregnancy
with dehydration, weight loss, electrolyte abnormalities, and ketonuria.
7. A 30-year-old pregnant woman at 28 weeks has a blood pressure of 148/94 mm Hg on
two separate measurements. She has no proteinuria, headache, visual changes, or
laboratory abnormalities. Which diagnosis is most appropriate?
A. Chronic hypertension
B. Preeclampsia with severe features
C. Gestational hypertension
D. Eclampsia
Answer: C
Rationale: New-onset hypertension after 20 weeks without proteinuria or evidence of end-
organ dysfunction is gestational hypertension.
8. A 34-year-old woman at 34 weeks' gestation has blood pressure of 162/112 mm Hg,
severe headache, and right upper-quadrant pain. Laboratory studies show elevated AST
and ALT and thrombocytopenia. Which diagnosis is most likely?
A. HELLP syndrome
B. Acute pancreatitis
C. Cholestasis of pregnancy
D. Gestational hypertension
Answer: A
Rationale: HELLP syndrome consists of hemolysis, elevated liver enzymes, and low platelet
count and is a severe hypertensive pregnancy complication.
, 9. A 26-year-old woman at 35 weeks' gestation has generalized tonic-clonic seizure activity.
Her blood pressure is 170/110 mm Hg. Which medication is most appropriate for
preventing recurrent seizures?
A. Diazepam
B. Phenytoin
C. Lorazepam
D. Magnesium sulfate
Answer: D
Rationale: Magnesium sulfate is the preferred medication for seizure prevention and
treatment in eclampsia.
10. A 37-year-old woman with preeclampsia develops severe persistent headache and visual
disturbances despite initial treatment. What is the most appropriate definitive
management?
A. Continued observation until 40 weeks
B. Delivery after maternal stabilization
C. Immediate cesarean delivery in every case
D. Bed rest alone
Answer: B
Rationale: Severe features of preeclampsia require delivery after appropriate maternal
stabilization because definitive treatment is termination of the pregnancy.
11. A 28-year-old woman at 30 weeks' gestation reports intense generalized itching,
particularly on her palms and soles. She has no rash. Laboratory testing shows elevated
serum bile acids. Which diagnosis is most likely?
A. Intrahepatic cholestasis of pregnancy
B. Preeclampsia
C. Pemphigoid gestationis
D. Atopic eruption of pregnancy
Answer: A
