OB/GYN: ACOG OBSTETRICS TEST
BANK. NEWEST 2025-2026 EDITION.
QUESTIONS & CORRECT VERIFIED
ANSWERS. GRADED A
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 -
ANSD
A 17-year-old G1 woman at 24 weeks gestation presents with vaginal
bleeding. She denies any pain, cramping or dysuria. She reports last
having intercourse three weeks ago. Prenatal care and labs have been
unremarkable. Her vital signs are normal and she is afebrile. Pelvic
,ultrasound reveals a fundal placenta and viable fetus. Abdominal
examination is unremarkable. Vaginal examination reveals a uniformly
friable cervix with a small amount of blood in the vault. Digital examination
reveals a firm, closed cervix. What is the most likely diagnosis that explains
the bleeding?
A. Trauma
B. Cervical cancer
C. Cervicitis
D. Bloody show
E. Threatened abortion - ANSC. Cervicitis caused by chlamydia,
gonorrhea, trichomonas or other infections can present with vaginal
bleeding. The cervix is much more vascular during pregnancy and
inflammation can lead to bleeding. Evaluation for other causes of bleeding
must be completed and then treatment for the infection should be initiated.
The patient does not give any history of trauma and cancer is unlikely
because of her age. She is not in labor, and a bloody show associated with
cervical dilatation is not consistent with the history provided. Threatened
abortion occurs during the first trimester.
A 17-year-old G1P0 female at 39 weeks gestation presents with increased
swelling in her face and hands over the last two days. Her blood pressure
is 155/99. She has 2 plus pitting edema of the lower extremities. A 24-hour
urine collection shows 440 mg of protein. What is the next best step in the
management of this patient?
A. Fluid restriction
B. Magnesium sulfate
C. Furosemide
,D. Hydralazine
E. Delivery - ANSE. Regardless of disease severity, the only definitive
therapy for preeclampsia is delivery of the fetus and placenta. This solution
can occasionally be delayed in the setting of stable disease (mild or
severe) when it occurs at an extremely early gestational age. Fluid
management must be monitored closely in this person. Magnesium sulfate
is the mainstay of therapy during labor and for 24 hours postpartum to
lower the seizure threshold. Low-dose aspirin may have some benefit in
decreasing the risk of preeclampsia in a subset of high-risk patients.
Hydralazine is often the antihypertensive agent of choice for controlling
elevated blood pressures in the acute setting.
A 17-year-old G2P0 female has severe right lower quadrant pain. Her last
normal menstrual period seven weeks ago. She notes that last night she
began having suprapubic pain that radiated to her right lower quadrant.
This morning, the pain awoke her from sleep. She has had no vaginal
bleeding, no nausea or vomiting. The patient's history is notable for two first
trimester elective abortions and a history of Chlamydia treated twice. Vital
signs are: blood pressure 90/60; pulse 99; respirations 22; and temperature
98.6°F (37°C). On physical exam, the patient is noted to be curled on a
stretcher in a fetal position and says she hurts too much to move. She has
rebound and voluntary guarding on abdominal examination. She has
profound cervical motion tenderness and rectal tenderness. Her Beta-hCG
level is 2500 mIU/ml; hematocrit 24%; and urinalysis negative. Ultrasound
shows no intrauterine pregnancy, a right adnexal mass t - ANSB. This
patient has a ruptured ectopic pregnancy until proven otherwise. Her vital
signs, examination and anemia are consistent with an intra-abdominal
, bleed. Exploratory laparoscopy/laparotomy is indicated at this point.
Conservative management with observation, serial examinations or repeat
Beta-hCG testing could be dangerous in a patient suspected of having a
ruptured ectopic pregnancy. Medical management (methotrexate) is not
used in a patient with an acute surgical abdomen. Dilation and curettage
would not be the next step in management and might only be considered in
this scenario after the patient's abdomen was explored.
A 19-year-old G1 woman at 40 weeks gestation has an uncomplicated
vaginal delivery followed by a brisk hemorrhage. Her past medical history is
significant for steroid-dependent asthma. Her blood pressure is 110/70;
pulse 84; and she is afebrile. Which of the following uterotonic agents
should not be used in this patient?
A. Intramuscular oxytocin
B. Intravenous oxytocin
C. Prostaglandin F2-alpha
D. Prostaglandin E1 (Misoprostol)
E. Methylergonovine - ANSC. Methergine, prostaglandins and oxytocin are
all uterotonics and used to increase uterine contractions and decrease
uterine bleeding. Prostaglandin F2-alpha (Hemabate) is a potent smooth
muscle constrictor, which also has a bronchio-constrictive effect. As such, it
should be used with caution in any patient with a reported history of
asthma. It is absolutely contraindicated in patients with poorly controlled or
severe asthma. Misoprostol, non-FDA approved for this purpose, is often
used for cervical ripening and labor induction.
BANK. NEWEST 2025-2026 EDITION.
QUESTIONS & CORRECT VERIFIED
ANSWERS. GRADED A
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 -
ANSD
A 17-year-old G1 woman at 24 weeks gestation presents with vaginal
bleeding. She denies any pain, cramping or dysuria. She reports last
having intercourse three weeks ago. Prenatal care and labs have been
unremarkable. Her vital signs are normal and she is afebrile. Pelvic
,ultrasound reveals a fundal placenta and viable fetus. Abdominal
examination is unremarkable. Vaginal examination reveals a uniformly
friable cervix with a small amount of blood in the vault. Digital examination
reveals a firm, closed cervix. What is the most likely diagnosis that explains
the bleeding?
A. Trauma
B. Cervical cancer
C. Cervicitis
D. Bloody show
E. Threatened abortion - ANSC. Cervicitis caused by chlamydia,
gonorrhea, trichomonas or other infections can present with vaginal
bleeding. The cervix is much more vascular during pregnancy and
inflammation can lead to bleeding. Evaluation for other causes of bleeding
must be completed and then treatment for the infection should be initiated.
The patient does not give any history of trauma and cancer is unlikely
because of her age. She is not in labor, and a bloody show associated with
cervical dilatation is not consistent with the history provided. Threatened
abortion occurs during the first trimester.
A 17-year-old G1P0 female at 39 weeks gestation presents with increased
swelling in her face and hands over the last two days. Her blood pressure
is 155/99. She has 2 plus pitting edema of the lower extremities. A 24-hour
urine collection shows 440 mg of protein. What is the next best step in the
management of this patient?
A. Fluid restriction
B. Magnesium sulfate
C. Furosemide
,D. Hydralazine
E. Delivery - ANSE. Regardless of disease severity, the only definitive
therapy for preeclampsia is delivery of the fetus and placenta. This solution
can occasionally be delayed in the setting of stable disease (mild or
severe) when it occurs at an extremely early gestational age. Fluid
management must be monitored closely in this person. Magnesium sulfate
is the mainstay of therapy during labor and for 24 hours postpartum to
lower the seizure threshold. Low-dose aspirin may have some benefit in
decreasing the risk of preeclampsia in a subset of high-risk patients.
Hydralazine is often the antihypertensive agent of choice for controlling
elevated blood pressures in the acute setting.
A 17-year-old G2P0 female has severe right lower quadrant pain. Her last
normal menstrual period seven weeks ago. She notes that last night she
began having suprapubic pain that radiated to her right lower quadrant.
This morning, the pain awoke her from sleep. She has had no vaginal
bleeding, no nausea or vomiting. The patient's history is notable for two first
trimester elective abortions and a history of Chlamydia treated twice. Vital
signs are: blood pressure 90/60; pulse 99; respirations 22; and temperature
98.6°F (37°C). On physical exam, the patient is noted to be curled on a
stretcher in a fetal position and says she hurts too much to move. She has
rebound and voluntary guarding on abdominal examination. She has
profound cervical motion tenderness and rectal tenderness. Her Beta-hCG
level is 2500 mIU/ml; hematocrit 24%; and urinalysis negative. Ultrasound
shows no intrauterine pregnancy, a right adnexal mass t - ANSB. This
patient has a ruptured ectopic pregnancy until proven otherwise. Her vital
signs, examination and anemia are consistent with an intra-abdominal
, bleed. Exploratory laparoscopy/laparotomy is indicated at this point.
Conservative management with observation, serial examinations or repeat
Beta-hCG testing could be dangerous in a patient suspected of having a
ruptured ectopic pregnancy. Medical management (methotrexate) is not
used in a patient with an acute surgical abdomen. Dilation and curettage
would not be the next step in management and might only be considered in
this scenario after the patient's abdomen was explored.
A 19-year-old G1 woman at 40 weeks gestation has an uncomplicated
vaginal delivery followed by a brisk hemorrhage. Her past medical history is
significant for steroid-dependent asthma. Her blood pressure is 110/70;
pulse 84; and she is afebrile. Which of the following uterotonic agents
should not be used in this patient?
A. Intramuscular oxytocin
B. Intravenous oxytocin
C. Prostaglandin F2-alpha
D. Prostaglandin E1 (Misoprostol)
E. Methylergonovine - ANSC. Methergine, prostaglandins and oxytocin are
all uterotonics and used to increase uterine contractions and decrease
uterine bleeding. Prostaglandin F2-alpha (Hemabate) is a potent smooth
muscle constrictor, which also has a bronchio-constrictive effect. As such, it
should be used with caution in any patient with a reported history of
asthma. It is absolutely contraindicated in patients with poorly controlled or
severe asthma. Misoprostol, non-FDA approved for this purpose, is often
used for cervical ripening and labor induction.
