MED740 Obstetrics and Gynecology Clerkship Exam Prep –
Real Practice Questions, Answers & Detailed Rationales
(Updated 2026) | Prenatal & Postpartum Care, Labor &
Delivery Management, Gynecologic Disorders & Reproductive
Health, Obstetric Emergencies, Fetal Monitoring & Maternal
Assessment, Contraception & Women’s Health, Surgical
Gynecology, Clinical Decision-Making & OB/GYN Clerkship
Review
Question 1: A 28-year-old G1P0 at 12 weeks gestation presents for her first prenatal
visit. Which of the following screening tests is MOST appropriately offered at this
gestational age?
A. Group B Streptococcus culture
B. Gestational diabetes screening with 1-hour glucose challenge
C. First-trimester combined screening for aneuploidy
D. Late-pregnancy ultrasound for fetal growth assessment
CORRECT ANSWER: C. First-trimester combined screening for aneuploidy
Rationale: First-trimester combined screening, which includes nuchal translucency
ultrasound and maternal serum markers (PAPP-A and free β-hCG), is optimally
performed between 11 and 14 weeks gestation to assess risk for trisomy 21 and 18.
Group B Streptococcus screening occurs at 35–37 weeks, gestational diabetes
screening at 24–28 weeks, and growth ultrasounds are typically reserved for the third
trimester or when clinically indicated.
Question 2: During active labor, a term primigravida demonstrates cervical dilation
progressing from 4 cm to 6 cm over 3 hours with adequate contractions. According
to contemporary labor management guidelines, this pattern is BEST described as:
A. Protracted active phase
B. Normal active phase labor
C. Arrest of dilation
D. Prolonged latent phase
CORRECT ANSWER: B. Normal active phase labor
Rationale: Contemporary guidelines (ACOG, 2014) recognize that the active phase of
labor begins at 6 cm dilation. Progress from 4 cm to 6 cm over 3 hours in a primigravida
with adequate contractions falls within expected parameters. Arrest of dilation is
diagnosed only after ≥4 hours of adequate contractions or ≥6 hours of inadequate
contractions with no cervical change at ≥6 cm. Protracted labor refers to slower-than-
expected but ongoing progress.
Question 3: A 32-year-old woman at 34 weeks gestation presents with new-onset
hypertension (150/95 mmHg), proteinuria (300 mg/24h), and headache. Which
finding would MOST strongly suggest progression to severe features of
preeclampsia?
,A. Platelet count of 110,000/μL
B. Serum creatinine of 1.0 mg/dL
C. Right upper quadrant pain
D. Fetal growth restriction
CORRECT ANSWER: C. Right upper quadrant pain
Rationale: Right upper quadrant or epigastric pain is a hallmark symptom of severe
preeclampsia, reflecting hepatic capsular distension or ischemia. While
thrombocytopenia (<100,000/μL), renal insufficiency (creatinine >1.1 mg/dL or
doubling), and fetal growth restriction are concerning, RUQ pain is a specific indicator
of severe disease requiring urgent evaluation and often delivery. Platelet count of
110,000/μL does not meet the threshold for severe thrombocytopenia.
Question 4: Which of the following fetal heart rate patterns on electronic
monitoring is MOST concerning for acute fetal hypoxia?
A. Early decelerations with moderate variability
B. Variable decelerations with accelerations
C. Late decelerations with minimal variability
D. Sinusoidal pattern with normal baseline
CORRECT ANSWER: C. Late decelerations with minimal variability
Rationale: Late decelerations that are recurrent and associated with minimal or absent
variability suggest uteroplacental insufficiency and fetal metabolic acidosis. This
pattern is Category II or III per NICHD criteria and warrants immediate intervention.
Early decelerations are benign and head-compression related. Variable decelerations
with accelerations suggest cord compression but with reassuring recovery. Sinusoidal
pattern is rare and associated with fetal anemia or severe hypoxia but is less common
than late decelerations with minimal variability as an acute indicator.
Question 5: A woman presents 6 weeks postpartum with persistent vaginal
bleeding, uterine tenderness, and fever. The MOST likely diagnosis is:
A. Endometritis
B. Retained products of conception
C. Subinvolution of the placental site
D. Cervical laceration
CORRECT ANSWER: A. Endometritis
Rationale: Postpartum endometritis typically presents within the first 1–2 weeks (but
can occur up to 6 weeks) with fever, uterine tenderness, foul lochia, and sometimes
bleeding. It is the most common postpartum infection, especially after cesarean
delivery. Retained products may cause bleeding but less commonly fever without
infection. Subinvolution causes late bleeding but not fever. Cervical laceration presents
immediately postpartum with acute bleeding.
,Question 6: A 24-year-old woman with type 1 diabetes is planning pregnancy.
Which preconception intervention is MOST critical to reduce the risk of congenital
anomalies?
A. Initiation of low-dose aspirin
B. Optimization of glycemic control with HbA1c <6.5%
C. Folic acid supplementation at 4 mg daily
D. Screening for diabetic retinopathy
CORRECT ANSWER: B. Optimization of glycemic control with HbA1c <6.5%
Rationale: Poor glycemic control in early pregnancy is the strongest modifiable risk
factor for congenital malformations in diabetic pregnancies. Achieving HbA1c <6.5%
(ideally <6.0%) before conception significantly reduces risks of cardiac, neural tube,
and skeletal anomalies. While high-dose folic acid (4 mg) is recommended for diabetic
women, glycemic control has the greatest impact on structural anomalies. Aspirin is for
preeclampsia prevention later in pregnancy.
Question 7: Which of the following is a contraindication to trial of labor after
cesarean (TOLAC)?
A. One prior low-transverse cesarean incision
B. Prior classical uterine incision
C. Maternal request for vaginal birth
D. Interpregnancy interval of 18 months
CORRECT ANSWER: B. Prior classical uterine incision
Rationale: A prior classical (vertical) uterine incision carries a 4–9% risk of uterine
rupture during labor, making TOLAC contraindicated. Low-transverse incisions have a
rupture risk of 0.5–1%, allowing TOLAC consideration. Maternal request and
interpregnancy interval >18 months are favorable factors for TOLAC success, not
contraindications.
Question 8: A 30-year-old woman at 38 weeks presents with painless vaginal
bleeding. Ultrasound confirms placenta previa. Which management step is MOST
appropriate?
A. Immediate cesarean delivery
B. Digital cervical examination to assess dilation
C. Expectant management with pelvic rest
D. Administration of terbutaline for tocolysis
CORRECT ANSWER: C. Expectant management with pelvic rest
Rationale: In stable patients with placenta previa and no active heavy bleeding,
expectant management with pelvic rest, avoidance of digital exams (which can provoke
hemorrhage), and close monitoring is standard until fetal lung maturity or bleeding
necessitates delivery. Immediate cesarean is reserved for life-threatening hemorrhage
, or fetal compromise. Digital exams are contraindicated. Tocolysis is not indicated
without preterm labor.
Question 9: Which of the following findings is diagnostic of bacterial vaginosis?
A. Vaginal pH <4.5
B. Clue cells on saline wet mount
C. Positive whiff test with potassium hydroxide
D. Thin, homogeneous white discharge
CORRECT ANSWER: B. Clue cells on saline wet mount
Rationale: Bacterial vaginosis is diagnosed by Amsel criteria: ≥3 of 4 findings—thin
homogeneous discharge, vaginal pH >4.5, positive whiff test, and clue cells on
microscopy. Clue cells (epithelial cells covered with adherent bacteria) are the most
specific single finding. While the other options support the diagnosis, clue cells are
required for definitive microscopic diagnosis. pH <4.5 is normal and argues against BV.
Question 10: A 45-year-old woman presents with 6 months of irregular, heavy
menstrual bleeding. Endometrial biopsy shows complex endometrial hyperplasia
without atypia. First-line management is:
A. Total hysterectomy
B. Progestin therapy
C. Endometrial ablation
D. Observation with repeat biopsy in 6 months
CORRECT ANSWER: B. Progestin therapy
Rationale: For endometrial hyperplasia without atypia, progestin therapy (oral,
intrauterine levonorgestrel) is first-line to reverse hyperplasia and prevent progression.
Hysterectomy is reserved for atypia, failed medical therapy, or patient preference.
Ablation is contraindicated with hyperplasia due to risk of masking progression.
Observation alone risks progression to cancer.
Question 11: Which of the following is the MOST common cause of first-trimester
miscarriage?
A. Maternal endocrine disorders
B. Uterine structural anomalies
C. Fetal chromosomal abnormalities
D. Maternal infection
CORRECT ANSWER: C. Fetal chromosomal abnormalities
Rationale: Approximately 50–70% of first-trimester miscarriages result from fetal
chromosomal abnormalities, most commonly autosomal trisomies, monosomy X, or
polyploidy. Maternal factors (endocrine, anatomic, immunologic) account for a smaller
proportion. Infections are rare causes of early loss.
Real Practice Questions, Answers & Detailed Rationales
(Updated 2026) | Prenatal & Postpartum Care, Labor &
Delivery Management, Gynecologic Disorders & Reproductive
Health, Obstetric Emergencies, Fetal Monitoring & Maternal
Assessment, Contraception & Women’s Health, Surgical
Gynecology, Clinical Decision-Making & OB/GYN Clerkship
Review
Question 1: A 28-year-old G1P0 at 12 weeks gestation presents for her first prenatal
visit. Which of the following screening tests is MOST appropriately offered at this
gestational age?
A. Group B Streptococcus culture
B. Gestational diabetes screening with 1-hour glucose challenge
C. First-trimester combined screening for aneuploidy
D. Late-pregnancy ultrasound for fetal growth assessment
CORRECT ANSWER: C. First-trimester combined screening for aneuploidy
Rationale: First-trimester combined screening, which includes nuchal translucency
ultrasound and maternal serum markers (PAPP-A and free β-hCG), is optimally
performed between 11 and 14 weeks gestation to assess risk for trisomy 21 and 18.
Group B Streptococcus screening occurs at 35–37 weeks, gestational diabetes
screening at 24–28 weeks, and growth ultrasounds are typically reserved for the third
trimester or when clinically indicated.
Question 2: During active labor, a term primigravida demonstrates cervical dilation
progressing from 4 cm to 6 cm over 3 hours with adequate contractions. According
to contemporary labor management guidelines, this pattern is BEST described as:
A. Protracted active phase
B. Normal active phase labor
C. Arrest of dilation
D. Prolonged latent phase
CORRECT ANSWER: B. Normal active phase labor
Rationale: Contemporary guidelines (ACOG, 2014) recognize that the active phase of
labor begins at 6 cm dilation. Progress from 4 cm to 6 cm over 3 hours in a primigravida
with adequate contractions falls within expected parameters. Arrest of dilation is
diagnosed only after ≥4 hours of adequate contractions or ≥6 hours of inadequate
contractions with no cervical change at ≥6 cm. Protracted labor refers to slower-than-
expected but ongoing progress.
Question 3: A 32-year-old woman at 34 weeks gestation presents with new-onset
hypertension (150/95 mmHg), proteinuria (300 mg/24h), and headache. Which
finding would MOST strongly suggest progression to severe features of
preeclampsia?
,A. Platelet count of 110,000/μL
B. Serum creatinine of 1.0 mg/dL
C. Right upper quadrant pain
D. Fetal growth restriction
CORRECT ANSWER: C. Right upper quadrant pain
Rationale: Right upper quadrant or epigastric pain is a hallmark symptom of severe
preeclampsia, reflecting hepatic capsular distension or ischemia. While
thrombocytopenia (<100,000/μL), renal insufficiency (creatinine >1.1 mg/dL or
doubling), and fetal growth restriction are concerning, RUQ pain is a specific indicator
of severe disease requiring urgent evaluation and often delivery. Platelet count of
110,000/μL does not meet the threshold for severe thrombocytopenia.
Question 4: Which of the following fetal heart rate patterns on electronic
monitoring is MOST concerning for acute fetal hypoxia?
A. Early decelerations with moderate variability
B. Variable decelerations with accelerations
C. Late decelerations with minimal variability
D. Sinusoidal pattern with normal baseline
CORRECT ANSWER: C. Late decelerations with minimal variability
Rationale: Late decelerations that are recurrent and associated with minimal or absent
variability suggest uteroplacental insufficiency and fetal metabolic acidosis. This
pattern is Category II or III per NICHD criteria and warrants immediate intervention.
Early decelerations are benign and head-compression related. Variable decelerations
with accelerations suggest cord compression but with reassuring recovery. Sinusoidal
pattern is rare and associated with fetal anemia or severe hypoxia but is less common
than late decelerations with minimal variability as an acute indicator.
Question 5: A woman presents 6 weeks postpartum with persistent vaginal
bleeding, uterine tenderness, and fever. The MOST likely diagnosis is:
A. Endometritis
B. Retained products of conception
C. Subinvolution of the placental site
D. Cervical laceration
CORRECT ANSWER: A. Endometritis
Rationale: Postpartum endometritis typically presents within the first 1–2 weeks (but
can occur up to 6 weeks) with fever, uterine tenderness, foul lochia, and sometimes
bleeding. It is the most common postpartum infection, especially after cesarean
delivery. Retained products may cause bleeding but less commonly fever without
infection. Subinvolution causes late bleeding but not fever. Cervical laceration presents
immediately postpartum with acute bleeding.
,Question 6: A 24-year-old woman with type 1 diabetes is planning pregnancy.
Which preconception intervention is MOST critical to reduce the risk of congenital
anomalies?
A. Initiation of low-dose aspirin
B. Optimization of glycemic control with HbA1c <6.5%
C. Folic acid supplementation at 4 mg daily
D. Screening for diabetic retinopathy
CORRECT ANSWER: B. Optimization of glycemic control with HbA1c <6.5%
Rationale: Poor glycemic control in early pregnancy is the strongest modifiable risk
factor for congenital malformations in diabetic pregnancies. Achieving HbA1c <6.5%
(ideally <6.0%) before conception significantly reduces risks of cardiac, neural tube,
and skeletal anomalies. While high-dose folic acid (4 mg) is recommended for diabetic
women, glycemic control has the greatest impact on structural anomalies. Aspirin is for
preeclampsia prevention later in pregnancy.
Question 7: Which of the following is a contraindication to trial of labor after
cesarean (TOLAC)?
A. One prior low-transverse cesarean incision
B. Prior classical uterine incision
C. Maternal request for vaginal birth
D. Interpregnancy interval of 18 months
CORRECT ANSWER: B. Prior classical uterine incision
Rationale: A prior classical (vertical) uterine incision carries a 4–9% risk of uterine
rupture during labor, making TOLAC contraindicated. Low-transverse incisions have a
rupture risk of 0.5–1%, allowing TOLAC consideration. Maternal request and
interpregnancy interval >18 months are favorable factors for TOLAC success, not
contraindications.
Question 8: A 30-year-old woman at 38 weeks presents with painless vaginal
bleeding. Ultrasound confirms placenta previa. Which management step is MOST
appropriate?
A. Immediate cesarean delivery
B. Digital cervical examination to assess dilation
C. Expectant management with pelvic rest
D. Administration of terbutaline for tocolysis
CORRECT ANSWER: C. Expectant management with pelvic rest
Rationale: In stable patients with placenta previa and no active heavy bleeding,
expectant management with pelvic rest, avoidance of digital exams (which can provoke
hemorrhage), and close monitoring is standard until fetal lung maturity or bleeding
necessitates delivery. Immediate cesarean is reserved for life-threatening hemorrhage
, or fetal compromise. Digital exams are contraindicated. Tocolysis is not indicated
without preterm labor.
Question 9: Which of the following findings is diagnostic of bacterial vaginosis?
A. Vaginal pH <4.5
B. Clue cells on saline wet mount
C. Positive whiff test with potassium hydroxide
D. Thin, homogeneous white discharge
CORRECT ANSWER: B. Clue cells on saline wet mount
Rationale: Bacterial vaginosis is diagnosed by Amsel criteria: ≥3 of 4 findings—thin
homogeneous discharge, vaginal pH >4.5, positive whiff test, and clue cells on
microscopy. Clue cells (epithelial cells covered with adherent bacteria) are the most
specific single finding. While the other options support the diagnosis, clue cells are
required for definitive microscopic diagnosis. pH <4.5 is normal and argues against BV.
Question 10: A 45-year-old woman presents with 6 months of irregular, heavy
menstrual bleeding. Endometrial biopsy shows complex endometrial hyperplasia
without atypia. First-line management is:
A. Total hysterectomy
B. Progestin therapy
C. Endometrial ablation
D. Observation with repeat biopsy in 6 months
CORRECT ANSWER: B. Progestin therapy
Rationale: For endometrial hyperplasia without atypia, progestin therapy (oral,
intrauterine levonorgestrel) is first-line to reverse hyperplasia and prevent progression.
Hysterectomy is reserved for atypia, failed medical therapy, or patient preference.
Ablation is contraindicated with hyperplasia due to risk of masking progression.
Observation alone risks progression to cancer.
Question 11: Which of the following is the MOST common cause of first-trimester
miscarriage?
A. Maternal endocrine disorders
B. Uterine structural anomalies
C. Fetal chromosomal abnormalities
D. Maternal infection
CORRECT ANSWER: C. Fetal chromosomal abnormalities
Rationale: Approximately 50–70% of first-trimester miscarriages result from fetal
chromosomal abnormalities, most commonly autosomal trisomies, monosomy X, or
polyploidy. Maternal factors (endocrine, anatomic, immunologic) account for a smaller
proportion. Infections are rare causes of early loss.
