LATEST OB/GYN – CRITICAL CARE MEDICINE
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF OBSTETRICS &
GYNECOLOGY (ABOG) | COMPLETE EXAM Q&A
WITH RATIONALES
1. A 28-year-old G1P0 at 38 weeks gestation presents
with severe epigastric pain, nausea, and headache.
Blood pressure is 170/110 mm Hg. Urine protein is 3+
(300 mg/dL). Platelet count is 80,000/μL. AST is 120
U/L, ALT 150 U/L. What is the most appropriate next
step?
A) Magnesium sulfate and immediate delivery
(cesarean or induction)
B) Labetalol and outpatient follow-up
C) Expectant management until 39 weeks
D) IV hydralazine and discharge
Correct answer: A
Rationale: This patient has severe preeclampsia with
HELLP syndrome (thrombocytopenia, elevated liver
enzymes). Delivery is indicated regardless of
gestational age after 34 weeks.
,2. A 32-year-old G2P1 at 40 weeks gestation
undergoes cesarean delivery under spinal
anesthesia. Immediately after delivery, she becomes
hypotensive (BP 70/40 mm Hg), bradycardic (HR 50
bpm), and complains of difficulty breathing. What is
the most likely diagnosis?
A) High spinal anesthesia (sympathectomy,
bradycardia)
B) Amniotic fluid embolism
C) Hemorrhage
D) Pulmonary embolism
Correct answer: A
Rationale: High spinal anesthesia causes
sympathetic blockade (hypotension) and
bradycardia; may also affect phrenic nerve
(dyspnea). Treat with vasopressors and airway
support.
3. A 28-year-old G1P0 at 39 weeks gestation is in
active labor. She develops a fever of 38.5°C, maternal
tachycardia (120 bpm), and fetal tachycardia (180
bpm). Uterine tenderness is present. What is the
most appropriate next step?
A) IV broad-spectrum antibiotics (ampicillin and
gentamicin) and expedite delivery
,B) Acetaminophen and continue labor
C) Immediate cesarean delivery
D) Amnioinfusion
Correct answer: A
Rationale: Clinical chorioamnionitis (intraamniotic
infection) requires broad-spectrum IV antibiotics and
prompt delivery (vaginal or cesarean).
4. A 35-year-old G3P2 at 37 weeks gestation presents
with sudden-onset severe abdominal pain and vaginal
bleeding. She has a history of prior cesarean
delivery. Ultrasound suggests possible uterine
rupture. What is the most appropriate next step?
A) Emergency laparotomy
B) Magnesium sulfate
C) Tocolytic therapy
D) Expectant management
Correct answer: A
Rationale: Suspected uterine rupture with
hemodynamic instability (or fetal distress) requires
emergent laparotomy.
, 5. A 25-year-old G1P0 at 41 weeks gestation
undergoes induction of labor with oxytocin. She
develops a contraction lasting 3 minutes with a non-
reassuring fetal heart rate pattern (bradycardia).
What is the most appropriate next step?
A) Discontinue oxytocin, reposition patient, give
oxygen, IV fluids
B) Increase oxytocin to augment labor
C) Immediate cesarean delivery
D) Administer terbutaline
Correct answer: A
Rationale: Tetanic contraction with fetal bradycardia
requires stopping oxytocin, repositioning (left
lateral), oxygen, and IV fluids. Terbutaline (tocolysis)
if no improvement.
6. A 30-year-old G2P1 at 39 weeks gestation
undergoes cesarean delivery. Estimated blood loss is
1500 mL. Uterus is boggy. What is the most
appropriate immediate step?
A) Bimanual uterine massage and oxytocin
B) Bakri balloon placement
C) Hysterectomy
D) Uterine artery embolization
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF OBSTETRICS &
GYNECOLOGY (ABOG) | COMPLETE EXAM Q&A
WITH RATIONALES
1. A 28-year-old G1P0 at 38 weeks gestation presents
with severe epigastric pain, nausea, and headache.
Blood pressure is 170/110 mm Hg. Urine protein is 3+
(300 mg/dL). Platelet count is 80,000/μL. AST is 120
U/L, ALT 150 U/L. What is the most appropriate next
step?
A) Magnesium sulfate and immediate delivery
(cesarean or induction)
B) Labetalol and outpatient follow-up
C) Expectant management until 39 weeks
D) IV hydralazine and discharge
Correct answer: A
Rationale: This patient has severe preeclampsia with
HELLP syndrome (thrombocytopenia, elevated liver
enzymes). Delivery is indicated regardless of
gestational age after 34 weeks.
,2. A 32-year-old G2P1 at 40 weeks gestation
undergoes cesarean delivery under spinal
anesthesia. Immediately after delivery, she becomes
hypotensive (BP 70/40 mm Hg), bradycardic (HR 50
bpm), and complains of difficulty breathing. What is
the most likely diagnosis?
A) High spinal anesthesia (sympathectomy,
bradycardia)
B) Amniotic fluid embolism
C) Hemorrhage
D) Pulmonary embolism
Correct answer: A
Rationale: High spinal anesthesia causes
sympathetic blockade (hypotension) and
bradycardia; may also affect phrenic nerve
(dyspnea). Treat with vasopressors and airway
support.
3. A 28-year-old G1P0 at 39 weeks gestation is in
active labor. She develops a fever of 38.5°C, maternal
tachycardia (120 bpm), and fetal tachycardia (180
bpm). Uterine tenderness is present. What is the
most appropriate next step?
A) IV broad-spectrum antibiotics (ampicillin and
gentamicin) and expedite delivery
,B) Acetaminophen and continue labor
C) Immediate cesarean delivery
D) Amnioinfusion
Correct answer: A
Rationale: Clinical chorioamnionitis (intraamniotic
infection) requires broad-spectrum IV antibiotics and
prompt delivery (vaginal or cesarean).
4. A 35-year-old G3P2 at 37 weeks gestation presents
with sudden-onset severe abdominal pain and vaginal
bleeding. She has a history of prior cesarean
delivery. Ultrasound suggests possible uterine
rupture. What is the most appropriate next step?
A) Emergency laparotomy
B) Magnesium sulfate
C) Tocolytic therapy
D) Expectant management
Correct answer: A
Rationale: Suspected uterine rupture with
hemodynamic instability (or fetal distress) requires
emergent laparotomy.
, 5. A 25-year-old G1P0 at 41 weeks gestation
undergoes induction of labor with oxytocin. She
develops a contraction lasting 3 minutes with a non-
reassuring fetal heart rate pattern (bradycardia).
What is the most appropriate next step?
A) Discontinue oxytocin, reposition patient, give
oxygen, IV fluids
B) Increase oxytocin to augment labor
C) Immediate cesarean delivery
D) Administer terbutaline
Correct answer: A
Rationale: Tetanic contraction with fetal bradycardia
requires stopping oxytocin, repositioning (left
lateral), oxygen, and IV fluids. Terbutaline (tocolysis)
if no improvement.
6. A 30-year-old G2P1 at 39 weeks gestation
undergoes cesarean delivery. Estimated blood loss is
1500 mL. Uterus is boggy. What is the most
appropriate immediate step?
A) Bimanual uterine massage and oxytocin
B) Bakri balloon placement
C) Hysterectomy
D) Uterine artery embolization
