COMLEX-USA Obstetrics and Gynecology 1 — Questions and Answers
Question 1: A 28-year-old woman at 38 weeks gestation presents with severe headache, visual disturbances, and blood pressure of 158/105 mmHg. Urine dipstick shows 3+ proteinuria. Which is the definitive treatment?
- IV labetalol
- Magnesium sulfate
- Delivery of the fetus (Correct answer)
- Oral nifedipine
Correct answer: Delivery of the fetus
Delivery of the fetus and placenta is the only definitive treatment for preeclampsia, as the placenta is the underlying cause.
Question 2: A 24-year-old woman presents with 6 weeks of amenorrhea, vaginal bleeding, and left lower quadrant pain. Beta-hCG is 1,500 mIU/mL and transvaginal ultrasound shows no intrauterine gestational sac. She is hemodynamically stable. Which is the most appropriate management?
- Expectant management alone
- Dilation and curettage
- Methotrexate administration (Correct answer)
- Immediate laparotomy
Correct answer: Methotrexate administration
Methotrexate is indicated for hemodynamically stable ectopic pregnancy with beta-hCG <5,000 mIU/mL and no fetal cardiac activity on ultrasound.
Question 3: A nulliparous woman delivers vaginally at term and has 700 mL of blood loss within the first hour after placental delivery. The uterus is boggy on exam. What is the most common cause of this complication?
- Retained placental fragments
- Uterine atony (Correct answer)
- Cervical laceration
- Coagulopathy
Correct answer: Uterine atony
Uterine atony accounts for approximately 80% of postpartum hemorrhage cases and is the most common cause.
Question 4: A 32-year-old nulliparous woman presents with cyclic pelvic pain, progressive dysmenorrhea, and dyspareunia. CA-125 is mildly elevated. What is the gold standard for diagnosis?
- Transvaginal ultrasound
- MRI of the pelvis
- Diagnostic laparoscopy with biopsy (Correct answer)
- Endometrial biopsy
Correct answer: Diagnostic laparoscopy with biopsy
Diagnostic laparoscopy with histological confirmation of ectopic endometrial tissue is the gold standard for diagnosing endometriosis.
Question 5: A 36-week pregnant woman has a positive Group B Streptococcus vaginal-rectal culture. Which antibiotic should be administered intrapartum for prophylaxis?
- IV penicillin G or ampicillin (Correct answer)
- Oral clindamycin
- IV erythromycin
- IV vancomycin
Correct answer: IV penicillin G or ampicillin
IV penicillin G is first-line intrapartum GBS prophylaxis, with ampicillin as an acceptable alternative.
Question 6: A 26-year-old woman has irregular periods, hirsutism, and obesity. Transvaginal ultrasound shows bilateral ovaries with 14 follicles each (< 10 mm). Testosterone is mildly elevated. What is the most likely diagnosis?
- Hypothyroidism
- Cushing syndrome
- Polycystic ovary syndrome (Correct answer)
- Congenital adrenal hyperplasia
Correct answer: Polycystic ovary syndrome
PCOS is diagnosed by Rotterdam criteria: oligo-anovulation, clinical or biochemical hyperandrogenism, and polycystic ovarian morphology (≥12 follicles per ovary).
Question 7: A 34-year-old woman at 30 weeks gestation has painless vaginal bleeding. Ultrasound shows the placenta completely covering the internal cervical os. She is currently stable. What is the most appropriate management?
- Immediate cesarean section
- Amniocentesis for fetal lung maturity
- Pelvic rest, hospitalization, and planned delivery at 36–37 weeks (Correct answer)
- Vaginal delivery with oxytocin augmentation
Correct answer: Pelvic rest, hospitalization, and planned delivery at 36–37 weeks
Stable placenta previa at 30 weeks is managed conservatively with pelvic rest and monitoring, with planned cesarean at 36–37 weeks.
