COMLEX-USA Obstetrics and Gynecology 3

Question 1

A 21-year-old woman presents with vaginal itching, dysuria, and a frothy, malodorous yellow-green discharge. Wet prep shows motile pear-shaped organisms. What is the treatment of choice?

Accepted Answer

Metronidazole 2 g orally single dose

Answer

Fluconazole 150 mg orally

Answer

Clindamycin vaginal cream

Answer

Acyclovir orally

Question 2

Electronic fetal monitoring at 38 weeks shows late decelerations after each contraction with absent variability and baseline FHR of 140 bpm. What is the most appropriate management?

Accepted Answer

Immediate cesarean delivery

Answer

Oxygen by face mask and lateral position change

Answer

IV fluid bolus and continue monitoring

Answer

Amnioinfusion

Question 3

A 19-year-old woman at 18 weeks gestation presents with painless cervical dilation to 4 cm and no uterine contractions. Membranes are intact. Which diagnosis is most likely?

Accepted Answer

Cervical insufficiency

Answer

Inevitable abortion

Answer

Preterm labor

Answer

Chorioamnionitis

Question 4

A 27-year-old woman at 10 weeks gestation has beta-hCG of 185,000 mIU/mL, vaginal bleeding, and a uterine ultrasound showing a 'snowstorm' appearance with no fetal parts. After uterine evacuation, what must be closely monitored?

Accepted Answer

Serial beta-hCG for gestational trophoblastic neoplasia

Answer

Uterine adhesion formation (Asherman syndrome)

Answer

Recurrent ectopic pregnancy risk

Answer

Cervical incompetence

Question 5

A 55-year-old woman presents with abdominal bloating, early satiety, and increased girth for 3 months. CA-125 is 480 U/mL. CT shows bilateral adnexal masses with peritoneal implants. Which histological subtype of ovarian cancer is most common?

Accepted Answer

High-grade serous adenocarcinoma

Answer

Mucinous adenocarcinoma

Answer

Endometrioid carcinoma

Answer

Clear cell carcinoma

Question 6

At a 24-week prenatal visit, a 1-hour 50g glucose challenge test returns 158 mg/dL. What is the next appropriate step?

Accepted Answer

Perform a 3-hour 100g oral glucose tolerance test

Answer

Diagnose gestational diabetes and start insulin

Answer

Check HbA1c to confirm diagnosis

Answer

Repeat the 1-hour test in 4 weeks

Question 7

A 23-year-old competitive marathon runner presents with 4 months of secondary amenorrhea. Labs show low FSH, low LH, low estradiol, and normal prolactin. TSH is normal. What is the most likely diagnosis?

Accepted Answer

Hypothalamic amenorrhea

Answer

Polycystic ovary syndrome

Answer

Premature ovarian insufficiency

Answer

Prolactinoma