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Obstetrics and Gynecology Flashcards

7 cards from real NBME practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

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  1. A 26-year-old G1P0 at 16 weeks undergoes amniocentesis. Results show markedly elevated amniotic fluid AFP and a positive acetylcholinesterase. What is the most likely diagnosis?

    Answer: Open neural tube defect

    Elevated amniotic AFP combined with positive acetylcholinesterase is diagnostic of an open neural tube defect, confirming fetal neural tissue is exposed to amniotic fluid.

  2. A 24-year-old at 28 weeks with gestational diabetes has a growth ultrasound showing estimated fetal weight at the 97th percentile with a disproportionately large abdominal circumference. This finding is most directly caused by which fetal mechanism?

    Answer: Fetal hyperinsulinemia causing increased fat deposition

    Maternal hyperglycemia leads to fetal hyperinsulinemia, which acts as a growth factor causing macrosomia through increased fat and glycogen deposition.

  3. A 34-year-old G2P1 at 11 weeks has first-trimester screening showing nuchal translucency of 4.2 mm, elevated free β-hCG, and low PAPP-A. This pattern is most consistent with which chromosomal abnormality?

    Answer: Trisomy 21 (Down syndrome)

    Increased NT, elevated free β-hCG, and decreased PAPP-A is the classic first-trimester combined screen pattern for trisomy 21.

  4. A 29-year-old Rh-negative woman at 28 weeks has a negative antibody screen and has not previously received Rh immunoglobulin. What is the appropriate management?

    Answer: Administer Rh immunoglobulin now and again within 72 hours of delivery

    Unsensitized Rh-negative women should receive 300 mcg Rh immunoglobulin at 28 weeks and again postpartum to prevent alloimmunization.

  5. A 30-year-old woman at 36 weeks is GBS-positive and has a reported history of anaphylaxis to penicillin. GBS susceptibilities are available. What is the correct intrapartum antibiotic prophylaxis regimen?

    Answer: Clindamycin IV if the isolate is susceptible

    For penicillin allergy with high anaphylaxis risk, clindamycin is used if the GBS isolate is susceptible; if resistant or unknown, vancomycin is given.

  6. A 31-year-old G3P2 at 38 weeks undergoes a nonstress test. Over 20 minutes, the baseline FHR is 138 bpm with two accelerations of 15 bpm lasting 15 seconds each. How should this tracing be interpreted?

    Answer: Reactive — reassuring fetal status

    A reactive NST requires at least 2 accelerations of ≥15 bpm lasting ≥15 seconds within a 20-minute window, which this tracing meets.

  7. A 22-year-old primigravida at 32 weeks has BP 158/106 mmHg, blurred vision, and 3+ proteinuria. Magnesium sulfate is administered. What is the primary therapeutic goal of magnesium in this clinical scenario?

    Answer: Prevent eclamptic seizures

    Magnesium sulfate is used as seizure prophylaxis (eclampsia prevention) in severe-range preeclampsia; it is not an effective antihypertensive agent.