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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 25-year-old at 6 weeks amenorrhea presents with vaginal bleeding and left lower quadrant pain. β-hCG is 2,400 mIU/mL; transvaginal ultrasound shows no intrauterine pregnancy and a small left adnexal mass without cardiac activity. She is hemodynamically stable. Most appropriate next step?

    Answer: Single-dose intramuscular methotrexate

    A hemodynamically stable patient with presumed ectopic pregnancy, β-hCG <5,000 mIU/mL, adnexal mass without cardiac activity, and no contraindications is a candidate for single-dose methotrexate.

  2. A 30-year-old woman with 3 consecutive first-trimester spontaneous abortions is found to have antiphospholipid antibody syndrome. What is the recommended treatment during her next pregnancy?

    Answer: Low molecular weight heparin plus low-dose aspirin

    Antiphospholipid syndrome causing recurrent pregnancy loss is treated with LMWH plus low-dose aspirin throughout pregnancy, as warfarin is teratogenic.

  3. A 28-year-old woman with primary infertility undergoes hysterosalpingography showing bilateral tubal occlusion. Her partner's semen analysis is normal. What is the most likely cause of her tubal pathology?

    Answer: Prior Chlamydia trachomatis pelvic infection

    Prior Chlamydia trachomatis infection causing pelvic inflammatory disease is the most common cause of tubal factor infertility due to tubal scarring and occlusion.

  4. A 36-year-old woman with hypertension well-controlled on lisinopril asks about contraception. Which method is CONTRAINDICATED in this patient?

    Answer: Combined estrogen-progestin oral contraceptives

    Combined oral contraceptives are contraindicated in women with hypertension due to increased risk of stroke and myocardial infarction, especially over age 35.

  5. A 32-year-old woman undergoing IVF achieves a positive β-hCG two weeks after embryo transfer. She presents with severe abdominal distension, dyspnea, and 6 kg weight gain over 5 days. What is the most likely diagnosis?

    Answer: Ovarian hyperstimulation syndrome (OHSS)

    OHSS is a complication of ovarian stimulation characterized by massive fluid shifts, ascites, weight gain, and dyspnea, worsened by the rise in hCG from an established pregnancy.

  6. A 27-year-old G1P0 is found to have a missed abortion at 10 weeks on ultrasound. She chooses medical management rather than expectant or surgical treatment. Which medication is most appropriate?

    Answer: Misoprostol 800 mcg vaginally

    Misoprostol, a prostaglandin E1 analogue, is used for medical management of missed abortion to cause cervical ripening and uterine contractions leading to expulsion.

  7. A 34-year-old nulligravid woman with PCOS presents with infertility, anovulatory cycles, and elevated androgens. BMI is 31, LH:FSH ratio is 3:1. Per current ACOG guidelines, which is the preferred first-line agent for ovulation induction?

    Answer: Letrozole

    Letrozole (an aromatase inhibitor) is now the first-line ovulation induction agent for PCOS, demonstrating higher live birth rates than clomiphene in randomized trials.