NBME Obstetrics and Gynecology 2

Question 1

A 28-year-old G2P1 at 39 weeks presents with painless vaginal bleeding. Ultrasound confirms the placenta completely covers the internal cervical os. What is the most appropriate management?

Accepted Answer

Immediate cesarean delivery

Answer

Pelvic rest with outpatient monitoring

Answer

Oxytocin induction of labor

Answer

Tocolysis with magnesium sulfate

Question 2

A 32-year-old G1P0 at 34 weeks develops sudden severe abdominal pain, a board-like rigid uterus, and fetal bradycardia. What is the most likely diagnosis?

Accepted Answer

Placental abruption

Answer

Complete placenta previa

Answer

Uterine rupture

Answer

Acute polyhydramnios

Question 3

A postpartum patient on day 3 has a temperature of 38.6°C, uterine tenderness on palpation, and foul-smelling lochia. What is the most appropriate antibiotic regimen?

Accepted Answer

IV clindamycin plus gentamicin

Answer

Oral amoxicillin-clavulanate for 7 days

Answer

Oral metronidazole alone for 10 days

Answer

IV ampicillin alone

Question 4

A 55-year-old postmenopausal woman presents with vaginal bleeding. Endometrial biopsy shows complex atypical hyperplasia. What is the recommended next step?

Accepted Answer

Total hysterectomy

Answer

Repeat biopsy in 3 months

Answer

Cyclic progestin therapy for 6 months

Answer

External beam radiation therapy

Question 5

During a total abdominal hysterectomy, the ureter is inadvertently injured. At which anatomical location is the ureter most vulnerable during this procedure?

Accepted Answer

Where it passes beneath the uterine artery

Answer

At the pelvic brim where it crosses the iliac vessels

Answer

At the ureterovesical junction

Answer

At the level of the ovarian fossa

Question 6

A neonate is delivered by emergency cesarean for non-reassuring fetal heart tones. Apgar scores are 3 at 1 minute and 6 at 5 minutes. Which intervention has the strongest evidence for improving neurological outcomes in this setting?

Accepted Answer

Therapeutic hypothermia initiated within 6 hours

Answer

IV systemic corticosteroids

Answer

Prophylactic IV magnesium sulfate

Answer

Controlled hyperventilation to reduce ICP

Question 7

A 38-year-old woman has progressive dysmenorrhea, dyspareunia, and pelvic pain. Transvaginal ultrasound reveals a 5-cm ovarian cyst with diffuse low-level internal echoes (ground glass appearance). What is the most likely diagnosis?

Accepted Answer

Endometrioma

Answer

Mature teratoma (dermoid cyst)

Answer

Mucinous cystadenoma

Answer

Tubo-ovarian abscess