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

Complete placenta previa with active bleeding at term requires immediate cesarean delivery because vaginal delivery is contraindicated.

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

Sudden severe pain with uterine rigidity and fetal distress is the classic presentation of placental abruption (premature separation of the placenta).

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

Postpartum endometritis is treated with IV clindamycin plus gentamicin, which provides coverage for gram-negative and anaerobic organisms.

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

Complex atypical hyperplasia carries a 25–30% risk of concurrent endometrial carcinoma, so total hysterectomy is the definitive treatment.

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

The ureter passes directly beneath the uterine artery ('water under the bridge'), making this the most common site of ureteral injury during hysterectomy.

NBME Practice Test

NBME Practice Test

NBME Obstetrics and Gynecology 2