NCCPA Obstetrics and Gynecology 1 — Questions and Answers
Question 1: A 28-year-old woman at 10 weeks gestation presents with severe nausea, vomiting, and a uterus larger than expected for dates. Beta-hCG is markedly elevated and ultrasound shows a 'snowstorm' appearance. What is the most likely diagnosis?
- Ectopic pregnancy
- Complete hydatidiform mole (Correct answer)
- Placenta previa
- Twin gestation
Correct answer: Complete hydatidiform mole
A complete hydatidiform mole classically presents with markedly elevated beta-hCG, uterine size greater than dates, hyperemesis, and a 'snowstorm' pattern on ultrasound due to trophoblastic proliferation.
Question 2: A 25-year-old woman at 8 weeks gestation presents with sharp left lower quadrant pain and vaginal spotting. Her beta-hCG is 2,400 mIU/mL and transvaginal ultrasound shows no intrauterine gestational sac. What is the next best step?
- Repeat beta-hCG in 48 hours (Correct answer)
- Immediate diagnostic laparoscopy
- Administer methotrexate empirically
- Perform dilation and curettage
Correct answer: Repeat beta-hCG in 48 hours
With a beta-hCG below the discriminatory zone (~1,500–2,000 mIU/mL) and no IUP visualized, the appropriate next step is to repeat beta-hCG in 48 hours to determine if it rises appropriately or plateaus/declines, guiding management of possible ectopic or early IUP.
Question 3: A 32-year-old G2P1 at 36 weeks gestation presents with sudden painless bright red vaginal bleeding. Vital signs are stable and fetal heart tones are reassuring. What is the most important initial step?
- Perform a digital cervical exam
- Obtain transvaginal ultrasound
- Obtain transabdominal ultrasound (Correct answer)
- Prepare for immediate cesarean delivery
Correct answer: Obtain transabdominal ultrasound
Painless third-trimester bleeding is placenta previa until proven otherwise; transabdominal ultrasound should be obtained first to locate the placenta before any digital exam, which is contraindicated if previa is suspected.
Question 4: At what gestational age is Group B Streptococcus (GBS) screening routinely performed?
- 28–30 weeks
- 32–34 weeks
- 35–37 weeks (Correct answer)
- 39–40 weeks
Correct answer: 35–37 weeks
ACOG recommends universal GBS screening with a vaginal-rectal swab at 35–37 weeks gestation to guide intrapartum antibiotic prophylaxis.
Question 5: A 30-year-old primigravida at 39 weeks has been in active labor for 14 hours. She is 6 cm dilated with ruptured membranes. Contractions are every 4–5 minutes. What is the most appropriate diagnosis?
- Latent phase arrest
- Active phase arrest
- Secondary arrest of dilation (Correct answer)
- Normal labor progress
Correct answer: Secondary arrest of dilation
Secondary (active phase) arrest of dilation is defined as no cervical change for ≥4 hours despite adequate uterine contractions after reaching 6 cm, which warrants consideration of augmentation or operative delivery.
Question 6: A 26-year-old woman develops heavy vaginal bleeding within 1 hour of an uncomplicated vaginal delivery. The uterus is soft and 'boggy' on palpation. What is the first-line management?
- Administer misoprostol rectally
- Perform bimanual uterine compression and oxytocin infusion (Correct answer)
- Perform emergency hysterectomy
- Administer tranexamic acid IV
Correct answer: Perform bimanual uterine compression and oxytocin infusion
Uterine atony is the most common cause of postpartum hemorrhage; immediate bimanual uterine massage and IV oxytocin are the first-line interventions to stimulate uterine contraction.
Question 7: Which lab finding is most consistent with HELLP syndrome?
- Elevated creatinine, thrombocytosis, low AST
- Hemolytic anemia, elevated liver enzymes, low platelets (Correct answer)
- Proteinuria, elevated BUN, normal platelet count
- Leukocytosis, elevated bilirubin, normal liver enzymes
Correct answer: Hemolytic anemia, elevated liver enzymes, low platelets
HELLP syndrome is defined by Hemolysis (microangiopathic hemolytic anemia), Elevated Liver enzymes (AST/ALT), and Low Platelets (<100,000/µL), representing a severe variant of preeclampsia.
NCCPA Obstetrics and Gynecology 1
A 28-year-old woman at 10 weeks gestation presents with severe nausea, vomiting, and a uterus larger than expected for dates.
Beta-hCG is markedly elevated and ultrasound shows a 'snowstorm' appearance.
What is the most likely diagnosis?