NCCPA Obstetrics and Gynecology 2 — Questions and Answers
Question 1: A 38-year-old woman presents with irregular periods, hirsutism, acne, and difficulty conceiving. Transvaginal ultrasound shows bilateral enlarged ovaries with 12 or more peripheral follicles each. LH:FSH ratio is elevated. What is the most likely diagnosis?
- Hypothyroidism
- Hyperprolactinemia
- Polycystic ovary syndrome (PCOS) (Correct answer)
- Premature ovarian insufficiency
Correct answer: Polycystic ovary syndrome (PCOS)
PCOS is diagnosed by the Rotterdam criteria (≥2 of 3: oligo/anovulation, hyperandrogenism, polycystic ovaries on ultrasound) and is the most common cause of anovulatory infertility.
Question 2: A 29-year-old woman presents with cyclic pelvic pain that worsens just before and during menstruation, dyspareunia, and dyschezia. She has been trying to conceive for 18 months. The most appropriate initial diagnostic tool is:
- MRI of the pelvis
- Diagnostic laparoscopy (Correct answer)
- Transvaginal ultrasound
- CA-125 level
Correct answer: Diagnostic laparoscopy
Diagnostic laparoscopy with histologic confirmation is the gold standard for diagnosing endometriosis, as imaging and serum markers are neither sensitive nor specific enough for definitive diagnosis.
Question 3: According to USPSTF guidelines, at what age should average-risk women begin cervical cancer screening with Pap smear alone?
- 18 years
- 21 years (Correct answer)
- 25 years
- 30 years
Correct answer: 21 years
The USPSTF recommends cervical cancer screening beginning at age 21 with cytology (Pap smear) alone every 3 years for average-risk women, regardless of sexual activity onset.
Question 4: A 55-year-old postmenopausal woman presents with hot flashes, vaginal dryness, and mood changes. She has no personal or family history of breast cancer or VTE. What is the most appropriate management for her vasomotor symptoms?
- Selective serotonin reuptake inhibitor (SSRI)
- Systemic hormone replacement therapy (HRT) (Correct answer)
- Ospemifene
- Medroxyprogesterone acetate alone
Correct answer: Systemic hormone replacement therapy (HRT)
Systemic hormone replacement therapy (estrogen ± progestogen) is the most effective treatment for moderate-to-severe vasomotor symptoms of menopause and is appropriate in women without contraindications.
Question 5: A 22-year-old woman presents with lower abdominal pain, fever (38.4°C), cervical motion tenderness, and mucopurulent cervical discharge. The most appropriate treatment regimen for outpatient management is:
- Oral doxycycline 100 mg BID × 14 days alone
- IM ceftriaxone 500 mg once plus oral doxycycline 100 mg BID × 14 days with metronidazole 500 mg BID × 14 days (Correct answer)
- IV clindamycin and gentamicin
- Oral azithromycin 1 g once plus levofloxacin
Correct answer: IM ceftriaxone 500 mg once plus oral doxycycline 100 mg BID × 14 days with metronidazole 500 mg BID × 14 days
Current CDC guidelines recommend IM ceftriaxone 500 mg once (for gonorrhea) plus doxycycline 100 mg BID × 14 days and metronidazole 500 mg BID × 14 days for outpatient PID treatment.
Question 6: A 45-year-old woman presents with menorrhagia and pelvic pressure. Pelvic exam reveals an enlarged, irregularly shaped uterus. Transvaginal ultrasound shows multiple well-defined hypoechoic masses within the myometrium. What is the most likely diagnosis?
- Endometrial polyps
- Ovarian fibromas
- Uterine leiomyomas (fibroids) (Correct answer)
- Adenomyosis
Correct answer: Uterine leiomyomas (fibroids)
Uterine leiomyomas (fibroids) are the most common benign pelvic tumors in women, presenting with menorrhagia, pelvic pressure, and an enlarged irregular uterus with well-defined hypoechoic intramyometrial masses on ultrasound.
Question 7: A 34-year-old G3P2 woman is found on routine prenatal ultrasound at 20 weeks to have a placenta that overlies the internal cervical os. She is asymptomatic. What is the recommended management?
- Immediate cesarean delivery
- Repeat transvaginal ultrasound at 28–32 weeks (Correct answer)
- Vaginal delivery with continuous fetal monitoring
- Cervical cerclage placement
Correct answer: Repeat transvaginal ultrasound at 28–32 weeks
Most placenta previas identified in the second trimester resolve by the third trimester as the lower uterine segment develops; repeat ultrasound at 28–32 weeks (and again at 36 weeks if persisting) is recommended before changing the delivery plan.
NCCPA Obstetrics and Gynecology 2
A 38-year-old woman presents with irregular periods, hirsutism, acne, and difficulty conceiving.
Transvaginal ultrasound shows bilateral enlarged ovaries with 12 or more peripheral follicles each.
LH:FSH ratio is elevated.
What is the most likely diagnosis?