NCCPA Obstetrics and Gynecology

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?

Accepted Answer

Complete hydatidiform mole

Answer

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?

Accepted Answer

Repeat beta-hCG in 48 hours

Answer

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?

Accepted Answer

Obtain transabdominal ultrasound

Answer

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?

Accepted Answer

35–37 weeks

Answer

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?

Accepted Answer

Secondary arrest of dilation

Answer

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.

(NCCPA) National Commission on Certification of Physician Assistants Practice Test

(NCCPA) National Commission on Certification of Physician Assistants Practice Test

NCCPA Obstetrics and Gynecology