PANRE Obstetrics and Gynecology 2 — Questions and Answers
Question 1: A 28-year-old G2P1 at 32 weeks gestation presents with sudden painless vaginal bleeding. Her uterus is soft and nontender. What is the most likely diagnosis?
- Placental abruption
- Placenta previa (Correct answer)
- Vasa previa
- Bloody show
Correct answer: Placenta previa
Painless vaginal bleeding with a soft, nontender uterus in the third trimester is the classic presentation of placenta previa.
Question 2: A 35-year-old woman with PCOS is anovulatory and desires conception. After lifestyle modification fails, what is the first-line pharmacologic ovulation induction agent?
- Letrozole (Correct answer)
- Clomiphene citrate
- Metformin
- Gonadotropins
Correct answer: Letrozole
Letrozole (an aromatase inhibitor) is now preferred over clomiphene as first-line ovulation induction in PCOS due to higher live birth rates.
Question 3: A 24-year-old presents with cyclic pelvic pain, dysmenorrhea, and dyspareunia. CA-125 is mildly elevated. What is the gold standard for diagnosis?
- Pelvic MRI
- Transvaginal ultrasound
- Diagnostic laparoscopy (Correct answer)
- Endometrial biopsy
Correct answer: Diagnostic laparoscopy
Diagnostic laparoscopy with biopsy is the gold standard for diagnosing endometriosis, as imaging modalities cannot detect peritoneal implants reliably.
Question 4: Which fetal heart rate pattern is most concerning for uteroplacental insufficiency during labor?
- Early decelerations
- Variable decelerations
- Late decelerations (Correct answer)
- Accelerations
Correct answer: Late decelerations
Late decelerations—nadir after the peak of a contraction—reflect uteroplacental insufficiency and fetal hypoxemia.
Question 5: A postmenopausal woman on tamoxifen for breast cancer presents with abnormal uterine bleeding. What is the most appropriate next step?
- Reassurance and observation
- Transvaginal ultrasound
- Endometrial biopsy (Correct answer)
- Hysteroscopy
Correct answer: Endometrial biopsy
Any postmenopausal bleeding in a tamoxifen user warrants endometrial biopsy to rule out endometrial carcinoma, given tamoxifen's uterotrophic effects.
Question 6: A 31-year-old G1P0 at 39 weeks has a Bishop score of 4. She is being considered for labor induction. Which agent is appropriate for cervical ripening?
- Oxytocin IV infusion
- Misoprostol or dinoprostone (Correct answer)
- Amniotomy alone
- Castor oil
Correct answer: Misoprostol or dinoprostone
An unfavorable cervix (Bishop score <6) requires cervical ripening with prostaglandins such as misoprostol or dinoprostone before or alongside induction.
Question 7: A 26-year-old woman at 10 weeks gestation is found to have a urine culture positive for asymptomatic bacteriuria with >100,000 CFU/mL of E. coli. What is the correct management?
- No treatment needed in pregnancy
- Treat with nitrofurantoin or cephalexin (Correct answer)
- Treat only if symptoms develop
- Repeat culture in 4 weeks
Correct answer: Treat with nitrofurantoin or cephalexin
Asymptomatic bacteriuria in pregnancy requires antibiotic treatment to prevent progression to pyelonephritis and adverse fetal outcomes.
PANRE Obstetrics and Gynecology 2
A 28-year-old G2P1 at 32 weeks gestation presents with sudden painless vaginal bleeding.
Her uterus is soft and nontender.
What is the most likely diagnosis?