PANRE Obstetrics and Gynecology 3 — Questions and Answers
Question 1: A 38-year-old G3P2 at 36 weeks presents with severe headache, visual disturbances, and BP 158/106 mmHg. Her 24-hour urine protein is 450 mg. What is the definitive treatment?
- IV labetalol and close monitoring
- Magnesium sulfate and deliver (Correct answer)
- Oral nifedipine and outpatient management
- Bed rest until term
Correct answer: Magnesium sulfate and deliver
Severe preeclampsia at 36 weeks requires delivery (the only cure) along with magnesium sulfate for seizure prophylaxis and antihypertensives.
Question 2: A 22-year-old woman presents with mucopurulent cervical discharge, cervical motion tenderness, and uterine tenderness. What empiric treatment regimen is recommended by CDC guidelines?
- Azithromycin 1g single dose
- Ceftriaxone 500mg IM plus doxycycline 100mg BID for 14 days (Correct answer)
- Metronidazole 500mg BID for 7 days
- Ciprofloxacin 500mg BID for 14 days
Correct answer: Ceftriaxone 500mg IM plus doxycycline 100mg BID for 14 days
CDC guidelines for outpatient PID recommend ceftriaxone (for gonorrhea) plus doxycycline with or without metronidazole to cover chlamydia and anaerobes.
Question 3: A 45-year-old woman undergoes LEEP for CIN 2. Pathology returns with CIN 2 and negative margins. What is the recommended follow-up?
- Return to routine screening in 3 years
- Co-testing (HPV + cytology) at 1 and 2 years post-treatment (Correct answer)
- Repeat colposcopy in 6 months
- Hysterectomy
Correct answer: Co-testing (HPV + cytology) at 1 and 2 years post-treatment
After excisional treatment of CIN 2-3 with negative margins, co-testing at 1 and 2 years is recommended before returning to routine screening.
Question 4: A 33-year-old woman at 16 weeks gestation has a serum alpha-fetoprotein (AFP) of 3.2 MOM. What is the most appropriate next step?
- Reassure the patient; this is normal
- Amniocentesis for karyotype
- Targeted ultrasound to evaluate for neural tube defects and other causes (Correct answer)
- Repeat AFP in 4 weeks
Correct answer: Targeted ultrasound to evaluate for neural tube defects and other causes
Elevated maternal serum AFP (≥2.5 MOM) warrants targeted ultrasound to evaluate for open neural tube defects, abdominal wall defects, or dating error.
Question 5: A 29-year-old primigravida at 41+2 weeks is in active labor. She has an epidural and has been completely dilated for 3.5 hours with no fetal descent despite adequate pushing. Fetal station is 0. What is this called?
- Latent phase arrest
- Active phase arrest
- Arrest of descent (Correct answer)
- Protracted active phase
Correct answer: Arrest of descent
Arrest of descent is diagnosed when the fetal presenting part fails to descend after a defined period of pushing in the second stage of labor.
Question 6: A breastfeeding mother 6 weeks postpartum desires contraception. Which method is contraindicated?
- Levonorgestrel IUD
- Progestin-only pill
- Copper IUD
- Combined oral contraceptive pill (Correct answer)
Correct answer: Combined oral contraceptive pill
Combined oral contraceptives (estrogen + progestin) are contraindicated in the first 6 weeks postpartum in breastfeeding women due to estrogen's suppression of milk production.
Question 7: A 55-year-old postmenopausal woman with an intact uterus wants hormone therapy for vasomotor symptoms. What regimen must be prescribed?
- Estrogen alone
- Progestin alone
- Combined estrogen plus progestin (Correct answer)
- Testosterone therapy
Correct answer: Combined estrogen plus progestin
Women with an intact uterus must receive combined estrogen plus progestin therapy; unopposed estrogen increases the risk of endometrial hyperplasia and carcinoma.
PANRE Obstetrics and Gynecology 3
A 38-year-old G3P2 at 36 weeks presents with severe headache, visual disturbances, and BP 158/106 mmHg.
Her 24-hour urine protein is 450 mg.
What is the definitive treatment?