PANRE Obstetrics and Gynecology 4 — Questions and Answers
Question 1: A 25-year-old woman presents with 7 weeks of amenorrhea, left lower quadrant pain, and vaginal spotting. Serum hCG is 2,200 mIU/mL and transvaginal ultrasound shows no intrauterine gestational sac. She is hemodynamically stable. What is the most appropriate management?
- Expectant management
- Dilation and curettage
- Methotrexate 50 mg/m² IM (Correct answer)
- Laparoscopic salpingectomy
Correct answer: Methotrexate 50 mg/m² IM
A hemodynamically stable patient with a presumed unruptured ectopic pregnancy, hCG <5,000, and no contraindications is a candidate for medical management with methotrexate.
Question 2: Which maternal serum marker is characteristically low in trisomy 21 on second-trimester quad screening?
- AFP
- hCG
- Inhibin A
- Unconjugated estriol (Correct answer)
Correct answer: Unconjugated estriol
In Down syndrome, unconjugated estriol (uE3) is low, while hCG and inhibin A are elevated and AFP is low on quad screen.
Question 3: A 32-year-old G1P0 at 34 weeks is diagnosed with preterm premature rupture of membranes (PPROM). She is GBS-negative and has no signs of infection. What is the standard of care?
- Immediate delivery by cesarean section
- Expectant management with latency antibiotics and antenatal corticosteroids (Correct answer)
- Amnioinfusion to restore fluid
- Cerclage placement
Correct answer: Expectant management with latency antibiotics and antenatal corticosteroids
PPROM between 34 and 36+6 weeks is managed expectantly with latency antibiotics and corticosteroids until delivery is indicated or spontaneous labor occurs.
Question 4: A 40-year-old woman has menorrhagia and a uterus enlarged to 12 weeks size with multiple fibroids. She has completed childbearing. She wants a definitive solution. What is the most appropriate option?
- Uterine fibroid embolization
- Hysterectomy (Correct answer)
- Endometrial ablation
- GnRH agonist therapy
Correct answer: Hysterectomy
Hysterectomy is the definitive treatment for symptomatic uterine fibroids in a woman who has completed childbearing and wants no further pregnancies.
Question 5: A 19-year-old sexually active woman presents for her first gynecologic visit. According to current USPSTF guidelines, at what age should cervical cancer screening (Pap smear) begin?
- At first sexual intercourse
- Age 18
- Age 21 (Correct answer)
- Age 25
Correct answer: Age 21
Current guidelines recommend beginning cervical cancer screening with cytology alone at age 21, regardless of sexual activity onset.
Question 6: A 34-year-old woman at 28 weeks gestation has a 1-hour glucose challenge test result of 158 mg/dL. A subsequent 3-hour 100g OGTT shows: fasting 92, 1-hr 182, 2-hr 154, 3-hr 138 mg/dL. How many values are abnormal?
- One abnormal value — gestational diabetes diagnosed
- Two abnormal values — gestational diabetes diagnosed (Correct answer)
- Three abnormal values — gestational diabetes diagnosed
- No abnormal values — no gestational diabetes
Correct answer: Two abnormal values — gestational diabetes diagnosed
Using Carpenter-Coustan criteria (fasting ≥95, 1-hr ≥180, 2-hr ≥155, 3-hr ≥140), the 1-hr (182) and 2-hr (154) values are abnormal, diagnosing GDM with ≥2 abnormal values.
Question 7: A 62-year-old woman presents with a pelvic organ prolapse bulging beyond the introitus, bladder symptoms, and significant quality-of-life impairment. She fails pessary management. What is the most appropriate next step?
- Pelvic floor physical therapy alone
- Surgical repair (Correct answer)
- Topical estrogen and reassurance
- Anticholinergic medication
Correct answer: Surgical repair
Symptomatic prolapse that fails conservative management (pessary, pelvic PT) with significant quality-of-life impact is an indication for surgical repair.
PANRE Obstetrics and Gynecology 4
A 25-year-old woman presents with 7 weeks of amenorrhea, left lower quadrant pain, and vaginal spotting.
Serum hCG is 2,200 mIU/mL and transvaginal ultrasound shows no intrauterine gestational sac.
She is hemodynamically stable.
What is the most appropriate management?