PANRE Obstetrics and Gynecology 5 — Questions and Answers
Question 1: A 27-year-old woman at 12 weeks gestation is Rh-negative. Her partner is Rh-positive. She has no antibodies on indirect Coombs test. When should she receive Rh immunoglobulin (RhoGAM)?
- Only at delivery
- At 28 weeks and within 72 hours of delivery (Correct answer)
- Only if bleeding occurs
- Every 4 weeks starting at 20 weeks
Correct answer: At 28 weeks and within 72 hours of delivery
Unsensitized Rh-negative women receive RhoGAM at 28 weeks gestation and again within 72 hours of delivery to prevent alloimmunization.
Question 2: A 48-year-old woman presents with hot flashes, night sweats, and irregular menses for 14 months. FSH is 58 mIU/mL. She denies a history of VTE or breast cancer. What is the most effective treatment for her vasomotor symptoms?
- Venlafaxine
- Black cohosh
- Menopausal hormone therapy (Correct answer)
- Clonidine
Correct answer: Menopausal hormone therapy
Menopausal hormone therapy remains the most effective treatment for vasomotor symptoms in menopausal women without contraindications.
Question 3: A 30-year-old G2P1 at 38 weeks presents in active labor. On exam, the presenting part is at +2 station. After 2 hours of adequate pushing, the fetal head is visible and crowning. Suddenly you note the turtle sign. What does this indicate?
- Cord prolapse
- Shoulder dystocia (Correct answer)
- Fetal macrosomia
- Nuchal cord
Correct answer: Shoulder dystocia
The turtle sign (retraction of the fetal head against the perineum after delivery) is pathognomonic for shoulder dystocia.
Question 4: A 23-year-old woman develops a new breast mass during pregnancy at 22 weeks. Ultrasound shows a solid, irregular hypoechoic lesion. What is the next appropriate step?
- Observe until after delivery
- MRI breast without contrast
- Core needle biopsy (Correct answer)
- Mammogram
Correct answer: Core needle biopsy
A suspicious solid breast mass during pregnancy requires tissue diagnosis via core needle biopsy, which is safe in pregnancy.
Question 5: A 16-year-old girl has never had a menstrual period. Physical exam shows normal secondary sexual characteristics and a blind vaginal pouch. Karyotype is 46,XY. What is the diagnosis?
- Turner syndrome
- Mullerian agenesis (MRKH)
- Androgen insensitivity syndrome (Correct answer)
- Congenital adrenal hyperplasia
Correct answer: Androgen insensitivity syndrome
Complete androgen insensitivity syndrome (46,XY) presents with primary amenorrhea, normal female phenotype, breast development, and absent uterus/upper vagina.
Question 6: A 35-year-old G0 woman is found to have a 6 cm simple ovarian cyst on transvaginal ultrasound performed for pelvic pain. CA-125 is normal. What is the most appropriate management?
- Immediate surgical removal
- Repeat ultrasound in 6-12 weeks (Correct answer)
- CT scan of abdomen and pelvis
- Oral contraceptive suppression for 3 months
Correct answer: Repeat ultrasound in 6-12 weeks
Simple ovarian cysts ≤10 cm in premenopausal women with normal CA-125 can be followed with repeat ultrasound in 6-12 weeks.
Question 7: During a routine prenatal visit at 28 weeks, a patient's fundal height measures 24 cm. Ultrasound confirms fetal growth restriction with estimated fetal weight at the 8th percentile. What is the most important next step?
- Schedule repeat ultrasound in 4 weeks
- Umbilical artery Doppler velocimetry (Correct answer)
- Immediate delivery
- Amniocentesis
Correct answer: Umbilical artery Doppler velocimetry
Umbilical artery Doppler velocimetry is the primary surveillance tool for fetal growth restriction, assessing placental resistance and guiding delivery timing.
PANRE Obstetrics and Gynecology 5
A 27-year-old woman at 12 weeks gestation is Rh-negative.
Her partner is Rh-positive.
She has no antibodies on indirect Coombs test.
When should she receive Rh immunoglobulin (RhoGAM)?