SPEX Obstetrics and Gynecology 2 — Questions and Answers
Question 1: A 28-year-old at 32 weeks gestation presents with sudden painless vaginal bleeding. Fetal heart tones are normal. What is the most likely diagnosis?
- Placenta previa (Correct answer)
- Placental abruption
- Vasa previa
- Cervical polyp
Correct answer: Placenta previa
Painless vaginal bleeding in the third trimester is the classic presentation of placenta previa, where the placenta overlies the cervical os.
Question 2: Which tocolytic agent is contraindicated in a patient with gestational hypertension requiring treatment for preterm labor?
- Magnesium sulfate
- Indomethacin
- Nifedipine
- Terbutaline (Correct answer)
Correct answer: Terbutaline
Terbutaline (a beta-agonist) can worsen hypertension and cause significant cardiovascular side effects, making it contraindicated in hypertensive patients.
Question 3: A multipara at 38 weeks has a Bishop score of 8. What does this indicate?
- Induction is likely to fail
- The cervix is favorable for induction (Correct answer)
- Immediate cesarean delivery is indicated
- Cervical ripening agents are required
Correct answer: The cervix is favorable for induction
A Bishop score ≥8 indicates a favorable cervix with high likelihood of successful labor induction without the need for cervical ripening agents.
Question 4: What is the recommended management for a pregnant patient diagnosed with primary genital herpes at 36 weeks gestation?
- Immediate cesarean delivery
- Acyclovir suppressive therapy until delivery (Correct answer)
- Expectant management without treatment
- Induction of labor at 37 weeks
Correct answer: Acyclovir suppressive therapy until delivery
Acyclovir suppressive therapy from 36 weeks reduces viral shedding and the risk of recurrent outbreak at delivery, decreasing the need for cesarean section.
Question 5: A woman at 10 weeks gestation is found to have a TSH of 0.05 mIU/L and elevated free T4. She has no symptoms. What is the most appropriate next step?
- Start methimazole immediately
- Start propylthiouracil (PTU)
- Reassure and repeat labs in 4 weeks (Correct answer)
- Perform thyroid ultrasound and refer to endocrinology
Correct answer: Reassure and repeat labs in 4 weeks
Gestational hyperthyroidism from hCG stimulation is common in the first trimester and typically resolves spontaneously; reassurance and follow-up is appropriate for asymptomatic cases.
Question 6: Which finding on fetal umbilical artery Doppler is most concerning for fetal compromise?
- Systolic-to-diastolic ratio of 3
- Absent end-diastolic flow (Correct answer)
- Pulsatility index at the 75th percentile
- Normal waveform with mild resistance
Correct answer: Absent end-diastolic flow
Absent or reversed end-diastolic flow on umbilical artery Doppler indicates severely increased placental vascular resistance and is associated with significant fetal compromise.
Question 7: A 35-year-old G2P1 at 16 weeks has a maternal serum AFP of 3.5 MoM. What is the most appropriate next step?
- Amniocentesis for karyotype
- Detailed fetal anatomy ultrasound (Correct answer)
- Chorionic villus sampling
- Reassure and repeat AFP at 20 weeks
Correct answer: Detailed fetal anatomy ultrasound
Elevated maternal serum AFP (≥2.5 MoM) warrants detailed ultrasound to evaluate for open neural tube defects, abdominal wall defects, or other structural anomalies.
SPEX Obstetrics and Gynecology 2
A 28-year-old at 32 weeks gestation presents with sudden painless vaginal bleeding.
Fetal heart tones are normal.
What is the most likely diagnosis?