SPEX Obstetrics and Gynecology 4 — Questions and Answers
Question 1: A 26-year-old presents at 8 weeks gestation with nausea, vomiting, uterine size larger than dates, and a serum hCG of 280,000 mIU/mL. Ultrasound shows a 'snowstorm' appearance. What is the diagnosis?
- Missed abortion
- Complete hydatidiform mole (Correct answer)
- Twin pregnancy
- Partial mole
Correct answer: Complete hydatidiform mole
A complete hydatidiform mole presents with markedly elevated hCG, absence of fetal parts, and a 'snowstorm' ultrasound pattern due to hydropic chorionic villi.
Question 2: A 38-year-old G0 undergoes IVF. After embryo transfer she develops severe abdominal distension, shortness of breath, and oliguria. Her estradiol was 4,800 pg/mL at trigger. What is the most likely complication?
- Ectopic pregnancy
- Ovarian hyperstimulation syndrome (OHSS) (Correct answer)
- Ovarian torsion
- Pulmonary embolism
Correct answer: Ovarian hyperstimulation syndrome (OHSS)
Severe OHSS presents with massive ovarian enlargement, ascites, pleural effusion, and oliguria following ovarian stimulation, especially with very high estradiol levels.
Question 3: A 32-year-old at 34 weeks presents with itching on palms and soles, no rash, and elevated serum bile acids. What is the recommended management?
- Topical antihistamines and expectant management to 40 weeks
- Ursodeoxycholic acid and delivery at 37 weeks (Correct answer)
- Immediate delivery by cesarean section
- Cholestyramine and repeat labs at 38 weeks
Correct answer: Ursodeoxycholic acid and delivery at 37 weeks
Intrahepatic cholestasis of pregnancy is treated with ursodeoxycholic acid to reduce symptoms and bile acids, with delivery recommended at 37 weeks to prevent stillbirth.
Question 4: During second-stage labor, the fetal head delivers but the shoulders do not. The turtle sign is noted. What is the first maneuver to attempt?
- Zavanelli maneuver
- McRoberts maneuver with suprapubic pressure (Correct answer)
- Fundal pressure
- Internal podalic version
Correct answer: McRoberts maneuver with suprapubic pressure
McRoberts maneuver (hyperflexion of maternal thighs) combined with suprapubic pressure is the first-line management for shoulder dystocia.
Question 5: A 55-year-old postmenopausal woman with a pelvic mass has a CA-125 of 850 U/mL, ascites, and a solid-cystic ovarian mass on imaging. What is the most likely diagnosis?
- Benign serous cystadenoma
- Epithelial ovarian carcinoma (Correct answer)
- Uterine leiomyoma
- Endometrioma
Correct answer: Epithelial ovarian carcinoma
Postmenopausal solid-cystic ovarian mass with markedly elevated CA-125 and ascites is highly suspicious for epithelial ovarian carcinoma.
Question 6: Which Müllerian anomaly is most associated with recurrent pregnancy loss?
- Uterine didelphys
- Arcuate uterus
- Unicornuate uterus
- Uterine septum (Correct answer)
Correct answer: Uterine septum
A uterine septum is the Müllerian anomaly most commonly associated with recurrent pregnancy loss due to implantation on poorly vascularized septal tissue.
Question 7: A 19-year-old presents with primary amenorrhea, absent breast development, normal pubic hair, and a 46,XY karyotype. What is the most likely diagnosis?
- Turner syndrome
- Complete androgen insensitivity syndrome
- Congenital adrenal hyperplasia
- Swyer syndrome (Correct answer)
Correct answer: Swyer syndrome
Swyer syndrome (46,XY complete gonadal dysgenesis) presents with female phenotype, absent puberty, and streak gonads; gonads must be removed due to malignancy risk.
SPEX Obstetrics and Gynecology 4
A 26-year-old presents at 8 weeks gestation with nausea, vomiting, uterine size larger than dates, and a serum hCG of 280,000 mIU/mL.
Ultrasound shows a 'snowstorm' appearance.
What is the diagnosis?