SPEX Obstetrics and Gynecology 4

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?

Accepted Answer

Complete hydatidiform mole

Answer

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?

Accepted Answer

Ovarian hyperstimulation syndrome (OHSS)

Answer

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?

Accepted Answer

Ursodeoxycholic acid and delivery at 37 weeks

Answer

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?

Accepted Answer

McRoberts maneuver with suprapubic pressure

Answer

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?

Accepted Answer

Epithelial ovarian carcinoma

Answer

Postmenopausal solid-cystic ovarian mass with markedly elevated CA-125 and ascites is highly suspicious for epithelial ovarian carcinoma.

SPEX Exam Practice Test

SPEX Exam Practice Test

SPEX Obstetrics and Gynecology 4