OBGYN - Exam Questions with Correctly Solved
Answers
1. You are caring for a 29-year-old G3P2 at 39 weeks gestation, who has been
laboring for 6 hours. She is a diet-controlled diabetic. Her last child was
9 pounds 8 ounces. She has been completely dilated for 2 hours, and the
fetal head is at a plus 2 station, which is unchanged. What is the next most
appropriate course of action?
A Begin oxytocin
B Vacuum extraction
C High forcep extraction
D High forcep rotation
E Cesarean section: Cesarian Section
The patient is a diabetic with a history of a macrosomic infant; the likelihood of
macrosomia in this infant is significant. Instrument delivery is not recommended if
macrosomia is suspected. By definition, she has had an arrest of descent of the
fetal head and one should be highly suspicious for macrosomia, in which case a
c-section is the preferred method of delivery.
2. A 75-year-old woman presents to your office complaining of intense pruritis
of the vulva and occasional bleeding. She is unsure if the bleeding is caused
by her scratching in attempts to alleviate the itching. She has tried some OTC
preparations to alleviate the itching and has not had any relief from them. She
denies any vaginal discharge or dysuria. On physical examination you notice
excoriations and some scattered lesions that look like eczema on the vulva
and they do not scrape off. Also noted was inguinal lymphadenopathy. You
decide to do a punch biopsy. The pathology report reveals large eosinophilic
cells.
Question
What is the most likely diagnosis?
Answer Choices
1 Lichen sclerosis
2 Vulvar carcinoma
3 Paget's disease
4 Melanoma
5 Candida albicans: Paget's disease
Explanation Paget's diseaseis associated with intense pruritus of the vulva, along
,with lesions that resemble eczema. Pathology also characteristically shows large
eosinophilic Paget's cells (1).
Lichen sclerosis is not correct because the pathology would reveal changes asso-
ciated with chronic inflammation.
Vulvar carcinoma is incorrect as it generally shows squamous cell characteristics.
(1).
Melanoma is incorrect as the lesion will generally appear hyperpigmented (1).
Candida albicans is incorrect because the lesions that appear on the vulva do not
scrape off and she does not have any vaginal discharge. Candida albicans is also
not associated with inguinal lymphadenopathy.
3. The pregnant mother of a 2-year-old patient is concerned about exposure
to environmental neurotoxins affecting her developing fetus.
She asks you questions about whether the placenta would block any transfer
of toxins to a growing fetus. Which environmental neurotoxin transfer to the
fetal system is actually enhanced by the placenta?
Answer Choices
1 Mercury
2 Cadmium
3 Polychlorinated biphenyls
4 Insecticides
5 Environmental tobacco smoke: mercury
Explanation Methyl mercury is absorbed almost completely and crosses the placen-
ta easily and then becomes stored in the fetus. Fetal blood concentrations exceed
maternal concentrations by 50-100%. High doses can result in mental retardation,
spastic paralysis, and death. Low doses are linked to deficits in neuromotor perfor-
mance, cognition, memory, and language.
The placenta effectively blocks the transfer of cadmium. Studies have shown cad-
mium concentrations in umbilical cord blood to be significantly lower than that in
maternal blood and placental cadmium concentration to be highest.
Polychlorinated biphenyls (PCP) have contaminated sport fish, particularly bot-
tom-feeding species from water contaminated with PCPs. Also during the 1940s and
1950s the inside of concrete silos on many farms in the Midwest were coated with
sealants containing PCPs that over time have peeled off and become mixed with
silage to feed beef and dairy cattle. Incinerators and other PCP-disposal facilities
or hazardous waste sites are other sources of PCP exposure. PCPs are synthetic
,hydrocarbons that are lipophilic, have a long half-life, and can cross the placenta
easily. Fetuses and neonates are more sensitive to PCPs because the hepatic
microsomal enzyme system that facilitates metabolism and excretion are not fully
functional.
Insecticides or pesticides appear to cross the placenta relatively easily being
lipophilic and having a low molecular weight. Residue levels of DDT and its metabo-
lites were detected in maternal blood, placenta, and umbilical cord blood of moth-
er/child pair studies. A correlation exists between pesticide concentration and age,
dietary habits, and area of residence of pregnant women.
Environmental tobacco smoke (ETS) exposure during fetal development is one of
the most ubiquitous and hazardous of environment
4. A 23-year-old primigravida is admitted to your ward because of vaginal
bleeding and cramping at 26 weeks. The ultrasound shows fetal heartbeat,
and you try to stop a miscarriage by ordering terbutaline. What do you tell the
nurse to watch for?
Answer Choices
1 Constipation and dry mouth
2 Headache, tachycardia, and nausea
3 Sedation, urinary retention, and dry mouth
4 Anxiety, headache, and mydriasis
5 Cold extremities, arrhythmia, and insomnia: headache, tachycardia and nau-
sea
Explanation
Terbutaline relaxes smooth muscle in the bronchial system and the uterus by
stimulating ²2r- eceptors. It is a tocolytic drug, and most commonly used in patients
with bronchospasms caused by reversible obstructive airway disease. Headache,
tachycardia, and nausea are common side effects of beta-mimetic drugs, which relax
the uterine muscle. Other side effects are shown in the following table.
Central nervous system Drowsiness, dizziness, headache, tremor, nervousness
Gastrointestinal Nausea, vomiting
Cardiovascular Palpitations, tachycardia, arrhythmia
Respiratory Paradox bronchospasm
Metabolic Hypokalemia
Skin Diaphoresis
Other Dry mouth and throat
Constipation and dry mouth are side effects of skeletal muscle relaxants, like
, cyclobenzaprine, which is used as short-term treatment of muscle spasms.
Sedation, urinary retention, and dry mouth are side effects of antihistamine drugs,
which effect the peripheral H1-receptors. Urinary retention and sedation however are
side effects of the "older" drugs like brompheniramine, chlorpheniramine, clemas-
tine, promethazine, and triprolidine and not the "newer" ones like fexofenadine,
loratadine, and cetirizine.
Anxiety, headache, and mydriasis are signs of atropine overdosage. Atropin is
an anticholinergic that inhibits acetylcholine at the parasympathica neuroeffector
junction. It blocks vagal effects on the sinuatrial and atrioventricular nodes thereby
enhancing conduction through the AV node and increasing the heart rate. It is used
to treat bradycardia and to dilate the pupils.
Cold extremities, bronchospasm, and insomnia are side effects of beta-blockers.
Beta-blockers (or symppatholytics) decrease myocardial contractility, heart rate,
blood pressure, and cardiac output (less blood getting to the periphery, which
explains cold e
5. A 32-year-old woman is 2-hours status post cesarean delivery of a twin ges-
tation at 36 weeks. Her pregnancy was uncomplicated. She presented in early
labor, which became prolonged despite oxytocin infusion. A cesarean section
was performed when her labor became non-progressive. In the recovery area,
she notes nausea and lightheadedness. On exam, her heart rate is 133 beats
per minute, and blood pressure is 76/42 mm Hg. Significant vaginal bleeding
is noted; abdominal palpation reveals a soft uterus.
Question
What intervention would be most appropriate?
Answer Choices
1 Administration of intravenous magnesium
2 Bimanual uterine massage
3 Immediate surgical exploration
4 Transfusion with fresh frozen plasma
5 Transvaginal ultrasound: bimanual uterine massage
Explanation
The most likely cause of bleeding in this patient is uterine atony. Uterine atony
occurs when the uterine myometrium fails to contract following delivery. Contractions
Answers
1. You are caring for a 29-year-old G3P2 at 39 weeks gestation, who has been
laboring for 6 hours. She is a diet-controlled diabetic. Her last child was
9 pounds 8 ounces. She has been completely dilated for 2 hours, and the
fetal head is at a plus 2 station, which is unchanged. What is the next most
appropriate course of action?
A Begin oxytocin
B Vacuum extraction
C High forcep extraction
D High forcep rotation
E Cesarean section: Cesarian Section
The patient is a diabetic with a history of a macrosomic infant; the likelihood of
macrosomia in this infant is significant. Instrument delivery is not recommended if
macrosomia is suspected. By definition, she has had an arrest of descent of the
fetal head and one should be highly suspicious for macrosomia, in which case a
c-section is the preferred method of delivery.
2. A 75-year-old woman presents to your office complaining of intense pruritis
of the vulva and occasional bleeding. She is unsure if the bleeding is caused
by her scratching in attempts to alleviate the itching. She has tried some OTC
preparations to alleviate the itching and has not had any relief from them. She
denies any vaginal discharge or dysuria. On physical examination you notice
excoriations and some scattered lesions that look like eczema on the vulva
and they do not scrape off. Also noted was inguinal lymphadenopathy. You
decide to do a punch biopsy. The pathology report reveals large eosinophilic
cells.
Question
What is the most likely diagnosis?
Answer Choices
1 Lichen sclerosis
2 Vulvar carcinoma
3 Paget's disease
4 Melanoma
5 Candida albicans: Paget's disease
Explanation Paget's diseaseis associated with intense pruritus of the vulva, along
,with lesions that resemble eczema. Pathology also characteristically shows large
eosinophilic Paget's cells (1).
Lichen sclerosis is not correct because the pathology would reveal changes asso-
ciated with chronic inflammation.
Vulvar carcinoma is incorrect as it generally shows squamous cell characteristics.
(1).
Melanoma is incorrect as the lesion will generally appear hyperpigmented (1).
Candida albicans is incorrect because the lesions that appear on the vulva do not
scrape off and she does not have any vaginal discharge. Candida albicans is also
not associated with inguinal lymphadenopathy.
3. The pregnant mother of a 2-year-old patient is concerned about exposure
to environmental neurotoxins affecting her developing fetus.
She asks you questions about whether the placenta would block any transfer
of toxins to a growing fetus. Which environmental neurotoxin transfer to the
fetal system is actually enhanced by the placenta?
Answer Choices
1 Mercury
2 Cadmium
3 Polychlorinated biphenyls
4 Insecticides
5 Environmental tobacco smoke: mercury
Explanation Methyl mercury is absorbed almost completely and crosses the placen-
ta easily and then becomes stored in the fetus. Fetal blood concentrations exceed
maternal concentrations by 50-100%. High doses can result in mental retardation,
spastic paralysis, and death. Low doses are linked to deficits in neuromotor perfor-
mance, cognition, memory, and language.
The placenta effectively blocks the transfer of cadmium. Studies have shown cad-
mium concentrations in umbilical cord blood to be significantly lower than that in
maternal blood and placental cadmium concentration to be highest.
Polychlorinated biphenyls (PCP) have contaminated sport fish, particularly bot-
tom-feeding species from water contaminated with PCPs. Also during the 1940s and
1950s the inside of concrete silos on many farms in the Midwest were coated with
sealants containing PCPs that over time have peeled off and become mixed with
silage to feed beef and dairy cattle. Incinerators and other PCP-disposal facilities
or hazardous waste sites are other sources of PCP exposure. PCPs are synthetic
,hydrocarbons that are lipophilic, have a long half-life, and can cross the placenta
easily. Fetuses and neonates are more sensitive to PCPs because the hepatic
microsomal enzyme system that facilitates metabolism and excretion are not fully
functional.
Insecticides or pesticides appear to cross the placenta relatively easily being
lipophilic and having a low molecular weight. Residue levels of DDT and its metabo-
lites were detected in maternal blood, placenta, and umbilical cord blood of moth-
er/child pair studies. A correlation exists between pesticide concentration and age,
dietary habits, and area of residence of pregnant women.
Environmental tobacco smoke (ETS) exposure during fetal development is one of
the most ubiquitous and hazardous of environment
4. A 23-year-old primigravida is admitted to your ward because of vaginal
bleeding and cramping at 26 weeks. The ultrasound shows fetal heartbeat,
and you try to stop a miscarriage by ordering terbutaline. What do you tell the
nurse to watch for?
Answer Choices
1 Constipation and dry mouth
2 Headache, tachycardia, and nausea
3 Sedation, urinary retention, and dry mouth
4 Anxiety, headache, and mydriasis
5 Cold extremities, arrhythmia, and insomnia: headache, tachycardia and nau-
sea
Explanation
Terbutaline relaxes smooth muscle in the bronchial system and the uterus by
stimulating ²2r- eceptors. It is a tocolytic drug, and most commonly used in patients
with bronchospasms caused by reversible obstructive airway disease. Headache,
tachycardia, and nausea are common side effects of beta-mimetic drugs, which relax
the uterine muscle. Other side effects are shown in the following table.
Central nervous system Drowsiness, dizziness, headache, tremor, nervousness
Gastrointestinal Nausea, vomiting
Cardiovascular Palpitations, tachycardia, arrhythmia
Respiratory Paradox bronchospasm
Metabolic Hypokalemia
Skin Diaphoresis
Other Dry mouth and throat
Constipation and dry mouth are side effects of skeletal muscle relaxants, like
, cyclobenzaprine, which is used as short-term treatment of muscle spasms.
Sedation, urinary retention, and dry mouth are side effects of antihistamine drugs,
which effect the peripheral H1-receptors. Urinary retention and sedation however are
side effects of the "older" drugs like brompheniramine, chlorpheniramine, clemas-
tine, promethazine, and triprolidine and not the "newer" ones like fexofenadine,
loratadine, and cetirizine.
Anxiety, headache, and mydriasis are signs of atropine overdosage. Atropin is
an anticholinergic that inhibits acetylcholine at the parasympathica neuroeffector
junction. It blocks vagal effects on the sinuatrial and atrioventricular nodes thereby
enhancing conduction through the AV node and increasing the heart rate. It is used
to treat bradycardia and to dilate the pupils.
Cold extremities, bronchospasm, and insomnia are side effects of beta-blockers.
Beta-blockers (or symppatholytics) decrease myocardial contractility, heart rate,
blood pressure, and cardiac output (less blood getting to the periphery, which
explains cold e
5. A 32-year-old woman is 2-hours status post cesarean delivery of a twin ges-
tation at 36 weeks. Her pregnancy was uncomplicated. She presented in early
labor, which became prolonged despite oxytocin infusion. A cesarean section
was performed when her labor became non-progressive. In the recovery area,
she notes nausea and lightheadedness. On exam, her heart rate is 133 beats
per minute, and blood pressure is 76/42 mm Hg. Significant vaginal bleeding
is noted; abdominal palpation reveals a soft uterus.
Question
What intervention would be most appropriate?
Answer Choices
1 Administration of intravenous magnesium
2 Bimanual uterine massage
3 Immediate surgical exploration
4 Transfusion with fresh frozen plasma
5 Transvaginal ultrasound: bimanual uterine massage
Explanation
The most likely cause of bleeding in this patient is uterine atony. Uterine atony
occurs when the uterine myometrium fails to contract following delivery. Contractions
