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OB/GYN: ACOG GYNECOLOGY Questions and
verified answers 2025
A 28-year-old G2P2 woman returns today for follow up
on her abnormal pap smear which reveals atypical
squamous cells of undetermined significance (ASCUS).
Reflex HPV testing is positive for high risk type. She has
never had a prior abnormal pap smear, and has been
following the recommended screening guidelines. She is
asymptomatic. Her pelvic exam reveals a normal cervix
with a small amount of cervical mucous. What is the next
best step in the management of this patient?
A. Routine screening
B. Repeat Pap smear in one year
C. Repeat HPV testing in one year
D. Repeat co-testing with Pap and HPV in one year
E. Colposcopy - ....ANSWER ....✔✔ E
A 17-year-old G0 high school student is brought in by
her mother for her first gynecologic examination. She
began her menses at age 12 and has had regular
periods for the past three years. Her last menstrual
period was one week ago. For privacy, you ask to
,2|Page
examine the patient without her mother. Further history is
obtained in the examination room. She admits that she
has been sexually active with her boyfriend for the past
three years. She uses condoms occasionally and is
fearful about possible pregnancy. She requests that her
mother not be informed about her sexual activity. On
physical examination, she is anxious, but normally
developed. Her pelvic examination reveals no vulvar
lesions, minimal non-malodorous discharge, and a
nulliparous appearing cervix. The bimanual examination
reveals a normal size uterus, and her adnexa are non-
tender and not enlarged. Urine pregnancy test is
negative. In addition to discussing - ....ANSWER
....✔✔ D
A 25-year-old G0 woman is scheduled to discuss her
recent abnormal Pap smear which showed atypical
squamous cells of undetermined significance (ASCUS).
She has had one Pap smear at age 22 which was
normal. Her only significant gynecologic history is genital
warts that have not responded to treatment with local
application of trichloroacetic acid. She has had eight
sexual partners. She uses condoms and oral
contraceptives. She has smoked a pack a day for the
past two years. Which of the following is the most
appropriate next step in the management of this
patient?
A. HPV typing
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B. Repeat Pap smear in three years
C. Cone biopsy
D. Cryotherapy
E. Loop Electrosurgical Excision Procedure (LEEP) -
....ANSWER ....✔✔ A. HPV typing
A 39-year-old G0 woman presents to the clinic
reporting non-tender spots on her vulva for about a
week. No pruritus or pain is present. She also notes a
brownish rash on the palms of her hands. She admits to
IV drug abuse. She was diagnosed as HIV-positive two
years ago, but has not been compliant with suggested
treatment. On examination, three elevated plaques with
rolled edges are noted on the vulva. They are non-
tender. A brown macular rash is noted on the palms of
her hands and the soles of her feet. What is the most
appropriate next step in the management of this
patient?
A. Obtain a treponemal-specific test
B. Biopsy of the lesion
C. Colposcopic evaluation of the vulvar lesions
D. Culture the base of the lesion
E. Initiate empiric treatment with doxycycline and
ceftriaxone - ....ANSWER ....✔✔ A. The diagnosis of
syphilis is often established by serologic testing. Non-
, 4|Page
treponemal tests (VDRL or RPR) are non-specific. In this
patient with high suspicion for syphilis, specific testing
with treponemal antibody can confirm infection. The
classic coiled spirochete is easily seen with dark-field
microscopy but availability is limited. A characteristic
finding is a macular rash on the palms and soles that are
often described as copper penny lesions. Colposcopy
would not be diagnostic, but certainly is helpful to
evaluate for any vulvar lesions thought to be dysplastic.
Biopsies can be stained for spirochetes and may show a
necrotizing vasculitis, but certainly would not be the most
expedient way to make the diagnosis. Penicillin G is the
preferred drug for treating all stages of syphilis.
A 24-year-old G0 woman presents with multiple painful
ulcers involving the vulva. The sores initially were fluid
filled, but are now open, weeping and crusted. She
reports a fever and is having difficulty voiding due to
pain. She uses a vaginal ring for contraception. She has
multiple sexual partners and uses condoms for vaginal
intercourse. She is distraught that she may have a
sexually transmitted infection. She is healthy and does
not smoke or use drugs. On physical exam, she is in
obvious distress. Temperature is 100.2°F (37.9°C), pulse
100. Examination of the genital tract is limited due to
her discomfort. Multiple ulcers and erosions of variable
size are localized to the perineum, labia minora and
vestibule. Swelling is diffuse. The lesions are eroded,
some with a purulent eschar. There is exquisite
OB/GYN: ACOG GYNECOLOGY Questions and
verified answers 2025
A 28-year-old G2P2 woman returns today for follow up
on her abnormal pap smear which reveals atypical
squamous cells of undetermined significance (ASCUS).
Reflex HPV testing is positive for high risk type. She has
never had a prior abnormal pap smear, and has been
following the recommended screening guidelines. She is
asymptomatic. Her pelvic exam reveals a normal cervix
with a small amount of cervical mucous. What is the next
best step in the management of this patient?
A. Routine screening
B. Repeat Pap smear in one year
C. Repeat HPV testing in one year
D. Repeat co-testing with Pap and HPV in one year
E. Colposcopy - ....ANSWER ....✔✔ E
A 17-year-old G0 high school student is brought in by
her mother for her first gynecologic examination. She
began her menses at age 12 and has had regular
periods for the past three years. Her last menstrual
period was one week ago. For privacy, you ask to
,2|Page
examine the patient without her mother. Further history is
obtained in the examination room. She admits that she
has been sexually active with her boyfriend for the past
three years. She uses condoms occasionally and is
fearful about possible pregnancy. She requests that her
mother not be informed about her sexual activity. On
physical examination, she is anxious, but normally
developed. Her pelvic examination reveals no vulvar
lesions, minimal non-malodorous discharge, and a
nulliparous appearing cervix. The bimanual examination
reveals a normal size uterus, and her adnexa are non-
tender and not enlarged. Urine pregnancy test is
negative. In addition to discussing - ....ANSWER
....✔✔ D
A 25-year-old G0 woman is scheduled to discuss her
recent abnormal Pap smear which showed atypical
squamous cells of undetermined significance (ASCUS).
She has had one Pap smear at age 22 which was
normal. Her only significant gynecologic history is genital
warts that have not responded to treatment with local
application of trichloroacetic acid. She has had eight
sexual partners. She uses condoms and oral
contraceptives. She has smoked a pack a day for the
past two years. Which of the following is the most
appropriate next step in the management of this
patient?
A. HPV typing
,3|Page
B. Repeat Pap smear in three years
C. Cone biopsy
D. Cryotherapy
E. Loop Electrosurgical Excision Procedure (LEEP) -
....ANSWER ....✔✔ A. HPV typing
A 39-year-old G0 woman presents to the clinic
reporting non-tender spots on her vulva for about a
week. No pruritus or pain is present. She also notes a
brownish rash on the palms of her hands. She admits to
IV drug abuse. She was diagnosed as HIV-positive two
years ago, but has not been compliant with suggested
treatment. On examination, three elevated plaques with
rolled edges are noted on the vulva. They are non-
tender. A brown macular rash is noted on the palms of
her hands and the soles of her feet. What is the most
appropriate next step in the management of this
patient?
A. Obtain a treponemal-specific test
B. Biopsy of the lesion
C. Colposcopic evaluation of the vulvar lesions
D. Culture the base of the lesion
E. Initiate empiric treatment with doxycycline and
ceftriaxone - ....ANSWER ....✔✔ A. The diagnosis of
syphilis is often established by serologic testing. Non-
, 4|Page
treponemal tests (VDRL or RPR) are non-specific. In this
patient with high suspicion for syphilis, specific testing
with treponemal antibody can confirm infection. The
classic coiled spirochete is easily seen with dark-field
microscopy but availability is limited. A characteristic
finding is a macular rash on the palms and soles that are
often described as copper penny lesions. Colposcopy
would not be diagnostic, but certainly is helpful to
evaluate for any vulvar lesions thought to be dysplastic.
Biopsies can be stained for spirochetes and may show a
necrotizing vasculitis, but certainly would not be the most
expedient way to make the diagnosis. Penicillin G is the
preferred drug for treating all stages of syphilis.
A 24-year-old G0 woman presents with multiple painful
ulcers involving the vulva. The sores initially were fluid
filled, but are now open, weeping and crusted. She
reports a fever and is having difficulty voiding due to
pain. She uses a vaginal ring for contraception. She has
multiple sexual partners and uses condoms for vaginal
intercourse. She is distraught that she may have a
sexually transmitted infection. She is healthy and does
not smoke or use drugs. On physical exam, she is in
obvious distress. Temperature is 100.2°F (37.9°C), pulse
100. Examination of the genital tract is limited due to
her discomfort. Multiple ulcers and erosions of variable
size are localized to the perineum, labia minora and
vestibule. Swelling is diffuse. The lesions are eroded,
some with a purulent eschar. There is exquisite
