NBME Obstetrics and Gynecology 2 — Questions and Answers
Question 1: A 28-year-old G2P1 at 39 weeks presents with painless vaginal bleeding. Ultrasound confirms the placenta completely covers the internal cervical os. What is the most appropriate management?
- Immediate cesarean delivery (Correct answer)
- Pelvic rest with outpatient monitoring
- Oxytocin induction of labor
- Tocolysis with magnesium sulfate
Correct answer: Immediate cesarean delivery
Complete placenta previa with active bleeding at term requires immediate cesarean delivery because vaginal delivery is contraindicated.
Question 2: A 32-year-old G1P0 at 34 weeks develops sudden severe abdominal pain, a board-like rigid uterus, and fetal bradycardia. What is the most likely diagnosis?
- Complete placenta previa
- Placental abruption (Correct answer)
- Uterine rupture
- Acute polyhydramnios
Correct answer: Placental abruption
Sudden severe pain with uterine rigidity and fetal distress is the classic presentation of placental abruption (premature separation of the placenta).
Question 3: A postpartum patient on day 3 has a temperature of 38.6°C, uterine tenderness on palpation, and foul-smelling lochia. What is the most appropriate antibiotic regimen?
- Oral amoxicillin-clavulanate for 7 days
- IV clindamycin plus gentamicin (Correct answer)
- Oral metronidazole alone for 10 days
- IV ampicillin alone
Correct answer: IV clindamycin plus gentamicin
Postpartum endometritis is treated with IV clindamycin plus gentamicin, which provides coverage for gram-negative and anaerobic organisms.
Question 4: A 55-year-old postmenopausal woman presents with vaginal bleeding. Endometrial biopsy shows complex atypical hyperplasia. What is the recommended next step?
- Repeat biopsy in 3 months
- Cyclic progestin therapy for 6 months
- Total hysterectomy (Correct answer)
- External beam radiation therapy
Correct answer: Total hysterectomy
Complex atypical hyperplasia carries a 25–30% risk of concurrent endometrial carcinoma, so total hysterectomy is the definitive treatment.
Question 5: During a total abdominal hysterectomy, the ureter is inadvertently injured. At which anatomical location is the ureter most vulnerable during this procedure?
- At the pelvic brim where it crosses the iliac vessels
- Where it passes beneath the uterine artery (Correct answer)
- At the ureterovesical junction
- At the level of the ovarian fossa
Correct answer: Where it passes beneath the uterine artery
The ureter passes directly beneath the uterine artery ('water under the bridge'), making this the most common site of ureteral injury during hysterectomy.
Question 6: A neonate is delivered by emergency cesarean for non-reassuring fetal heart tones. Apgar scores are 3 at 1 minute and 6 at 5 minutes. Which intervention has the strongest evidence for improving neurological outcomes in this setting?
- IV systemic corticosteroids
- Therapeutic hypothermia initiated within 6 hours (Correct answer)
- Prophylactic IV magnesium sulfate
- Controlled hyperventilation to reduce ICP
Correct answer: Therapeutic hypothermia initiated within 6 hours
Therapeutic hypothermia (whole-body cooling to 33–34°C) initiated within 6 hours of birth reduces neurological injury and mortality in neonatal hypoxic-ischemic encephalopathy.
Question 7: A 38-year-old woman has progressive dysmenorrhea, dyspareunia, and pelvic pain. Transvaginal ultrasound reveals a 5-cm ovarian cyst with diffuse low-level internal echoes (ground glass appearance). What is the most likely diagnosis?
- Mature teratoma (dermoid cyst)
- Endometrioma (Correct answer)
- Mucinous cystadenoma
- Tubo-ovarian abscess
Correct answer: Endometrioma
An endometrioma ('chocolate cyst') presents with endometriosis symptoms and the classic ground-glass ultrasound appearance from accumulated old blood.
NBME Obstetrics and Gynecology 2
A 28-year-old G2P1 at 39 weeks presents with painless vaginal bleeding.
Ultrasound confirms the placenta completely covers the internal cervical os.
What is the most appropriate management?