Exam Sample:

1- 31-year-old woman comes to the physician for follow-up after an abnormal Pap test and
cervical biopsy. The patient's Pap test showed a high-grade squamous intraepithelial lesion
(HGSIL). This was followed by colposcopy and biopsy of the cervix. The biopsy specimen also
demonstrated HGSIL. The patient was counseled to undergo a loop electrosurgical excision
procedure (LEEP). Which of the following represents the potential long-term complications from
this procedure?
A. Abscess and chronic pelvic inflammatory disease
B. Cervical incompetence and cervical stenosis
C. Constipation and fecal incontinence
D. Hernia and intraperitoneal adhesions
E. Urinary incontinence and urinary retention

2- A 27-year-old woman, gravida 2, para 2, comes to the physician to have her staples removed
after an elective repeat cesarean delivery. Her pregnancy course was uncomplicated. She states
that she is doing well except that since the delivery she has noticed some episodes of sadness and
tearfulness. She is eating and sleeping normally and has no strange thoughts or thoughts of
hurting herself or others. Physical examination is within normal limits for a patient who is status
post cesarean delivery. Which of the following is the most likely diagnosis?
A. Maternity blues
B. Postpartum depression
C. Postpartum mania
D. Postpartum psychosis
E. Poststerilization depression

3- A 22-year-old primigravid woman comes to the labor and delivery ward at term with regular,
painful contractions. Her prenatal course was unremarkable. She has a past medical history
significant for mitral valve prolapse with regurgitation demonstrated on echocardiography. She
takes no medications and has no allergies to medications. Examination shows that her cervix is 4
centimeters dilated and the fetus is in vertex presentation. The fetal heart rate is reassuring.
Which of the following is the most appropriate management of this patient?
A. Administer intravenous antibiotics throughout labor.
B. Administer intravenous antibiotics 30 minutes prior to the delivery.
C. Administer intravenous antibiotics after the cord is clamped.
D. Administer intravenous antibiotics six hours after the delivery.
E. Antibiotic prophylaxis is not necessary

4- 26-year-old primigravid woman at 42 weeks' gestation comes to the labor and delivery ward
for induction of labor. The prenatal course was significant for a positive group B Streptococcus
culture performed at 35 weeks. Antenatal testing over the past 2 weeks has been unremarkable.
The patient is started on lactated Ringer's IV solution. Sterile vaginal examination shows that the
patient's cervix is long, thick, and closed. Prostaglandin (PGE2) gel is placed into the vagina, and
electronic fetal heart rate monitoring is continued. In approximately 60 minutes, the fetal heart
rate falls to the 90s, as the tocodynamometer shows the uterus to be contracting every 1 minute
with essentially no rest in between contractions. Which of the following was most likely the
cause of the uterine hyperstimulation?
A. Infection
B. IV fluids
C. Postdates pregnancy
D. Prostaglandin (PGE2) gel
E. Vaginal examination

5- A 16-year-old female comes to the physician because of an increased vaginal discharge. She
developed this symptom 2 days ago. She also complains of dysuria. She is sexually active with
one partner and uses condoms intermittently. Examination reveals some erythema of the cervix
but is otherwise unremarkable. A urine culture is sent which comes back negative. Sexually
transmitted disease testing is performed and the patient is found to have gonorrhea. While
treating this patient's gonorrhea infection, treatment must also be given for which of the
following?
A. Bacterial vaginosis
B. Chlamydia
C. Herpes
D. Syphilis
E. Trichomoniasis

6- A 16-year-old nulligravid woman comes to the emergency department because of heavy

vaginal bleeding. She states that she normally has heavy periods every month but missed a
period last month and this period has been unusually heavy with the passage of large clots. She
has no medical problems, has no history of bleeding difficulties, and takes no medications. Her
temperature is 37 C (98.6 F), blood pressure is 110/70 mm Hg, pulse is 96/minute and
respirations are 12/minute. Pelvic examination shows a moderate amount of blood in the vagina,
a closed cervix, and a normal uterus and adnexae. Hematocrit is 30%. Urine hCG is negative.
Which of the following is the most appropriate management?
A. Expectant management
B. Hysteroscopy
C. Oral contraceptive pills
D. Laparoscopy
E. Laparotomy

7- A 34-year-old woman comes the physician because of lower abdominal cramping. The
cramping started 2 days ago. Examination is unremarkable except for a pelvic examination that
reveals a 10-week sized uterus. Urine hCG is positive, and pelvic ultrasound reveals a 10-week
intrauterine pregnancy with a fetal heart rate of 160. The patient states that she is not sure
whether to keep the pregnancy. Which of the following is the most appropriate next step in
management?
A. Counsel the patient or refer to an appropriate counselor
B. Notify the patient's parents
C. Notify the patient's partner
D. Schedule a termination of pregnancy
E. Tell the patient that she is likely to have a miscarriage
8- A 29-year-old woman comes to the physician for follow-up of a right breast lump. The patient
first noticed the lump 4 months ago. It was aspirated at that time, and cytology was negative, but
the cyst recurred about 1 month later. The cyst was re-aspirated 2 months ago and, again, the
cytology was negative. The lump has recurred. Examination reveals a mass at 10 o'clock,
approximately 4 cm from the areola. Ultrasound demonstrates a cystic lesion. Which of the
following is the most appropriate next step in management?
A. Mammography in 1 year
B. Ultrasound in 1 year
C. Tamoxifen therapy
D. Open biopsy
E. Mastectomy

9- A 27-year-old primigravid woman at 39 weeks' gestation comes to the labor and delivery ward
with a gush of fluid and regular contractions. Examination shows that she is grossly ruptured,
contracting every 2 minutes, and that her cervix is dilated to 4 cm. The fetal heart rate tracing is
in the 140s and reactive. She is admitted to labor and delivery, and over the following 4 hours
she progresses to 9 cm dilation. Over the past hour, the fetal heart rate has increased from a
baseline of 140 to a baseline of 160. Furthermore, moderate to severe variable decelerations are
seen with each contraction. The fetal heart rate does not respond to scalp stimulation. The
decision is made to proceed with cesarean delivery. Which of the following is the reason for the
cesarean delivery and the preoperative diagnosis?
A. Fetal acidemia
B. Fetal distress
C. Fetal hypoxic encephalopathy
D. Low neonatal APGAR scores
E. Non-reassuring fetal heart rate tracing

10- A 29-year-old woman, gravida 2, para 1, at 38 weeks' gestation comes to the labor and
delivery ward with frequent painful contractions. Her prenatal course was significant for a urine
culture that showed 100,000 colony-forming units/milliliter of Group-B streptococci and asthma,
for which she uses an albuterol inhaler. Examination shows that she is contracting every 2
minutes and her cervix is 5 centimeters dilated and 100% effaced. Which of the following
medications should this patient be treated with during labor and delivery?
A. Betamethasone
B. Folic acid
C. Magnesium sulfate
D. Oxytocin
E. Penicillin