Ob-Gyn Exercise Questions

A 45-year-old woman, G5P3, presents to the clinic with 3-month history of abnormal uterine bleeding. She reports regular menstrual cycles occurring every 30 days. However, her menses now last for 7 days and are characterized by heavy flow with blood clots and dysmenorrhea that is refractory to analgesics. Her medical history is significant for myomectomy 12 years ago. On physical examination, her BMI is 40 kg/m². Abdominal examination reveals non-palpable uterus. Bimanual pelvic examination reveals uniformly enlarged, bulky, and tender uterus. No adnexal masses are appreciated.
Which one of the following is the most likely diagnosis?

A patient presents at 39 weeks gestation in active labor. During vaginal examination, ruptured membranes are noted, and the amniotic fluid is observed to be thick, dark black-green in color.
What is the most likely underlying cause for this finding?

A 23-year-old woman at 10 weeks of gestation presents with a history of vaginal bleeding and cramp-like lower abdominal pain. On examination, some placental tissue is seen passing through the cervix.
Which of the following is the most likely type of abortion?

A 45-year-old woman, G3P2, presents to the clinic with complaint of heavy menstrual bleeding for the past 8 months. Her cycles remain regular, occurring every 30 days and lasting 5 days. The bleeding is characterized by the passage of large blood clots and is associated with dysmenorrhea to be not relieved by analgesics. Her past medical history is significant for type 2 diabetes and hypertension. Her surgical history includes myomectomy 12 years ago for uterine fibroids. She has known diagnosis of polycystic ovarian syndrome.
On physical examination, her BMI is 40 kg/m². Abdominal examination is unremarkable with no palpable masses. Speculum examination reveals healthy-appearing cervix. Bimanual pelvic examination confirms normal-sized, non-tender uterus.
Which of the following is the most likely underlying diagnosis?

A 27-year-old primigravida at 39 weeks of gestation presents to the labor and delivery unit reporting a sudden, painless gush of clear fluid per vagina. On sterile speculum examination, you note clear fluid pooling in the posterior vaginal fornix. The Nitrazine test paper turns deep blue, indicating pH of 7.0.
Which of the following tests is considered another bedside diagnostic method for confirming the diagnosis?

A 24-year-old primigravida presents for routine antenatal care at 22 weeks gestation. Her blood pressure is measured at 140/95 mmHg on two separate occasions, 4 hours apart, with no associated symptoms. Urine dipstick testing reveals no proteinuria.
What is the most likely diagnosis?

A 26-year-old woman at 35 weeks gestation presents to the emergency department with episode of painless vaginal bleeding that has now resolved. A transvaginal ultrasound confirms complete placenta previa, with covering the entire internal cervical os. The mother is hemodynamically stable, the fetal heart rate is reassuring, and there is no evidence of active labor.
What is the most appropriate next step in management?

A 17-year-old primigravida presents to the clinic for her first prenatal visit after missing her period. She reports positive home pregnancy test. Her last menstrual period was 5 weeks ago, and she denies vaginal bleeding or abdominal pain. Pelvic examination shows closed cervical os. Transvaginal ultrasound demonstrates intrauterine gestational sac with no embryonic heartbeat.
Which one of the following is the most likely diagnosis?

A 28-year-old primigravida at 40 weeks gestation is in the second stage of labor. After 2 hours of active pushing, she is now exhausted and unable to push effectively. On vaginal exam, the fetal head is engaged at +2 station in the occiput-anterior position. Fetal heart rate tracing show minimal variability and recurrent late decelerations.
What is the most appropriate next step in management?

A 70-year-old woman presents with 6-week history of postmenopausal bleeding accompanied by dull pelvic pain and sensation of fullness. Ultrasound demonstrates single, 8-cm fundal mass with mixed echogenicity and central necrosis.
Which of the following is the most likely diagnosis?