Obstetrics & Gynecology

A 24-year-old G1P0 at 7 weeks has vaginal bleeding and cramping. Cervix is open; ultrasound shows products of conception in the cervical canal; β-hCG is falling. She is Rh-negative.

A 32-year-old G2P1 at 10 weeks with severe N/V, orthostatic symptoms, ketonuria, and >5% pre-pregnancy weight loss.

A 29-year-old G1 at 11 weeks asks about aneuploidy screening.

A 36-year-old G2 at 18 weeks has elevated AFP on quad screen. Dating is accurate. Next best step?

A 30-year-old G1 at 28 weeks has 1-hour GCT 170 mg/dL.

A 26-year-old G1 at 32 weeks with BP 152/98, 2+ edema, platelets 160k, AST/ALT normal, urine protein/creatinine ratio 0.5.

A 34-year-old G2 at 30 weeks has BP 168/112, headache, RUQ pain, 3+ protein; platelets 90k, AST 210, LDH elevated.

A 35-year-old G1 at 28 weeks with painless vaginal bleeding; vitals stable; uterus non-tender.

A 26-year-old at 32 weeks with painful vaginal bleeding and firm tender uterus after MVC; fetal heart tracing shows late decelerations.

A G2P1 at 39 weeks has regular contractions; sterile exam: 3 cm/70%/−2; fetus is breech by bedside US.

A 23-year-old G1 at 41 weeks with oligohydramnios (AFI 3 cm), BPP 4/10.

A 29-year-old in active labor has recurrent variable decelerations to 70 bpm lasting 60–90 s with moderate variability.

A 37-year-old multipara at 39 weeks delivers a 4100 g infant; after placental delivery she has brisk bleeding and a boggy uterus.

A 28-year-old G2 at 16 weeks with lower abdominal pain; bedside US shows “snowstorm” pattern; β-hCG 250,000 mIU/mL; no fetal parts.

A 22-year-old presents with 8-week amenorrhea, pelvic pain, and spotting. β-hCG 2,400 mIU/mL; transvaginal US shows no intrauterine pregnancy; stable vitals.

A 30-year-old at 34 weeks has pruritus of palms/soles, elevated bile acids; LFTs mildly high; no rash.

A 27-year-old postpartum day 3 develops dyspnea, tachycardia, chest pain; C-section 3 days ago. O₂ sat 88%.

A 19-year-old with secondary amenorrhea for 8 months after elective abortion with heavy curettage; now infertility; negative pregnancy test; normal FSH/TSH/prolactin.

A 52-year-old with postmenopausal bleeding; BMI 35; transvaginal US shows endometrial thickness 12 mm.

A 26-year-old with severe dysmenorrhea and cyclic pelvic pain; dyspareunia; infertility; fixed retroverted uterus on exam.

A 45-year-old with heavy regular menses and bulk symptoms; enlarged irregular uterus; Hb 9 g/dL.

A 26-year-old with acute unilateral lower abdominal pain mid-cycle; free fluid on US; negative pregnancy test; small ovarian cyst.

A 63-year-old with early satiety, bloating, and pelvic mass; CA-125 elevated; US shows complex adnexal mass with ascites.

A 21-year-old with multiple sexual partners has postcoital bleeding; exam shows friable ectopy; NAAT positive for chlamydia.

A 33-year-old with primary infertility, oligomenorrhea, acne, and hirsutism; BMI 31; LH:FSH ratio elevated; A1c 6.1%.

A 28-year-old G1 at 26 weeks with asymptomatic bacteriuria E. coli 10⁵ CFU/mL.

A 22-year-old postpartum day 5 with fever, uterine tenderness, and foul lochia; C-section performed after prolonged labor and ROM.

A 31-year-old with sudden severe unilateral pelvic pain, nausea/vomiting; adnexal tenderness; US shows enlarged ovary with peripheral follicles and absent Doppler flow.

A 25-year-old with intermenstrual bleeding and postcoital spotting; Pap normal 1 year ago; cervix shows polyp at os.

A 34-year-old G2 at 29 weeks with painless cervical dilation 3 cm and bulging membranes; no contractions.

A 22-year-old presents with secondary amenorrhea for 6 months; pregnancy test negative; prolactin normal; TSH normal; FSH low; intense marathon training and BMI 17.

A 40-year-old with cyclic pelvic pain and heavy menses; uniformly enlarged tender “boggy” uterus; ultrasound thickened myometrium.

A 27-year-old G1 at 24 weeks with positive antibody screen; prior history of transfusion; father’s antigen status unknown.

A 19-year-old with lower abdominal pain and amenorrhea 7 weeks; β-hCG 3,000; US shows adnexal mass with peripheral vascularity (ring of fire) and free fluid.

A 33-year-old at 35 weeks with preterm labor (3 cm, regular contractions) and unknown GBS status.

A 28-year-old postpartum day 1 cannot void after vaginal delivery with epidural; bladder palpable and distended.

A 42-year-old with hot flashes and irregular cycles; FSH elevated; desires contraception and symptom control.

A 25-year-old with painful vesicles on vulva, tender inguinal nodes; first episode.

A 31-year-old postpartum day 2 has breast engorgement, fever 38.6°C, unilateral breast erythema, and focal tenderness.

A 30-year-old with LSIL on Pap and positive high-risk HPV; she is nonpregnant and age 30.

A 26-year-old G2P1 at 40 weeks delivers the fetal head, but the shoulders fail to deliver; the “turtle sign” is noted.

A 30-year-old with one prior low-transverse cesarean requests vaginal birth at term; no other risk factors.

A 28-year-old at 30 weeks has sudden gush of fluid; pooling and positive nitrazine; afebrile, no contractions, reassuring NST.

A 25-year-old at 39 weeks has fever 38.9°C, uterine tenderness, maternal/fetal tachycardia, and purulent amniotic fluid.

A 24-year-old G1 at 22 weeks has intrauterine fetal demise; no uterine scar; desires vaginal delivery.

A 29-year-old 2 weeks postpartum has depressed mood, anhedonia, poor sleep, guilt, and impaired bonding; denies suicidality; breastfeeding.

A 34-year-old 1 week postpartum has insomnia, disorganized behavior, delusions about her baby, and auditory hallucinations.

A 23-year-old 3 weeks postpartum, exclusively breastfeeding, requests contraception.

A 27-year-old had unprotected intercourse 4 days ago; BMI 34; desires most effective emergency contraception.

A 28-year-old nonpregnant has HSIL cytology; HPV16 positive; reliable follow-up uncertain.

A 12-week pregnant patient has sudden severe unilateral pelvic pain; US shows enlarged ovary with peripheral follicles and decreased flow.

A 24-week pregnant patient has fever, flank pain, CVA tenderness, and pyuria; N/V prevent oral intake.

A 30-year-old at 36 weeks presents for routine care; asks about GBS screening.

A 35-year-old G3P2 at 33 weeks with complete previa and prior two cesareans has ultrasound signs of placental lacunae and loss of clear zone.

A laboring patient at 41 weeks has recurrent late decelerations with absent variability unresponsive to intrauterine resuscitation; cervix 3 cm.

A 25-year-old had complete molar pregnancy evacuated 6 weeks ago; serial β-hCGs plateau, then rise; chest X-ray normal.

A 38-year-old has a painful 3-cm fluctuant mass of the left posterior introitus; febrile; not pregnant.

A 46-year-old parous woman leaks urine with coughing and running; positive cough stress test; normal postvoid residual.

A 33-year-old with hemodynamically stable but heavy acute uterine bleeding (Hgb 9.2), not pregnant.

A 27-year-old Rh-negative G1 at 28 weeks with negative antibody screen asks about Rh prophylaxis.