1.

A 21-year-old primiparous patient arrives in Labor and Delivery with poor prenatal care, her
last visit being 8 weeks ago. She is 41 weeks by dates, and states she ruptured membranes
approximately 12 hours ago. On examination, estimated weight is 9 lb. She has thick
meconium. Her cervix is 3 cm, dilated, and the presenting part is at –2 station. The presenting
part is a face. The fetal heart tones are excellent; she is not contracting. What is the best
management?
a. oxytocin induction with group B strep prophylaxis
b. Misoprostol 25 μg, group B strep prophylaxis
c. expectant management with group B strep prophylaxis
d. epidural anesthesia to relax the pelvis, group B strep prophylaxis, and then oxytocin
e. cesarean section

2. A 21-year-old primigravida at 39 weeks’ gestation presents to labor and delivery with

complaints of uterine contractions since 5 AM that day. She is seen for a routine clinic visit at 3
PM and her cervix is found to be 2 cm dilated, 50% effaced, midposition, and moderate in
consistency, with the fetal vertex at 0 station. Reexamination on labor and delivery at 7 PM
shows no significant cervical change. Fetal heart tones are reassuring. She begs you to admit and
augment her because she is tired of being pregnant. You explain that she and the fetus are doing
well and that her Bishop’s score predicts the likelihood of a successful labor augmentation.
What is this gravida’s Bishop score?
(A) 8, cervix unripe
(B) 4, cervix unripe
(C) 2, cervix ripening
(D) 6, cervix ripening
(E) 9, cervix ripe

3. A female who possesses an X-linked trait may do so because either she inherited a
recessive gene from both her mother and her father or which of the following?
(A) She inherited a recessive gene from one of her parents and may express the
recessive characteristic as a function of the Lyon hypothesis.
(B) She has undergone spontaneous mutation from an environmental source.
(C) She is really a testicular feminization patient.
(D) She lacks the genetic expressor gene for dominance.
(E) She has a translocated Y determinant on one of her autosomes.

4. A 22-year-old woman and her husband are being counseled after a first-trimester miscarriage.
She has no significant medical problems. Her physical examination is unremarkable and in
counseling her you explain in lay terms that the most likely cause of her miscarriage is aneu-
ploidy. Which of the following is the most common aneuploidy causing miscarriage?
(A) trisomy 18
(B) 45,XO
(C) triploidy
(D) unbalanced translocation
(E) tetraploidy
5. A 21-year-old G2P1 comes to see you at 5 weeks’ gestation. She has returned from
spring break 3 weeks ago at which time she spent several nights partying and she states she
may have gotten drunk once or twice. She has not gotten drunk since then. What should you
counsel your patient?
(A) She most likely does not have to worry.
(B) She should have a targeted ultrasound at 16 weeks and quad screen.
(C) She should consider a CVS or amniocentesis to rule out fetal alcohol syndrome.
(D) She should consider termination if it is morally acceptable.
(E) You should draw serial HCG levels to check their rise.

6. A 33-year-old G3P0A2 had a quad screen drawn with an alpha-fetoprotein (AFP) level that
was 3.4 multiple of the median (MOM) at 15 weeks. The rest of the values were unremarkable.
What is the most appropriate next step?
A. redraw the AFP only
B. redraw the quad screen
C. perform a fasting blood draw of AFP
D. perform an ultrasound at this time
E. schedule a level 2 ultrasound at 19–20 weeks’ gestation

7.X-rays on a 35-year-old man after a motor vehicle accident reveal a basilar skull fracture
and raise a concern about an interruption of the hypophyseal portal circulation. This would
cause a decline in circulating which of the following?
a. arginine vasopressin (AVP)
b. dopamine
c. gonadotropins
d. oxytocin
e. prolactin (PRL)

8. Prior to initiating estrogen replacement therapy (ERT), your patient is counseled regarding the
long-term risks of estrogen deficiency associated with menopause. A major concern is
osteoporosis. With osteoporosis, the accelerated bone loss occurring in the first 1 to 8 years after
menopause is associated with which of the following?
(A) an elevation in circulating parathyroid hormone levels
(B) increased urinary loss of phosphorus and hydroxyproline
(C) no influence on trabecular bone
(D) primarily with affects on cortical bone
(E) X-ray can diagnose early osteoporosis (osteopenia)

9.Successful lactation is initiated by which of the following?

A. estrogen stimulation during pregnancy
B. progesterone stimulation during pregnancy
C. elevated levels of hCG
D. elevated levels of prolactin near term
E. the postpartum decline in circulating sex steroid levels
10Amenorrhea, estrogen deficiency, and elevated circulating gonadotropin levels are noted in a
normal-appearing 27-year-old woman. Which of the following conditions is most closely
associated with these findings?
(A) X chromosome abnormalities
(B) polyglandular autoimmune syndrome
(C) Kallmann syndrome
(D) alkylating antineoplastic drugs
(E) pelvic irradiation

11. One of the initial attempts at contraception involved placement of various items in the vagina
to prevent sperm from reaching the uterus. Historically, these have included crocodile dung,
honey, and preparations with mercury with varying success and complication. Currently
available spermicides destroy spermatozoa primarily by which of the following methods?
(A) activating acrosomal enzymes
(B) disrupting cell membranes
(C) inhibiting glucose transport
(D) altering vaginal enzymes
(E) increasing vaginal pH

12. A 42-year-old patient (G3P3003) requests a diaphragm for contraception.

When fitting the contraceptive diaphragm, it should sit comfortably between
which of the following?
(A) anterior and posterior vaginal fornices
(B) anterior vaginal fornix and posterior urethrovesical angle
(C) pubic symphysis and anterior vaginal fornix
(D) pubic symphysis and posterior vaginal fornix
(E) pubic symphysis and posterior urethrovesical angle

13. A 56-year-old woman comes to your office for a yearly examination. During physical
examination, you notice that her left breast has a 2-cm area of retraction in the upper-outer
quadrant that can be seen by simple inspection. What is the most likely diagnosis?
(A) Mondor’s disease
(B) benign fibroadenoma
(C) fibrocystic change
(D) breast cancer
(E) intraductal polyp

14. The part of the pelvis lying above the linea ter-minalis has little effect on a woman’s ability
to deliver a baby vaginally. What is the name of this portion of the pelvis?
(A) true pelvis
(B) midplane
(C) outlet
(D) false pelvis
(E) sacrum

15. A 25-year-old G3P2 in her sixth week of pregnancy, by last menstrual period (LMP)
calculation, has an endovaginal ultrasound examination because of vaginal bleeding. The
ultrasound confirms an intrauterine pregnancy with fetal cardiac activity present and fetal pole
length consistent with 6 weeks’ gestation. Scan of the adnexae reveals a 5-cm simple cyst on the
left ovary. Which of the following statements is true?
(A) This patient likely has both an intrauterine pregnancy and an ectopic pregnancy.
(B) This patient should be told that she will probably miscarry.
(C) The ovarian cyst should not be removed.
(D) First-trimester vaginal bleeding is uncommon and implies a poor pregnancy outcome.
(E) This patient has a blighted ovum.

16. A 21-year-old nulliparous woman presents for preconception counseling. Her history is
remarkable only for having been told her vagina is abnormally shaped. On pelvic examination,
there is a complete longitudinal vaginal septum. She is concerned as to the implications of this
regarding conceiving, continuing the pregnancy and delivery. In the presence of a complete
longitudinal vaginal septum, which of the following is true?
(A) delivery is usually difficult
(B) the uterus is less likely to be abnormal
(C) conception is nearly impossible
(D) there is an above-average incidence of urinary tract abnormalities
(E) prophylactic cesarean delivery is indicated