Q- A 28-year-old woman has 7 weeks of amenorrhea, lower abdominal pain, and vaginal spotting. hCG is 2,500 mIU/mL. Transvaginal ultrasound shows an empty uterus and a 2-cm adnexal mass without fetal cardiac activity. She is hemodynamically stable. What is the best treatment?
A- Methotrexate
B- Dilation and curettage
C- Repeat ultrasound in 4 weeks
D- Oxytocin infusion
A- Methotrexate. This is an unruptured ectopic pregnancy in a stable patient with low hCG and no fetal cardiac activity, which makes her a good candidate for methotrexate with serial hCG monitoring. A ruptured ectopic or an unstable patient needs surgery (salpingectomy or salpingostomy).
Q- A 32-year-old woman at 34 weeks of gestation has blood pressure of 165/112 mm Hg, proteinuria, and a severe headache. Which drug is given to prevent seizures?
A- Magnesium sulfate
B- Phenytoin
C- Diazepam
D- Labetalol
A- Magnesium sulfate. This is preeclampsia with severe features. Magnesium sulfate prevents eclamptic seizures, labetalol, hydralazine, or nifedipine lower the blood pressure, and delivery is the definitive treatment. Signs of magnesium toxicity include loss of deep tendon reflexes and respiratory depression, and the antidote is calcium gluconate.
Q- A 30-year-old woman at 34 weeks of gestation has sudden painless bright red vaginal bleeding. The uterus is soft and nontender. Which of the following must be avoided until the diagnosis is confirmed?
A- Transabdominal ultrasound
B- Digital vaginal examination
C- Fetal heart rate monitoring
D- Complete blood count
B- Digital vaginal examination. Painless bright red bleeding in the third trimester suggests placenta previa, and a digital exam can cause severe hemorrhage. Confirm the placental position with ultrasound first. Placental abruption, in contrast, causes painful bleeding with a tender, rigid uterus.
Q- A 24-year-old woman has irregular periods, hirsutism, acne, and obesity. Ultrasound shows enlarged ovaries with multiple small follicles. Which condition is she at increased risk for?
A- Endometrial carcinoma
B- Cervical carcinoma
C- Osteoporosis
D- Hyperthyroidism
A- Endometrial carcinoma. In polycystic ovary syndrome, chronic anovulation causes unopposed estrogen stimulation of the endometrium, leading to endometrial hyperplasia and cancer. PCOS is also linked to insulin resistance and type 2 diabetes. Combined oral contraceptives regulate the cycle and protect the endometrium, and letrozole is first-line for ovulation induction.
Q- Right after a vaginal delivery, a woman has heavy vaginal bleeding. Her uterus feels soft and boggy above the umbilicus. What is the most likely cause?
A- Uterine atony
B- Retained placental tissue
C- Genital tract laceration
D- Coagulopathy
A- Uterine atony, the most common cause of postpartum hemorrhage. Remember the 4 Ts: Tone, Trauma, Tissue, and Thrombin. First steps are bimanual uterine massage and oxytocin, followed by methylergonovine (avoid in hypertension), carboprost (avoid in asthma), misoprostol, and tranexamic acid.
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