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OB/Gyn NBME/ UWORLD (New 2025 / 2026
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Q: 36 AAF w/ heavy feeling in lower abdomen for 1 year. 9 - 10 days periods w/heavy cramps.
2 first trimester miscarraiges. Mobile globular mass w/several protuberances below the umbilicus. Dx Answer: Leiomyoma uteri.
Q: 10. 32 w/ pelvic pain for past 2 days after period ended. Hx of heavy periods w/clots. Hx of
sp abortion. Irregularly enlarged uterus, dilated cervix @ 5cm w/ spherical firm and smooth mass visible through external os w/ bleeding around it. Dx Answer: (prolapsing) Leiomyoma uteri. Aborting submucous myoma
Q: 4 wks after third degree laceration during labor, repaired w/ sutures and 24hr vaginal
packing to tamponade, 25 G1P1 prx w/ malrodous vaginal d/c for 2 wks w/ small red velvety area on posterior vaginal wall w/ foul-smelling brown d/c. dx Answer: Rectovaginal fistula
Q: 32 @ 18wks prx w/ confsuin & incoherence. Unsteady and falls down. Recenty w/ N/V txt
w/ iVF & antiemetics in ER. Persistent vomiting & lost 7kg of preg weight. PE shows nystagmus, epigastric pain, b/l pedal edema & b/l absent ankle reflex. Lab: low Hct, Na, K, Cl, inc Bicarb, inc AST & ALT. dx Answer:
Thiamine def. Wernicke encephalopathy (AMS ++ nystagmus + gait ataxia).
Q: 53 w/ heavy vaginal bleeding. Soaks pads q2hrs. menopause @ 45. Fam hx of breast ca. BP
low, obese, dark red blood in posterior vaginal vault. 3cm friable mass on ectocervix and extends laterally a dbleeding actively. Hb is low. Thin endometrial stripe and no adenexal mass. Risk factor Answer: Tobacco. Cervical cancer
Q: 32 @ 28wks prx w/painful contractions for 2 hrs q5mins. Cervix is closed. 3cm dilated w/
90% effaced bulging bag. U/S confirms vertex presentation. Betamethasone & indomethacin administered. NBS Answer: Administer magnesium sulfate.
Q: 35 @ 31 wks prx w/ RUQ abdominal pain, BP 160/90, low Hb, low PLT, low Proteins,
evelated liver enzymes & bilirubin, 2+protein on urine dipstick Answer: Distenstion of liver capsule. HELLP syndrome-> centrilobular necrosis, hematoma formation & thrombi in capillary portal system-> liver swelling w/ distension of the haptic capsule-> RUQ /epigastric pain
Q: pt s/p dx of preeclampsia is given corticosteroids and magnesium sulfate. 3 hrs later she
develops dyspnea and drop in oxygen sat, BP 150/80, 112 pulse, 91% on room air, bibasilar crackles, use of accessory muscles for breathing and 2+ pitting edema of lower extremeties. Cause of resp sxm Answer: Pulmondary edema (w/HTN-> inc afterload - > inc pulm capillary pressure - > pul edema)
Answer: No further screening (21-30: pap q3yrs. 30 - 65: pap q3yrs or pap + HPV test q5yrs. 65 on: d/c if - ve 3 pap or - ve 2 pap + HPV test)
Q: 31 @ 7wks prx w/vaginal bleeding and lowe abdominal pain. Hx of chlamydia cervicitis.
Surgical hx of LEEP for CIN3. Blood clots in vagina & active bleeding from a dilated cervix. Bimanual exam reveals a 6wk size tender uterus. US shows gestational sac in lower segment of uterus, simple cyst in right ovary & free fluid in posterior cul-de-sac. Dx Answer: Inevitable abortion.
Q: 29 @ 10wks gestation prx w/ vaginal bleeding of large clots and intense lower abdominal
cramping. Bp 90/65mmHg. She is AB - ve. Large clots evacuated from the vagina during pelvic exam, w/ actibe bleeding noted from an open cervical os. Hb is low, 9wk fetus notedon transvaginal US w/ no fetal cardiac activity. IVF administered. NBS Answer: Suction curettage. Because she's hemodynamically unstable. If she was stable; expectant management or administer misoprostol.
Q: 28 evaluated for infertility prx w/ clear vaginal d/c for 2 days. Took PCN last week an exam
shows clear mucus at cervical os. Cause of d/c Answer: ovulation. Vs. Cervical mucus plug seen in preg as a barrier to asc infection; brown, red or yellow thick mucus.
Q: 45 G5P5 prx w/ involuntary loss if urine. PE shows vaginal bulge (cystocele). Loses small
amount of urine when asked to cough. Cause Answer:
Urethral hypermobility. Stress incontinence dt weakness of pelvic floor so weak urethral sphincter.
Q: 26 w/ vulvar itching and vaginal d/c. hx of asthma and recently txt w/ inhaled
bronchodilators & systemic corticosteroids. Exam shows mucosal erythema and edema and thick discharge. Wet mount shows; txt Answer: Oral fluconazole.
Q: 55 postmenopausal w/ hx of bronchitis and coughing fit leading to a rib fracture 6 mos ago.
Fam hx of osteopenia, smoking hx, vegeteranian diet, MBI 30. Her most significant risk factor for bone fracture Answer: Previous rib fracture.
Q: 37 w/ BP readings of 145/90-150/85 over last 12 months. 2 wks ago readings was 245/90.
She is currently on a combined OCP for past 5 yrs and acetaminophen. No fam or personal hx or rish factors. Current Bp 150/90 and BMI 22. Cholesterol and labs normal. NBS Answer: D/c the OCP and switch to alternative birth control method.
Q: 40 G5aborta4 @ 35wks prx to L&D because she hasn't felt baby move in 24hrs. nausea,
smoking hx, fetus in breech positon & placenta previa. NST shows FHR @130s w/moderate variability and no decel. No accelerations after 1hr despite stimulation. Tocometry shows no contractions. NBS Answer: Biophysical profile
Encourage her to tell her husband but tell her you are required to inform the local health department. Pt should be given the opportunity to inform those at risk first.
Q: 34 G1P1 comes for infertility. Irregular cycles, LMP 3 months ago. Prior regular cylcle. Hx
of hypothyroidism managed w/levothyroxine, TSH normal. She is fatigued and wakes up at night due to feeling too warm. Most likely changes GnRH, FSH, Estrogen Answer: Inc GnRH & FSH, dec estrogen. She is primary primary ovarian insufficiency (hypergonadotropic hypogonadism)
Q: 19 w/ 6mos of amenorrhea, cycles regular until 9 mos ago. Eats high proteinlow-fat diet.
College soccer player. BMI 20. PRL &TSH normal. No bleeding after 10 day medroxyprogesterone acetate. Greatest risk Answer: Dec bone mineral density.
Q: 26 for infertility evaluation. 3 previous sexual partners. Regular periods, no medical
condition, both she and husband had normal puberty, BMI 23, pelvic exam normal, physical exam on husband is normal. NBS evaluation this couple infertility Answer: Semen analysis. Hysterosalpingography is done is pt has risk factors for tubal blockage (PID, endometriosis)
Q: 37 G7P2 aborta 4, comes in w/labor pains and delivers baby vaginally, cord avulses from
placenta and placenta removed in pieces manually, uterus bleeding desputed massage and uterotonic meds. Cause of bleeding Answer: Placenta accrete
Q: 53 for annual exam. Lmp 2 yrs ago. Hot flashes no improved with weight loss or ORC
meds. Hx of HTN & DM2 manages with diet & exercise.normal pelvic exam. Indication for systemic hormone replacement therapy. Answer: reduction of vasomotor symptoms.
Q: 25 primigravid @ 36wks prx w/ constant abdominal pain and vaginal bleed for 3 hrs. BP
160/100, firm distended and tender uterus. 75mL of blood in vagina from open cervical os. FHR 108/min w/no variability. Cause of pt bleeding Answer: Premature placental separation
Q: 41 G0P0 prx w/ loss of urine with coughing and sneezing for 4 mos. Hx of chlamydis, PE
shows irregularly enlarged anteverted and anteflexed uterus. Means to reveal the cause of the pt urinary sxm Answer: Ultrasonography of the pelvis. Stress urinary incontinence dt uterine fibroids (dx w/US of pelvis).
Q: 32 w. abdominal pain and nausea for 2 days, getting worse. Passed several blood lcots
vaginally, irregular menstrual cycle (unsure LMP), hx of dx w/ heart shaped uterus, preg test is +ve, transvaginal US shows sac @ upper left uterine cornu w/ free fluid in the posterior cul-de- sac. NBS Answer: Surgical exploration. Ruptured ectopic pregnancy
Answer: Intubation and mechanical ventilation. Amniotic fluid.
Q: stillborn born @ 36 wks to female of G5 P1 aborta 3, no prenatal care. Fetus has short bent
extremities, X-ray shows xle limb fractures, hypoplastic thoracic cavity. Most likely cause of abnormalities Answer: Osteogenesis imperfect type II (growth restriction + xle limb fractures + hypoplastic thoracic cavity in IUFD).
Q: 32 G3P2 @ 35 wks prx w/ frequent painful contractions. Shortened cervix dx on US @
24Wks and given bethamethasone. Progesterone given but non-compliant. 4cm dilated 90% effaced, fetus @ - 1 station, contractions q6mins & fetus in breech position. NBS Answer: Cesarean delivery. Because fetus is in breech position.
Q: 25 @ 9wks prx for counselling. Her father and nephew have hemophilia A, husband does
not. What is her risk of having a child w/ the dz Answer: The probability of having a child with hemophilia is 50%.
Q: 21 @ 36 wks prx w/ BP of 190/110 and is sent to hospital. @ hospital BP 184/106.
Noncompliant w/ insulin for GDM. Labs; elevated serum creatinine, transaminases, BGL 204, urinalysis 4+ proteinuria. Nifedipine, magnesium sulfate, insulin, oxytocin is given to induce of labor, 6hrs later his BP 150/90 mmHg; Ca 8mg/dL, Ca 143 mg/dL, Mg 9.2mg/dL. Cause for hypermagnesemia Answer: Renal insufficiency. Mg excreted by the kidneys.
Q: 36 @ 26wks, prenatal US consistent w/ LMP. US @19wks estimated fetal weight
consistent w/ 18 wks gestation and ASD. Hx of depression and on citalopram. Fundal height 22xm, HC, AC and estimated fetal weight ta 4th percentile. BPP is 8/8. Cause Answer: Fetal chromosomal abnormality.
Q: 10. 39 @ 38wks, prx for induction of labor, BP 14-/80, prolonged delivery via forceps
assisted vaginal delivery over midline episiotomy. Excessive traction placed on cord causing avulsion and placenta is manually extracted in pieces. US shows thin endometrial stripe. 60mins post delivery pt still bleeding and clot found in lower uterine segment. Soft (boggy) uterus and 4cm above umbilicus (enlarged). Cause of bleeding Answer: Uterine atony. Most likely reason for PPH <24hrs after delivery.
Q: bimanual massage of the uterus and 2 large bore IV lines are placed due to ongoing
postpartum hemorrhage. NBS Answer: Infusion of oxytocin. (uterine atony is the most likely reason for PPH)
Q: 39 G4 para0 aborta3 @ 35wks dt intense constant lower abdominal pain. Hx of fibroids w/
myomectomy for removal of fibroids and uterine cavity was entered, 4cm cervical dilation, contractions q2-3 mins & last for 45secs, FHR 140s w/ decels to the 90s. NBS Answer: Laparotomy and delivery. Dt risk of uterine rupture following myomectomy.
Answer: Fetal sleep cycle.
Q: 36 G3P2 @ 15 wks, first trimester combined test results show an abnormally elevated b-
hCG and inc nuchal thickness but no other abnormalities. NBS Answer: Amniocentesis.
Q: 23 G1P0 @ 39 wks prx w/ abdominal pain and wet underwear (ROM). T 100.7. diffuse
tender uterus, 2cm dil cervix, nitrazine-positive clear fluid pooling in vagina fornix, icroscopy of fluid shows ferning. FHR 165. Lab shows anemia and elevated PMN. Dx Answer: Intramniotic infection. Promonged ROM (rupture of membrane) is a common risk factor for chorioamnionitis during 3rd trimester.
Q: NBS for pt w/ prolonged ROM & intraminiotic infection after giving antibiotics
Answer: Administer oxytocin. To induce labor.
Q: 23 G1P1 3days s/p delivery w/ second-degree perineal laceration, postpartum bleeding dt
uterine atony, still w/ vaginal bleeding and complains of tense warm and diffusely tender breasts. Massaging fundus leads to trickle of blood from the vagina. Dx Answer: Breast engorgement. Common 3 - 5 days after delivery when colostrum is replaced by milk.
Q: 32 @42 wks prx w/inc fetal movenend and uterine conrtactions q7mins, US shows fetal
macrosomia, oligohydraminos. Mother is advised do a CS dt risk for fetal asphyxia and death, she fully understands the risks and insists on vaginal birth. NBS Answer: Respect the pt's decision and proceed with vaginal delivery.
Q: 30 G1P0 @ 41 wks prx w/ regular painful uterine contractions. 4cm dilated, 100% effaced
w/ fetus at 0 station, 1 hour later 7cm dilated, 100% effaced w/ fetus at +1 station. FHR shows abrupt decel and rapid return to baseline. Cause of FHR pattern Answer: Umbilical cord compression. Variable decelerations.
Q: FHR tracing shows abrupt decline and return to baseline. NBS
Answer: Maternal repositioning. Variable decle indicate umbilical cord compression.
Q: 22 for first Gyn visit. Hx of yeast infection. Currently sexually active. In addition to her
first pap test, which of the following is the best recommendation for this pt Answer: cervical swab for chlamydia and gonorrhea
Q: 39 G3P2 @ 37wks px w/ bright vaginal bleed after intercourse. BP10/60, HR102. 30mL
clotted blood removed from vagina. US shows placental tissue covering cervical os. Contractions q3mins. NBS Answer: Cesarean delivery. CS @ 36- 37 wks w/pl previa.
Answer: NSAIDs (to reduce inflammation and pain).
Q: BP drops after induction of anesthesia, feels light-headed. Most probable cause of her
hypotension Answer: Vasodilation and venous pooling. Hypotension is a common side effect of epidural.
Q: 28 w/ infertility. Irregular periods. Labs show low FSH, LH , estradiol. Dx
Answer: Hypogonadotropic hypogonadism
Q: 23 prx w/ pelvic pain after sex. Hx of appendectomy. Preg test - ve. Pain in RLQ tender to
palpation. Pelvic US shows 4*5cm R cystic ovarian mass w/ moderate amount of free fluid in the pelvis. Dx Answer: Ovarian cyst rupture.
Q: competitive gymnast is 7wks pregnant. Still trains 5 times a week and 30 mins jog as warm
up. Advice Answer: Continue jogging, discontinue gymnastics. Due to the high fall risk.
Q: 28 for first prenatal visit in November. 8wks pregnant. Indicated in this visit
Answer: Inactivated influenza vaccine. Gonorrhea screen is for high risk pt.
Q: 18 fractured distal radius from fall, ambiguous ext genitalia @ birth. Normal int genitalia.
Nodulocystic acne, clitoromegaly, dec estradiol & estrone, elevated FSH, LF, testosterone, androstenedione. Multiple varian cysts. Dx Answer: Aromatase def. needed to convert androstenedione to estrone and testosterone to estradiol. (normal int genitalia+ext virilization+undetectable serum estrogen levels). Congenital CAH would have electrolyte abnormalities
Q: 32 G2P1 @ 38 wks prx w/ intense itching. Immigrated into the US 15 yrs ago. 1+ edema on
BLE. No jaundice. Diffuse excoriations on the skin. Labs show elevated bilirubin, bile acids ALP, AST & ALT. Dx Answer: Intrahepatic cholestasis of pregnancy.
Q: 37 prx for infertility. Hx of miscarriage and spontaneous delivery 4 yrs ago. BMI 23,
aerobic instructor that teaches 2 60mins classes daily. No abnormal PE or pelvic exam findings. Cause of infertility Answer: Decreased ovarian reserve. Dt dec oocyte number and quality. Unlikely hypothalamic dysfunction dt her regular menses.
Q: 37 @ 34wks w/BP 152/96, DTR 3+. Low Hg and hematocrit, low PLT, Inc AST & ALT,
Inc Creatinine and Urine protein/creatinine ratio 0.82 (>0.3) dx Answer: Preeclampsia with severe features.
Answer: Oral contraceptives. Endometriosis; the 3 D's-> dysmenorrhea, dyspareunia, dyschezia (pain w. defecation), txt w/NSAID's or OCP.
Q: 29 G2P1 @ 10 wks prx w/ maild nausea. Lives in a house built in 1983, has 3 cats.
Screening test intiated @ this visit Answer: Rapid plasma regain test. Routine lead screening is NOT recommended.
Q: 29 G2P0 @ 18 wks based on LMP and physical exam. Hx of 1st trimester miscarriage.
Maternal serum AFP is elevated. Most likely abnormality associated with this finding Answer: Fetal abdominal wall defect. Multiple gestation unlikely as uterine size consistent w/ reliable dates.
Q: 42 G2P2 prx w/ pelvic pain. Painful menses, changes tampon q2hrs for first few days,
pelvic pain now constant even after menses. Uterus is soft and tender to palpation. Additional findings Answer: Uniformly enlarged uterus. Adenomyosis (endometrial glands in the myometrium); dysmenorrhea, heavy menstrual bleeding, chronic pelvic pain, boggy (soft), tender, uniformly enlarged uterus. Fibroids don't cause chronic pelvic pain.
Q: 27 @ 16 wks for initial visit. No hx of STI, Blood type O, Rh - ve. Rubella and varicella
titres both show immunity. Hb 10.2, Prenatal labs normal. Best recommendation Answer: Mumps-measles-rubella vaccine postpartum
Q: 26 prx w/ vulvar lesion, began as a papule and now has a small ulcer in the center. Burnin
gon urination but no fever. Sexually active and has had 5 partners over the past 5 years. PE shows 2cm ulcer w/ nonexudative based and a raised, indurated margin. Nontender to palpation. Moderate painless b/l inguinal LAN present. Dx Answer: Syphilis. B/l inguinal LAN & painless genital chancre.
Q: Pt w. painless chancre and b/l painless inguinal lymphadenopathy. RPR and HSV PCR are
negative. NBS> Empiric penicillin. Answer:
Q: 23 G2P1 @ 30 wks, sudden gush of clear fluid from her vagina, no fever or bleeding, baby
is moving. Closed cervix and pooling of nitrazine-positive clear fluid on speculum exam. US shows fetus in breech presentation. NBS Answer: Intramuschular bethamethasone. Preterm PROM. @ <37 wks, since fetus stable no need to induce labor, corticosteroids and antibiotics indicated. Delivery @ 34wks
Q: 36 G2P1 @ 9 wks presents for initial prenatal care, which changes might be seen in a
healthy pregnant patient when compared to the prepregnant state Answer: Decreased serum creatinine. There is a decreased protein S activity dt the hypercoagulable state.
Q: 22 G2P1 @ 28 wks. First trimester prenatal testing shows blood type: A negative and
Negative antibody screen. Next step at this gestational age
