20 case-based scenario questions in obstetrics:
1. A 30-year-old woman is 9 weeks pregnant with her first child. She forgets to take her prenatal vitamins for over a week. What advice would you give her?
2. A 22-year old woman comes to the clinic at 6 weeks gestation. She has type 1 diabetes. What aspects of her prenatal care will need special attention?
3. A 28-year-old woman comes to the clinic at 12 weeks. Her last period was 8 weeks ago. An ultrasound shows no fetal pole. What is the most likely diagnosis? What counselling would you provide?
4. A 19-year-old woman is 30 weeks pregnant with her first child. For the past 3 days she has noticed decreased fetal movement. What evaluation would you recommend?
5. A 32-year-old G2P1 presents at her 20 week anatomy scan appointment. Upon ultrasound evaluation, no fetal cardiac activity is seen. What management options would you discuss?
6. A 25-year-old woman is 8 weeks pregnant with her first child. She has type O negative blood type. What additional precautions need to be taken with her care?
7. A 36-year-old G4P3 presents with new onset hypertension at 34 weeks without proteinuria. What concerns would this raise and how would you manage this patient?
8. A 34-year-old woman presents at her first prenatal visit complaining of nausea, vomiting, and weight loss. Labs are notable for hyperemesis gravidarum. How would you manage this condition?
9. A 32-year-old G3P2 presents with complaints of abdominal pain at 15 weeks. Upon examination, her fundal height is larger than dates. An ultrasound shows twins. How would the remaining pregnancy be monitored?
10. A 19-year old G1P0 presents with ruptured membranes at 34 weeks. A fetal fibronectin test is positive. How would you counsel this patient regarding the risks of preterm birth?
11. A 36-year-old G4P3 presents with complaints of itching at 26 weeks without risk factors for preeclampsia. labs are notable for elevated liver enzymes. What condition is suspected and how is it treated?
12. A 28-year old woman presents at her initial prenatal visit concerned about a 3cm fibroid she has had for 2 years. Reassure her that in most cases fibroids do not cause problems in pregnancy but certain complications can occur. List 2-3 potential complications.
13. A patient delivers a 3.8kg infant vaginally at 38 weeks. During the third stage of labor, she begins having heavy bleeding despite delivery of the placenta. List 4 potential causes and next steps in managing the postpartum hemorrhage.
14. A 32-year-old G2P1 woman is found to have an incomplete abortion at 9 weeks gestation. List 2 options for managing the miscarriage and factors that would help determine the recommended treatment.
15. A lady delivered a healthy baby girl two days ago. Now she complains of severe headache, blurring of vision and abdominal pain. Her blood pressure is 170/100 mm Hg. What is likely diagnosis and how would you manage it?
16. A 35-year-old G3P2 woman is admitted with complaints of constant leakage of clear fluid from her vagina since morning. On examination cervix is 1cm dilated. What will be your diagnosis and management?
17. A woman presents with a bulging pinkish sac protruding from her vagina. Fetus is visible through this thin sac. Identify this condition and how should it be managed immediately.
18. A woman delivers full term stillbirth after prolonged labor. List four conditions that can lead to stillbirths and need investigation.
19. A 20-year-old G1 lady is admitted in labor at 38 weeks with clear liquor in evening. Her labor progresses well but during second stage of labor baby seems difficult to deliver. Describe failure of progress in second stage and its management.
20. A woman delivers a baby with stiff and extended upper limbs. The palms are turned away. Identify this deformity and briefly discuss its genetic cause and clinical significance.
10 case-based scenario questions in Gynecology
1. **Question 1:**
*A 25-year-old woman presents with lower abdominal pain. On examination, she has cervical motion tenderness, adnexal tenderness, and a fever of 38.5°C (101.3°F). What is the most likely diagnosis?*
– A) Endometriosis
– B) Ovarian cyst
– C) Pelvic inflammatory disease (PID)
– D) Ectopic pregnancy
– E) Mittelschmerz
2. **Question 2:**
*A 32-year-old G3P3 woman complains of involuntary loss of urine with laughing and sneezing. She denies any dysuria or urgency. Which of the following is the most likely diagnosis?*
– A) Stress incontinence
– B) Overactive bladder
– C) Urge incontinence
– D) Vesicovaginal fistula
– E) Urethral diverticulum
3. **Question 3:**
*A 38-year-old woman presents with heavy menstrual bleeding for the past six months. Her menstrual cycles are regular, and she reports no pelvic pain. What is the most appropriate initial step in the management of her condition?*
– A) Endometrial biopsy
– B) Pelvic ultrasound
– C) Hormonal therapy
– D) Hysteroscopy
– E) Progestin therapy
4. **Question 4:**
*A 28-year-old nulliparous woman complains of cyclic breast pain and tenderness for the past few months. On examination, her breasts are symmetrical, and there are no palpable masses. What is the most likely diagnosis?*
– A) Fibrocystic changes
– B) Breast carcinoma
– C) Mastitis
– D) Fibroadenoma
– E) Ductal ectasia
5. **Question 5:**
*A 45-year-old woman presents with hot flashes, night sweats, and vaginal dryness. She has a history of irregular menstrual cycles for the past year. What is the most appropriate treatment for her symptoms?*
– A) Combined estrogen-progestin therapy
– B) Estrogen-only therapy
– C) Selective estrogen receptor modulators (SERMs)
– D) Progestin-only therapy
– E) Non-hormonal options
6. **Question 6:**
*A 22-year-old sexually active woman is concerned about contraception. She has a history of migraine headaches with aura. Which contraceptive method is contraindicated in this patient?*
– A) Combined oral contraceptives
– B) Progestin-only pills
– C) Barrier methods
– D) Intrauterine device (IUD)
– E) Emergency contraception
7. **Question 7:**
*A 35-year-old woman, gravida 2, para 1, presents with a painless mass in her left breast. The mass is mobile, well-circumscribed, and not associated with skin changes. What is the most likely diagnosis?*
– A) Fibrocystic changes
– B) Breast carcinoma
– C) Fibroadenoma
– D) Mastitis
– E) Ductal ectasia
8. **Question 8:**
*A 28-year-old woman complains of irregular menstrual cycles and hirsutism. On examination, there are no signs of virilization. Laboratory studies reveal an elevated serum testosterone level. What is the most likely diagnosis?*
– A) Polycystic ovary syndrome (PCOS)
– B) Ovarian tumor
– C) Hyperprolactinemia
– D) Ovarian failure
– E) Congenital adrenal hyperplasia
9. **Question 9:**
*A 42-year-old woman, gravida 4, para 3, presents with a mass protruding through the vaginal introitus. She reports a sensation of “something coming down” for the past few months. On examination, a bulge is noted during the Valsalva maneuver. What is the most likely diagnosis?*
– A) Uterine fibroids
– B) Uterine prolapse
– C) Cystocele
– D) Rectocele
– E) Ovarian cyst
10. **Question 10:**
*A 28-year-old pregnant woman at 20 weeks gestation presents with painless, bright red vaginal bleeding. Ultrasound reveals a placenta that partially covers the internal cervical os. What is the most likely diagnosis?*
– A) Placenta previa
– B) Placental abruption
– C) Vasa previa
– D) Uterine rupture
– E) Cervical polyp