Free Obstetrics & Gynecology mock test

Obstetrics & Gynecology sample questions with answers

10 more original exam-style Obstetrics & Gynecology questions, worked in full. They are not real or recalled exam questions, and none of them is in the mock above or on the bank page, so sit the mock first if you have not.

1. Question 1 · General & Benign Gynecology

   A 43-year-old woman with a 14-week-size fibroid uterus and a haemoglobin of 8.2 g/dL is scheduled for open myomectomy in 3 months' time. She wishes to preserve her uterus. In addition to oral iron, which adjunctive measure is most appropriate in the interim?

   1. AContinuous GnRH agonist therapy alone for at least 12 months
   2. BUterine artery embolisation to shrink the fibroids before myomectomy
   3. CDanazol 800 mg daily until surgery
   4. DA GnRH agonist for 3 months with hormonal add-back therapy
   Show answer and explanation

   Correct answer: D. A GnRH agonist for 3 months with hormonal add-back therapy

   A short preoperative course of a GnRH agonist reduces uterine and fibroid volume and induces amenorrhoea, allowing correction of anaemia before surgery, and add-back therapy limits vasomotor symptoms and bone mineral density loss. Use beyond 6 months without add-back causes clinically significant bone loss, so 12 months of agonist alone is inappropriate. Uterine artery embolisation before planned myomectomy is not standard practice and may distort surgical planes and compromise reproductive tissue, and danazol has marked androgenic side-effects and is not a recommended first-line adjunct.

   Reference: ACOG Practice Bulletin No. 228, Management of Symptomatic Uterine Leiomyomas, 2021; NICE NG88, 2018 (updated 2021)

2. Question 2 · Maternal-Fetal Medicine & High-Risk Pregnancy

   A monochorionic diamniotic twin pregnancy at 19 weeks shows a recipient twin with a deepest vertical pocket of 9 cm and a visible bladder, and a donor twin with a deepest vertical pocket of 1 cm and a non-visible bladder. Dopplers are normal in both and neither is hydropic. What is the stage and the recommended treatment?

   1. AQuintero stage II; referral for fetoscopic laser photocoagulation of placental anastomoses
   2. BQuintero stage I; expectant management is always sufficient
   3. CQuintero stage IV; immediate delivery
   4. DTwin anaemia-polycythaemia sequence; intrauterine transfusion of the donor
   Show answer and explanation

   Correct answer: A. Quintero stage II; referral for fetoscopic laser photocoagulation of placental anastomoses

   Twin-to-twin transfusion syndrome is staged by Quintero criteria: stage I is the polyhydramnios-oligohydramnios sequence with a visible donor bladder, stage II adds a non-visible donor bladder, stage III abnormal Dopplers, stage IV hydrops and stage V demise, so this is stage II. Fetoscopic laser ablation of the communicating vessels is the treatment of choice for stage II and above before 26 weeks, having outperformed serial amnioreduction in randomised comparison. Delivery at 19 weeks is not viable, and TAPS is defined by discordant MCA peak systolic velocities without the fluid discordance seen here.

   Reference: Eurofoetus randomised trial, NEJM (2004); NICE NG137 Twin and Triplet Pregnancy (2019); ISUOG Practice Guidelines on twin pregnancy (2016)

3. Question 3 · Reproductive Endocrinology & Infertility

   A 31-year-old woman with a normal ovarian reserve and no prior losses asks whether adding PGT-A to her first IVF cycle will improve her chance of a baby. What is the most accurate response?

   1. APGT-A does not reliably improve cumulative live birth per started cycle and carries risks of embryo damage, no-result cycles and discard of potentially viable mosaic embryos
   2. BPGT-A reliably increases the cumulative live birth rate per started cycle in good-prognosis women
   3. CPGT-A is mandatory for any woman undergoing blastocyst transfer
   4. DPGT-A eliminates the risk of miscarriage after a euploid transfer
   Show answer and explanation

   Correct answer: A. PGT-A does not reliably improve cumulative live birth per started cycle and carries risks of embryo damage, no-result cycles and discard of potentially viable mosaic embryos

   Randomised trials, including in good-prognosis patients, show that PGT-A may shorten time to pregnancy per transfer but does not consistently improve cumulative live birth per started cycle, and it adds cost, biopsy risk, inconclusive results and the dilemma of mosaic embryos that can nevertheless produce healthy babies. It is not mandatory for blastocyst transfer, and euploid transfers still miscarry in roughly 10% of cases.

   Reference: ASRM Practice Committee and Genetic Counseling Professional Group, The use of preimplantation genetic testing for aneuploidy: a committee opinion (2024); ESHRE Add-ons in ART good practice recommendations (2023)

4. Question 4 · Operative Gynecology, Perioperative Management & Surgical Complications

   A 44-year-old woman with early-stage cervical cancer (FIGO stage IB1) asks about a minimally invasive radical hysterectomy. What should she be told based on the best available randomised evidence?

   1. AMinimally invasive radical hysterectomy gives equivalent survival and is the preferred approach
   2. BRobotic radical hysterectomy is superior to both laparoscopic and open approaches for survival
   3. COpen abdominal radical hysterectomy is recommended because minimally invasive surgery was associated with lower disease-free and overall survival
   4. DVaginal radical trachelectomy is the standard of care for all stage IB1 disease
   Show answer and explanation

   Correct answer: C. Open abdominal radical hysterectomy is recommended because minimally invasive surgery was associated with lower disease-free and overall survival

   The LACC randomised trial demonstrated significantly lower disease-free and overall survival with minimally invasive radical hysterectomy compared with open surgery in early-stage cervical cancer, so open abdominal radical hysterectomy is now recommended. The robotic approach is a form of minimally invasive surgery and shares this concern, and radical trachelectomy is a fertility-sparing option limited to selected small tumours in women wishing to conceive.

   Reference: Ramirez PT et al., LACC trial, N Engl J Med (2018); NCCN Cervical Cancer Guidelines and ESGO/ESTRO/ESP guidelines (2023)

5. Question 5 · Urogynecology & Pelvic Floor Disorders

   A gynaecologist is planning a vaginal hysterectomy for a woman with stage II uterine prolapse and wishes to reduce the risk of subsequent vault prolapse. Which intraoperative step is best supported by evidence?

   1. ARoutine placement of a synthetic mesh sheet over the vault
   2. BClosing the vaginal vault vertically rather than transversely
   3. CAttaching the uterosacral-cardinal ligament complex to the vaginal vault at the time of closure (e.g. McCall culdoplasty)
   4. DLeaving the peritoneum widely open to allow drainage
   Show answer and explanation

   Correct answer: C. Attaching the uterosacral-cardinal ligament complex to the vaginal vault at the time of closure (e.g. McCall culdoplasty)

   Suspension of the vaginal vault to the uterosacral-cardinal complex - classically the McCall culdoplasty - is the recommended prophylactic step at vaginal hysterectomy and reduces subsequent enterocele and vault prolapse. Prophylactic mesh at the vault is not recommended and carries erosion risk. The orientation of vault closure has no proven effect on prolapse, and leaving the peritoneum open does not confer support.

   Reference: RCOG/BSUG Green-top Guideline No. 46 (2015); Cruikshank SH & Kovac SR, randomised comparison of vault suspension techniques at vaginal hysterectomy, Am J Obstet Gynecol 1999

6. Question 6 · Contraception, Family Planning & Sexual Health

   A 16-year-old girl attends the emergency department 36 hours after an alleged sexual assault. She has showered and changed her clothes since the incident, is haemodynamically stable and has no significant injuries. She is frightened and has not told her family. What is the most appropriate management?

   1. APerform a full genital examination and take forensic swabs yourself before referring her anywhere
   2. BReassure her that forensic evidence is lost after showering, and simply prescribe emergency contraception
   3. COffer emergency contraception and HIV post-exposure prophylaxis assessment, obtain her consent to refer to a specialist sexual assault referral service where forensic examination can still be undertaken, and follow local safeguarding procedures for a minor
   4. DContact the police immediately and detain her in the department until officers arrive
   Show answer and explanation

   Correct answer: C. Offer emergency contraception and HIV post-exposure prophylaxis assessment, obtain her consent to refer to a specialist sexual assault referral service where forensic examination can still be undertaken, and follow local safeguarding procedures for a minor

   Forensic samples can still yield evidence for several days after vaginal penetration despite washing, so referral to a trained forensic examiner or sexual assault referral centre should be offered rather than assumed futile; non-specialist examination risks losing or contaminating evidence and causing further distress. Immediate medical needs - emergency contraception, HIV post-exposure prophylaxis within 72 hours, hepatitis B vaccination and later STI testing - must be addressed in parallel. As a minor she also triggers mandatory safeguarding and child protection processes, but care must remain consent-based and she cannot be detained.

   Reference: BASHH UK National Guidelines on the Management of Adult and Adolescent Complainants of Sexual Assault (2011, updated); WHO Clinical Management of Rape and Intimate Partner Violence Survivors (2019); RCOG guidance on safeguarding

7. Question 7 · General & Benign Gynecology

   A 26-year-old woman has been unable to have penetrative intercourse since marrying 2 years ago. Attempted vaginal examination provokes involuntary contraction of the pelvic floor and thigh adductor muscles with marked anticipatory anxiety. Gentle inspection shows normal vulval anatomy with no lesions, no vestibular erythema and no evidence of infection. What is the most appropriate management?

   1. AFractional CO2 laser treatment to the vagina
   2. BVestibulectomy
   3. CLong-term oral benzodiazepine therapy
   4. DCombined psychosexual/cognitive behavioural therapy, pelvic floor physiotherapy and graded desensitisation using vaginal trainers
   Show answer and explanation

   Correct answer: D. Combined psychosexual/cognitive behavioural therapy, pelvic floor physiotherapy and graded desensitisation using vaginal trainers

   This is genito-pelvic pain/penetration disorder (vaginismus), in which involuntary pelvic floor hypertonicity and fear of penetration, not structural pathology, prevent intercourse; the evidence supports a multimodal approach combining education, cognitive behavioural or psychosexual therapy, pelvic floor physiotherapy and graded dilator desensitisation, often with the partner involved. Vestibulectomy is a surgical option only for refractory, biopsy-supported provoked vestibulodynia with localised vestibular pain, which is absent here, and operating on normal tissue may worsen pain. Vaginal laser is not indicated for vaginismus in a premenopausal woman, and chronic benzodiazepine use risks dependence without treating the underlying conditioned response.

   Reference: ACOG Practice Bulletin No. 213, Female Sexual Dysfunction, 2019; DSM-5 criteria for genito-pelvic pain/penetration disorder

8. Question 8 · Maternal-Fetal Medicine & High-Risk Pregnancy

   A 28-year-old woman with cystic fibrosis is 12 weeks pregnant. Which single pre-pregnancy parameter is most strongly associated with adverse maternal and perinatal outcome in cystic fibrosis pregnancy?

   1. APre-pregnancy FEV1, particularly when below 50-60% predicted
   2. BSweat chloride concentration
   3. CNumber of previous intravenous antibiotic courses
   4. DPresence of a CFTR class III mutation
   Show answer and explanation

   Correct answer: A. Pre-pregnancy FEV1, particularly when below 50-60% predicted

   Pre-pregnancy lung function, expressed as FEV1 percent predicted, is the strongest predictor of maternal deterioration, preterm birth and perinatal complications, with values below about 50-60% predicted marking substantially higher risk; pulmonary hypertension and poor nutritional status compound this. Sweat chloride and genotype class describe disease biology but do not predict obstetric outcome, and antibiotic course counts are a crude surrogate at best.

   Reference: European Cystic Fibrosis Society/UK CF Trust consensus on pregnancy in cystic fibrosis; Edenborough FP et al., Guidelines for the management of pregnancy in women with cystic fibrosis, Journal of Cystic Fibrosis (2008)

9. Question 9 · Reproductive Endocrinology & Infertility

   A 26-year-old woman with PCOS on an antagonist IVF cycle has 26 follicles and a very high oestradiol on the day of planned trigger. Which strategy most effectively prevents severe ovarian hyperstimulation syndrome while preserving her cumulative chance of live birth?

   1. AReduce the hCG trigger dose to 5000 IU and transfer a single fresh embryo
   2. BTrigger with hCG, transfer a single embryo, and give albumin at retrieval
   3. CTrigger with a GnRH agonist and freeze all embryos for later transfer
   4. DCoast for 5 days, then trigger with hCG and perform a fresh transfer
   Show answer and explanation

   Correct answer: C. Trigger with a GnRH agonist and freeze all embryos for later transfer

   Replacing the hCG trigger with a GnRH agonist in an antagonist cycle, combined with a freeze-all policy, virtually eliminates both early and late OHSS while cumulative live birth rates are maintained through subsequent frozen transfers. Any hCG exposure, including a reduced dose, or a fresh transfer that may lead to pregnancy-derived hCG, sustains the syndrome; albumin is of marginal benefit and coasting is less effective and reduces oocyte yield.

   Reference: ASRM Practice Committee, Prevention and treatment of moderate and severe OHSS (2016); ESHRE Guideline: Ovarian Stimulation for IVF/ICSI (2019, updated 2023)

10. Question 10 · Operative Gynecology, Perioperative Management & Surgical Complications

    A department reviews a case in which a retained vaginal pack caused sepsis. Which approach to the morbidity and mortality review is most consistent with modern patient-safety science?

    1. AIdentify the individual who failed to remove the pack and issue a formal disciplinary warning
    2. BClose the case without further action because the patient recovered fully after treatment
    3. CConduct a systems-based analysis of contributing factors, such as documentation, handover and count procedures, within a just-culture framework and implement system changes
    4. DRestrict the review to the consultant in charge, with no multidisciplinary participation
    Show answer and explanation

    Correct answer: C. Conduct a systems-based analysis of contributing factors, such as documentation, handover and count procedures, within a just-culture framework and implement system changes

    Modern safety science holds that most adverse events arise from latent system weaknesses, so a structured multidisciplinary systems analysis within a just culture identifies contributory factors and generates durable corrective actions such as pack documentation and handover protocols. Blaming individuals discourages reporting and does not prevent recurrence, closing the case because of a good outcome ignores the near-miss learning, and excluding the multidisciplinary team loses essential frontline insight.

    Reference: WHO Patient Safety Curriculum Guide (2011); NHS England Patient Safety Incident Response Framework (2022); Reason J, Human Error and Organisational Accidents