Obstetrics & Gynecology Prometric exam questions

The Obstetrics & Gynecology exam in every GCC country

From each regulator's own exam pages; anything a regulator does not publish says so. Assessment mode also depends on your licence title, so confirm your route on your eligibility notice.

12 worked Obstetrics & Gynecology practice questions

Original exam-style questions from the bank, spread across the blueprint domains. They are not real or recalled exam questions. Try each one, then open the answer for the rationale and reference. None of them appear in the free mock exam, so reading them will not spoil it.

1. Question 1 · General Obstetrics: Preconception, Antenatal Care & Normal Pregnancy

   A non-stress test performed at 29 weeks in a woman with well-controlled chronic hypertension shows a baseline of 145 bpm, moderate variability, no decelerations, and accelerations of 10 bpm lasting 12 seconds. What is the correct interpretation?

   1. ANon-reactive tracing requiring immediate delivery
   2. BEvidence of fetal acidaemia requiring fetal blood sampling
   3. CSinusoidal pattern indicating fetal anaemia
   4. DReactive by the criteria appropriate for this gestational age
   Show answer and explanation

   Correct answer: D. Reactive by the criteria appropriate for this gestational age

   Before 32 weeks, reactivity is defined by accelerations of at least 10 bpm above baseline lasting at least 10 seconds, whereas from 32 weeks the criterion is 15 bpm for 15 seconds; this tracing therefore meets the age-appropriate definition of reactive. A normal baseline with moderate variability and no decelerations argues strongly against acidaemia. A sinusoidal pattern is a smooth undulating waveform with absent variability, which is not described here, and antenatal fetal blood sampling is not a standard investigation.

   Reference: ACOG Practice Bulletin No. 229, Antepartum Fetal Surveillance (2021); NICHD fetal monitoring nomenclature (Macones et al., 2008)

2. Question 2 · Labour, Delivery & Intrapartum Care

   A woman at 30 weeks presents with regular painful contractions, a temperature of 38.5 C, uterine tenderness, offensive vaginal discharge and a persistent fetal tachycardia of 180 bpm. The cervix is 4 cm dilated. What is the most appropriate management?

   1. ANifedipine tocolysis with a course of antenatal corticosteroids
   2. BAtosiban infusion to allow in-utero transfer
   3. CIndomethacin tocolysis and repeat assessment in 12 hours
   4. DBroad-spectrum intravenous antibiotics and expedited delivery
   Show answer and explanation

   Correct answer: D. Broad-spectrum intravenous antibiotics and expedited delivery

   Clinical chorioamnionitis is an absolute contraindication to tocolysis; treatment is prompt broad-spectrum antibiotics and delivery, since prolonging the pregnancy increases maternal sepsis and neonatal morbidity. Nifedipine, atosiban and indomethacin all delay delivery in the presence of intrauterine infection and are therefore inappropriate here.

   Reference: ACOG Practice Bulletin No. 171, Management of Preterm Labor, 2016; ACOG Committee Opinion No. 712, Intrapartum Management of Intraamniotic Infection, 2017

3. Question 3 · Obstetric Emergencies & Maternal Critical Care

   A woman presents 36 hours postpartum with severe perineal pain out of proportion to findings, fever, hypotension, a generalised erythematous rash and rapidly spreading discoloration of the perineal wound with crepitus. Which pathogen and management combination is most appropriate?

   1. ACandida albicans, requiring oral fluconazole
   2. BEscherichia coli, requiring oral nitrofurantoin and wound dressings
   3. CGroup A Streptococcus, requiring urgent surgical debridement plus intravenous antibiotics including a protein-synthesis inhibitor such as clindamycin
   4. DCoagulase-negative Staphylococcus, requiring observation and analgesia only
   Show answer and explanation

   Correct answer: C. Group A Streptococcus, requiring urgent surgical debridement plus intravenous antibiotics including a protein-synthesis inhibitor such as clindamycin

   Pain disproportionate to signs, rapid spread, crepitus and a scarlatiniform rash with shock indicate invasive group A streptococcal necrotising soft tissue infection with toxic shock, the classic cause of fulminant puerperal sepsis. Treatment is emergency surgical debridement for source control plus high-dose intravenous antibiotics that include clindamycin or another protein-synthesis inhibitor to suppress toxin production. Candida and coagulase-negative staphylococci do not cause this fulminant picture, and oral nitrofurantoin achieves no useful tissue levels and would not address a necrotising infection.

   Reference: RCOG Green-top Guideline No. 64b, Sepsis Following Pregnancy (2012); IDSA Practice Guidelines for Skin and Soft Tissue Infections (2014)

4. Question 4 · Gynecologic Oncology

   A 34-year-old woman had a radical hysterectomy with bilateral salpingo-oophorectomy for stage IB1 squamous cell carcinoma of the cervix and now has severe vasomotor symptoms and a low bone density result. She has no residual disease. What is the most appropriate advice about systemic hormone therapy?

   1. AHormone therapy is absolutely contraindicated after any gynaecological cancer
   2. BOnly vaginal oestrogen may be used, never systemic therapy
   3. CTibolone is contraindicated but combined oestrogen-progestogen is unsafe as well
   4. DSystemic oestrogen replacement is appropriate and is not contraindicated in cervical squamous cell carcinoma
   Show answer and explanation

   Correct answer: D. Systemic oestrogen replacement is appropriate and is not contraindicated in cervical squamous cell carcinoma

   Cervical squamous cell carcinoma is not hormone-dependent, so systemic hormone replacement is appropriate for a young woman with surgical menopause and is important for vasomotor symptoms, bone and cardiovascular health. Hormone therapy is not universally contraindicated after gynaecological cancer; it is oestrogen-dependent tumours such as high-risk endometrioid endometrial carcinoma, and hormone-receptor-positive breast cancer, where systemic oestrogen is avoided, and restricting a young castrate woman to vaginal oestrogen alone would leave her at avoidable skeletal and cardiovascular risk.

   Reference: British Menopause Society/NICE NG23 guidance on menopause after cancer; ESGO-ESTRO-ESP Cervical Cancer Guidelines (2023)

5. Question 5 · Early Pregnancy Problems & Postpartum Care

   A woman who had an emergency caesarean for a category III cardiotocograph describes intrusive memories and distress about the birth at her 6-week visit. Which statement best reflects the evidence on post-birth psychological support?

   1. AA single session of formal psychological debriefing offered routinely to all women prevents post-traumatic stress disorder and should be mandatory
   2. BSymptoms of this kind are universal after caesarean birth and require no assessment
   3. CRoutine single-session formal psychological debriefing is not recommended, but women should be offered an opportunity to discuss and review the events of the birth, with referral for evidence-based therapy such as trauma-focused CBT or EMDR if PTSD symptoms are present
   4. DBenzodiazepines should be prescribed as first-line treatment for birth-related traumatic stress
   Show answer and explanation

   Correct answer: C. Routine single-session formal psychological debriefing is not recommended, but women should be offered an opportunity to discuss and review the events of the birth, with referral for evidence-based therapy such as trauma-focused CBT or EMDR if PTSD symptoms are present

   Trials of routine single-session psychological debriefing have not shown prevention of PTSD and it may be harmful in some individuals, so it is not recommended as a universal intervention; however, women should be offered the chance to talk through what happened and review their records, which addresses unanswered questions. Persistent intrusive symptoms warrant formal assessment and referral for trauma-focused CBT or EMDR, and benzodiazepines are not first-line and carry dependence risk.

   Reference: NICE NG116, Post-traumatic Stress Disorder (2018); NICE NG194, Postnatal Care (2021)

6. Question 6 · Professionalism, Ethics, Law, Patient Safety, Communication & Evidence-Based Practice

   Root cause analysis of a ten-fold magnesium sulfate overdose on the labour ward finds that two different vial concentrations are stored in the same drawer with almost identical labels. Which recommendation is most likely to prevent recurrence?

   1. ACirculate an email reminding all staff to check concentrations carefully
   2. BAdd a line to the eclampsia protocol stating that the concentration must be double-checked
   3. CProvide an annual refresher lecture on medication safety for midwives and doctors
   4. DRemove the higher-concentration vials from the labour ward and stock only standardised pre-mixed magnesium sulfate infusions
   Show answer and explanation

   Correct answer: D. Remove the higher-concentration vials from the labour ward and stock only standardised pre-mixed magnesium sulfate infusions

   In the hierarchy of intervention effectiveness, forcing functions and design changes that remove the hazard are far stronger than person-dependent controls. Eliminating the look-alike vial and standardising to a single pre-mixed preparation makes the error physically difficult to commit. Reminders, protocol wording and periodic education rely on vigilance and memory, which are the weakest and least durable safeguards.

   Reference: Institute for Safe Medication Practices, Hierarchy of Effectiveness of Risk-Reduction Strategies; WHO Patient Safety Curriculum Guide (2011); ISMP List of High-Alert Medications in Acute Care Settings (2024)

7. Question 7 · General Obstetrics: Preconception, Antenatal Care & Normal Pregnancy

   A 34-year-old woman with type 2 diabetes and hypertension wishes to conceive within six months. Her HbA1c is 9.2% (77 mmol/mol). She takes metformin, lisinopril and atorvastatin. Which management plan is most appropriate before she attempts conception?

   1. AContinue all current medication and advise conception now, as delay worsens fertility
   2. BStop metformin, continue lisinopril and atorvastatin, and start insulin once pregnant
   3. CContinue metformin with added insulin, switch lisinopril to labetalol or nifedipine, stop atorvastatin, and defer conception until HbA1c is below 6.5% (48 mmol/mol)
   4. DContinue lisinopril and atorvastatin but add high-dose folic acid and aim for HbA1c below 8%
   Show answer and explanation

   Correct answer: C. Continue metformin with added insulin, switch lisinopril to labetalol or nifedipine, stop atorvastatin, and defer conception until HbA1c is below 6.5% (48 mmol/mol)

   Preconception glycaemic optimisation to an HbA1c below about 6.5% substantially reduces congenital malformation, miscarriage and stillbirth risk, and women are advised to avoid pregnancy while HbA1c exceeds 10%. ACE inhibitors are fetotoxic (renal dysgenesis, oligohydramnios, skull hypoplasia) and should be replaced preconception with labetalol, nifedipine or methyldopa, while statins are conventionally stopped as they are not required for the short duration of pregnancy. Metformin may be continued in pregnancy and insulin added as needed, so stopping metformin is unnecessary; this woman also needs 5 mg folic acid.

   Reference: NICE NG3, Diabetes in Pregnancy (updated 2020); ACOG Practice Bulletin No. 201, Pregestational Diabetes Mellitus (2018)

8. Question 8 · Labour, Delivery & Intrapartum Care

   After the uncomplicated vaginal birth of a cephalic first twin at 37 weeks, the second twin is found to be in a transverse lie with an unengaged presenting part. Membranes are intact and the fetal heart rate is normal. An experienced obstetrician is present with the theatre team on standby. What is the most appropriate management?

   1. AProceed immediately to caesarean section for the second twin
   2. BWait 60 minutes for spontaneous cephalic version to occur
   3. CApply a vacuum cup to the unengaged presenting part
   4. DPerform internal podalic version with total breech extraction
   Show answer and explanation

   Correct answer: D. Perform internal podalic version with total breech extraction

   With intact membranes, a reassuring heart rate and an experienced operator, internal podalic version followed by total breech extraction is the standard approach for a non-cephalic second twin and avoids the morbidity of combined vaginal-caesarean delivery. Immediate caesarean is not required when these conditions are met, prolonged waiting risks cord accident and cervical reconstriction, and vacuum extraction on an unengaged transverse fetus is unsafe and ineffective.

   Reference: Barrett JF et al., Twin Birth Study, New England Journal of Medicine, 2013; ACOG Practice Bulletin No. 231, Multifetal Gestations, 2021

9. Question 9 · Obstetric Emergencies & Maternal Critical Care

   A woman with antenatally diagnosed placenta percreta is booked for delivery at a tertiary centre. Which operative plan best reflects current recommended management?

   1. AEmergency caesarean at 39 weeks with vigorous manual removal of the placenta and uterine curettage
   2. BVaginal delivery with prophylactic uterine artery embolisation immediately afterwards
   3. CPlanned delivery at around 34-36 weeks by a multidisciplinary team, with a uterine incision away from the placenta, no attempt at placental separation, and proceeding to hysterectomy with the placenta left in situ
   4. DClassical caesarean at 32 weeks with piecemeal removal of the placenta and B-Lynch suture
   Show answer and explanation

   Correct answer: C. Planned delivery at around 34-36 weeks by a multidisciplinary team, with a uterine incision away from the placenta, no attempt at placental separation, and proceeding to hysterectomy with the placenta left in situ

   Recommended care for placenta accreta spectrum is scheduled delivery, generally between 34 and 36 weeks in a centre of excellence with an experienced multidisciplinary team, blood products available and critical care support, using a uterine incision sited to avoid the placenta and leaving the placenta undisturbed before caesarean hysterectomy. Attempting to separate or remove an adherent placenta is the principal cause of catastrophic haemorrhage. Vaginal delivery is not an option for percreta, and waiting to 39 weeks greatly increases the chance of emergency unplanned delivery with bleeding.

   Reference: FIGO Consensus Guidelines on Placenta Accreta Spectrum Disorders (2019); ACOG/SMFM Obstetric Care Consensus No. 7, Placenta Accreta Spectrum (2018)

10. Question 10 · Gynecologic Oncology

    A 31-year-old nulliparous woman with a strong wish to preserve fertility has a 1.5 cm squamous cell carcinoma of the cervix with 6 mm stromal invasion, no lymphovascular space invasion, and MRI and PET-CT showing no nodal or parametrial involvement. Which management best balances oncological safety and her fertility wish?

    1. ACone biopsy alone with follow-up cytology
    2. BRadical vaginal or abdominal trachelectomy with pelvic lymph node assessment
    3. CPrimary chemoradiation with ovarian transposition
    4. DType C radical hysterectomy with ovarian preservation
    Show answer and explanation

    Correct answer: B. Radical vaginal or abdominal trachelectomy with pelvic lymph node assessment

    A tumour of 2 cm or less confined to the cervix without nodal disease is the classic indication for fertility-sparing radical trachelectomy with pelvic lymph node assessment, which yields survival comparable to radical hysterectomy while permitting pregnancy. Conisation alone is acceptable only for very low-risk lesions with minimal invasion, chemoradiation destroys fertility whatever is done with the ovaries, and radical hysterectomy removes the uterus and defeats her stated goal.

    Reference: ESGO-ESTRO-ESP Guidelines for the Management of Patients with Cervical Cancer (2023); NCCN Clinical Practice Guidelines in Oncology, Cervical Cancer (2024)

11. Question 11 · Early Pregnancy Problems & Postpartum Care

    A 28-year-old primipara with a history of bipolar affective disorder becomes acutely confused on day 6 postpartum, is not sleeping, believes her baby has been swapped for another child, and is behaving erratically. What is the most appropriate immediate management?

    1. AStart an SSRI and arrange outpatient psychiatry review in two weeks
    2. BUrgent same-day psychiatric assessment and admission, ideally to a mother-and-baby unit, with attention to the safety of mother and infant
    3. CPrescribe a short course of hypnotics and discharge home with the health visitor informed
    4. DAdvise rest, family support and a repeat EPDS in one week
    Show answer and explanation

    Correct answer: B. Urgent same-day psychiatric assessment and admission, ideally to a mother-and-baby unit, with attention to the safety of mother and infant

    This is postpartum (puerperal) psychosis, a psychiatric emergency with high risk of suicide and infant harm, and it requires urgent same-day specialist assessment and inpatient care, preferably in a mother-and-baby unit. A history of bipolar disorder is the strongest risk factor. Outpatient SSRI therapy, watchful waiting or hypnotics alone are unsafe and can precipitate mood switching or leave mother and baby at risk.

    Reference: NICE CG192, Antenatal and Postnatal Mental Health (updated 2020); MBRRACE-UK Confidential Enquiries into Maternal Deaths

12. Question 12 · Urogynecology & Pelvic Floor Disorders

    A 48-year-old woman with refractory urgency incontinence is unwilling to accept any risk of self-catheterisation and wants a treatment that can be trialled reversibly before committing to a permanent device. Which third-line therapy best matches her preferences?

    1. AAugmentation cystoplasty
    2. BRepeat courses of intradetrusor botulinum toxin
    3. CUrinary diversion with ileal conduit
    4. DSacral neuromodulation, with a percutaneous test phase before implantation of the permanent generator
    Show answer and explanation

    Correct answer: D. Sacral neuromodulation, with a percutaneous test phase before implantation of the permanent generator

    Sacral neuromodulation uniquely offers a reversible percutaneous test stimulation period, and only patients with an adequate symptomatic response (usually 50% or more improvement) proceed to permanent implantation; it does not carry the retention/self-catheterisation risk of botulinum toxin. Botulinum toxin is rejected by her stated preference. Augmentation cystoplasty and urinary diversion are major irreversible operations reserved for severe refractory or neurogenic disease.

    Reference: NICE NG123 (2019); Amundsen CL et al., ROSETTA trial, JAMA 2016; EAU Guidelines on Non-neurogenic Female LUTS (2024)

Obstetrics & Gynecology reference books and guidelines

Every question in this bank names the textbook or guideline its answer rests on. These are the sources our Obstetrics & Gynecology questions cite most often - the reading list to revise from alongside the bank.

Where your regulator publishes a reading list, use the editions it names. Exam questions are not taken from any one book.