Master Obs & Gyn
for PMDC NLE Step 1
Access 50+ high-yield questions tailored for the 2026 syllabus. Includes AI-powered explanations and performance tracking.
Core Concepts
Obstetrics: Covers pregnancy, childbirth, and postpartum. Key maternal adaptations: increased blood volume (40-50%), cardiac output, and hypercoagulability. Gestational age is typically calculated from the first day of the last menstrual period (LMP) or early ultrasound.
- Gravidity: Total number of pregnancies. Parity: Number of births beyond 20 weeks gestation.
- Term Pregnancy: 37-41 weeks. Preterm: <37 weeks. Post-term: >42 weeks.
- Antenatal Care: Routine monitoring. Includes dating scan (early TVUS), anomaly scan (18-22 wks), vaccinations (Tdap, Flu), folic acid, iron.
Gynecology: Focuses on the female reproductive system. Menstrual cycle governed by GnRH, FSH, LH, Estrogen, Progesterone.
- Menstrual Cycle: Follicular (estrogen dominant), Ovulation (LH surge), Luteal (progesterone dominant).
- Amenorrhea: Primary (no menarche by 15 with secondary sexual characteristics, or 13 without) vs. Secondary (absence of menses for 3+ cycles).
Clinical Presentation
- Ectopic Pregnancy: Amenorrhea, unilateral lower abdominal pain, vaginal spotting. Rupture: hypovolemic shock.
- Miscarriage: Vaginal bleeding, lower abdominal cramping in early pregnancy.
- Pre-eclampsia: New HTN (>140/90 mmHg) and proteinuria (>0.3g/24h) after 20 weeks. Severe: BP >160/110, headache, visual changes, RUQ pain, thrombocytopenia.
- Gestational Diabetes Mellitus (GDM): Often asymptomatic; diagnosed by screening. Risks: fetal macrosomia, neonatal hypoglycemia.
- Placenta Previa: Painless bright red vaginal bleeding in late second/third trimester.
- Abruptio Placentae: Painful vaginal bleeding, sudden severe abdominal pain, uterine tenderness, fetal distress.
- Pelvic Inflammatory Disease (PID): Lower abdominal pain, fever, vaginal discharge, cervical motion tenderness.
- Uterine Fibroids: Menorrhagia, pelvic pressure/pain, urinary frequency. Often asymptomatic.
- Endometriosis: Chronic pelvic pain, severe dysmenorrhea, deep dyspareunia, infertility.
- Polycystic Ovary Syndrome (PCOS): Oligo/anovulation (irregular menses), hyperandrogenism (hirsutism, acne), polycystic ovaries on US.
Diagnosis (Gold Standard)
- Pregnancy: Serum/urine hCG.
- Ectopic Pregnancy: Transvaginal Ultrasound (TVUS) showing empty uterus + positive hCG; or adnexal mass/free fluid.
- Pre-eclampsia: BP measurement + 24-hour urine collection for proteinuria.
- Gestational Diabetes: Oral Glucose Tolerance Test (OGTT) at 24-28 weeks.
- Placenta Previa/Abruptio: Transabdominal Ultrasound (for previa), clinical findings (for abruptio).
- PID: Clinical diagnosis based on minimum criteria; laparoscopy is definitive but rarely needed.
- Endometriosis: Laparoscopy with biopsy.
- Cervical Cancer: Cervical biopsy (after abnormal Pap smear).
- Endometrial Cancer: Endometrial biopsy.
Management (First Line)
- Ectopic Pregnancy: Methotrexate (stable, unruptured) or Surgical (laparoscopic salpingectomy/salpingostomy).
- Miscarriage: Expectant, Medical (misoprostol), or Surgical (D&C).
- Pre-eclampsia: Delivery (definitive); Antihypertensives (Labetalol, Nifedipine); Magnesium Sulfate for seizure prophylaxis.
- Gestational Diabetes: Diet/exercise, then Insulin if targets not met.
- Placenta Previa: Strict rest, avoid vaginal exams, C-section for delivery if persists near term.
- Abruptio Placentae: Emergency C-section (if unstable or fetal distress), aggressive fluid resuscitation.
- Pelvic Inflammatory Disease: Broad-spectrum antibiotics (e.g., Ceftriaxone + Doxycycline + Metronidazole).
- Uterine Fibroids: NSAIDs/hormonal therapy (OCPs); Surgical: Myomectomy (fertility desired) or Hysterectomy.
- Endometriosis: NSAIDs, hormonal contraceptives (OCPs), GnRH agonists. Surgical excision.
- PCOS: Lifestyle modification, OCPs for menstrual regulation/hirsutism, Metformin for insulin resistance, Clomiphene for infertility.
- Postpartum Hemorrhage (PPH): Uterine massage, Oxytocin.
Exam Red Flags
- Sudden, severe, unilateral lower abdominal pain with missed period: Ectopic Pregnancy.
- Painless bright red vaginal bleeding in 3rd trimester: Placenta Previa. Painful dark red bleeding: Abruptio Placentae.
- New onset headache, visual changes, RUQ pain after 20 weeks gestation: Severe Pre-eclampsia/HELLP Syndrome.
- Postpartum fever, uterine tenderness, foul-smelling lochia: Puerperal Sepsis (Endometritis).
- Painless post-menopausal bleeding: Endometrial Cancer until proven otherwise.
- Sudden onset dyspnea, pleuritic chest pain, or hypoxemia in postpartum: Pulmonary Embolism (PE).
- Fixed, hard, irregular pelvic mass: Suggestive of malignancy (ovarian/uterine).
Sample Practice Questions
A 35-year-old P2G2 woman presents to the gynecology clinic complaining of heavy menstrual bleeding for the past 6 months. She describes soaking through multiple pads per day and occasional passage of large blood clots. She also reports pelvic pressure and a feeling of 'fullness' in her lower abdomen. Her last Pap smear was normal 1 year ago. On bimanual examination, the uterus is enlarged, irregular, and firm. What is the most likely diagnosis?
A 30-year-old G1P0 woman at 10 weeks gestation presents with persistent nausea and vomiting, leading to a 5 kg weight loss. She also reports experiencing a brownish vaginal discharge for the past week. On examination, her uterus is larger than expected for gestational age, and her blood pressure is 140/90 mmHg. A urine pregnancy test is positive, and her serum beta-hCG level is significantly elevated (250,000 mIU/mL). What is the most likely diagnosis?
A 24-year-old woman presents to the emergency department with sudden onset of severe, unilateral lower abdominal pain and mild vaginal spotting. Her last menstrual period was 7 weeks ago. She denies fever, chills, or urinary symptoms. On examination, her abdomen is tender in the left lower quadrant, with mild guarding. A urine pregnancy test is positive. Transvaginal ultrasound reveals an empty uterus and a complex adnexal mass measuring 4 cm on the left side, with free fluid in the cul-de-sac. Which of the following is the most appropriate immediate management?
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