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 28-year-old primigravida at 38 weeks gestation presents to the emergency department with sudden onset of painful vaginal bleeding and abdominal pain. She denies any trauma. Her blood pressure is 150/100 mmHg, heart rate is 110 bpm. Fetal heart rate monitoring shows late decelerations and decreased variability. On examination, the uterus is tender, rigid, and larger than expected for gestational age. Vaginal examination reveals dark, non-clotting blood. Which of the following is the most likely diagnosis?
A 28-year-old primigravida at 38 weeks gestation presents with sudden onset of severe, constant abdominal pain and dark red vaginal bleeding. Her uterus is tender and firm on palpation, and she reports decreased fetal movements. Fetal heart rate monitoring shows late decelerations. She has a history of chronic hypertension managed with labetalol. What is the most likely diagnosis?
A 65-year-old multiparous woman presents with a 6-month history of a 'bulge' in her vagina that worsens with coughing and standing. She also reports a feeling of pelvic pressure and occasional difficulty with defecation, requiring manual splinting. On speculum examination, a posterior vaginal wall bulge is noted. Which of the following is the most likely diagnosis?
Ready to see the answers?
Unlock All AnswersPMDC NLE Step 1
- ✓ 50+ Obs & Gyn Questions
- ✓ AI Tutor Assistance
- ✓ Detailed Explanations
- ✓ Performance Analytics