Master Obstetrics and Gynecology
for SMLE
Access 50+ high-yield questions tailored for the 2026 syllabus. Includes AI-powered explanations and performance tracking.
Core Concepts
Obstetrics and Gynecology (ObGyn) encompasses female reproductive health, pregnancy, childbirth, and puerperium. It combines medical and surgical management. Key principles include understanding normal physiological changes (menstrual cycle, pregnancy), early detection and management of complications, and preventative care (e.g., vaccination, screening). Emphasis is placed on maternal and fetal well-being, contraception, fertility, and management of gynecological pathologies across all ages.
Clinical Presentation
- Abnormal Vaginal Bleeding:
- Antepartum: Painless (Placenta Previa), Painful (Abruptio Placentae).
- Postpartum: Heavy bleeding after delivery (Postpartum Hemorrhage - PPH).
- Non-gravid: Menorrhagia, metrorrhagia, post-coital, post-menopausal (e.g., endometrial pathology, fibroids, polyps, cervical cancer).
- Pelvic Pain: Acute (e.g., Ectopic pregnancy, PID, ovarian torsion, ruptured cyst) or Chronic (e.g., Endometriosis, Adenomyosis, adhesions).
- Vaginal Discharge: Itchiness, odor, dysuria (e.g., Infections like Candidiasis, Bacterial Vaginosis, STIs).
- Pregnancy-related Symptoms: Nausea/vomiting, hypertension (e.g., Pre-eclampsia), reduced fetal movement, preterm contractions, symptoms of DVT/PE.
- Infertility: Inability to conceive after 12 months (or 6 months if >35 years) of unprotected intercourse.
- Urinary Symptoms: Frequency, urgency, incontinence (e.g., UTI, pelvic organ prolapse).
Diagnosis (Gold Standard)
- Pregnancy Confirmation: Serum/urine hCG.
- Ectopic Pregnancy: Transvaginal Ultrasound (TVS) showing extrauterine gestational sac + hCG levels not doubling appropriately.
- Gestational Diabetes Mellitus (GDM): Oral Glucose Tolerance Test (OGTT) at 24-28 weeks.
- Pre-eclampsia: New-onset hypertension (>140/90 mmHg after 20 weeks) with proteinuria or end-organ dysfunction.
- Placenta Previa/Abruptio Placentae: Transabdominal Ultrasound (for previa), clinical presentation (for abruption).
- Cervical Cancer Screening: Pap smear (cytology) followed by colposcopy with biopsy for abnormal results.
- Endometrial Cancer: Endometrial biopsy.
- Ovarian Mass: Pelvic Ultrasound; CA-125 for suspicion of malignancy.
- Pelvic Inflammatory Disease (PID): Clinical diagnosis (pelvic pain, cervical motion tenderness, adnexal tenderness, fever, discharge); definitive with laparoscopy.
- Infertility: Comprehensive workup including semen analysis, ovulation assessment (progesterone), tubal patency (HSG), ovarian reserve (AMH, FSH).
Management (First Line)
- Antenatal Care: Regular visits, screening (blood group, infections, GDM), nutritional advice, folic acid.
- Pre-eclampsia: Delivery is definitive management; Magnesium Sulfate for seizure prophylaxis/eclampsia treatment; Antihypertensives (Labetalol, Nifedipine, Hydralazine).
- Postpartum Hemorrhage (PPH): Uterine massage, Oxytocin; explore causes (tone, trauma, tissue, thrombin).
- Ectopic Pregnancy:
- Stable: Methotrexate (IM).
- Unstable/Contraindication to MTX: Surgical (laparoscopic salpingectomy).
- Gestational Diabetes: Dietary modifications, exercise; Insulin if diet/exercise fail.
- Preterm Labor: Tocolytics (Nifedipine, Indomethacin), Betamethasone (fetal lung maturity), antibiotics for PROM.
- Cervical Intraepithelial Neoplasia (CIN): LEEP (Loop Electrosurgical Excision Procedure) or cryotherapy.
- Pelvic Inflammatory Disease (PID): Broad-spectrum antibiotics (e.g., Ceftriaxone + Doxycycline + Metronidazole).
- Menorrhagia (Heavy Menstrual Bleeding): Tranexamic acid, NSAIDs, hormonal contraceptives (COCs), Mirena IUD.
- Contraception: Discuss options based on patient needs/contraindications (COCs, Progestin-only, IUD, implant, barrier methods).
Exam Red Flags
- Acute severe abdominal pain in pregnancy: Ectopic rupture, Abruptio Placentae, Uterine rupture.
- Vaginal bleeding in 3rd trimester: Placenta Previa (painless) or Abruptio Placentae (painful).
- New-onset hypertension with headache/visual changes/epigastric pain in pregnancy: Severe Pre-eclampsia/HELLP Syndrome.
- Reduced fetal movement at term: Fetal distress, requiring urgent assessment (NST, BPP).
- Post-menopausal bleeding: Endometrial cancer until proven otherwise (requires endometrial biopsy).
- Hemodynamic instability (tachycardia, hypotension) in any ObGyn context: Indicates significant blood loss (e.g., PPH, ruptured ectopic) or sepsis, requires immediate resuscitation.
- Shoulder Dystocia/Cord Prolapse during labor: Obstetric emergencies requiring immediate action.
Sample Practice Questions
A 62-year-old postmenopausal woman presents with a 3-month history of vague abdominal bloating and early satiety. A transvaginal ultrasound reveals a 7 cm complex left adnexal mass with solid and cystic components and internal septations. Her serum CA-125 level is 350 U/mL (normal < 35 U/mL). She has no family history of ovarian cancer. What is the most appropriate next step in the management of this patient?
A 28-year-old G1P0 just delivered a healthy term infant vaginally. Ten minutes after delivery of the placenta, estimated blood loss is 700 mL. The uterus is palpated as boggy and soft, extending above the umbilicus, and is not contracting effectively despite oxytocin infusion initiated immediately post-placental delivery. What is the most appropriate immediate next step in management?
A 28-year-old G0P0 woman presents to the emergency department with severe, sharp, unilateral lower abdominal pain that started suddenly an hour ago. She reports a missed menstrual period 7 weeks ago and has had light vaginal spotting for the past two days. Her vital signs are: BP 90/60 mmHg, HR 110 bpm, RR 20 bpm, T 37.0°C. On examination, she is pale and has significant right adnexal tenderness and guarding. A urine pregnancy test is positive. Transvaginal ultrasound is inconclusive due to poor visualization secondary to patient discomfort and suspected hemoperitoneum.
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