AMC MCQ Obstetrics & Gynaecology Questions: 10 Free Practice MCQs
Ten AMC MCQ-style obstetrics & gynaecology questions with the answer and the reasoning behind it. They come from the AU.med bank, which has 200 obstetrics & gynaecology questions and many more across every topic.
1 / 10
A 26-year-old woman presents to the emergency department with a 6-hour history of sudden-onset, severe, unilateral right lower abdominal pain associated with nausea and vomiting. She has a history of a 6 cm simple ovarian cyst diagnosed 2 weeks ago. On exam, she has localized tenderness and guarding in the right iliac fossa. Pelvic ultrasound reveals a 6.5 cm right ovarian mass with reduced stromal blood flow on Doppler flow imaging.
What is the most appropriate next step in management?
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Answer: C. Arrange urgent diagnostic and therapeutic laparoscopy
Why: Ovarian torsion is an acute gynecological emergency caused by the partial or complete rotation of the ovary on its pedicle, compromising vascular supply. Urgent laparoscopy is required for surgical detorsion (unwinding the ovary) and cystectomy of the predisposing cyst to prevent permanent ovarian ischemia and necrosis.
- A. Ovarian torsion is a gynaecological emergency; delaying surgical intervention leads to ovarian necrosis and irreversible loss of function.
- B. Elective surgery is inappropriate for an acute ischemic event that compromises organ viability.
- D. Methotrexate has no role in the management of ovarian torsion and is reserved for stable ectopic pregnancies.
Sources: RANZCOG: Gynaecological Emergencies Guideline
2 / 10
A 29-year-old woman at 38 weeks gestation presents two hours after her membranes ruptured. The diagnosis is uncertain from the history alone, and the midwife asks whether a vaginal examination should be performed now to confirm it.
What is the most appropriate next step to confirm the diagnosis?
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Answer: A. Perform a sterile speculum examination, avoiding a digital vaginal examination unless immediate induction is planned
Why: Where there is diagnostic uncertainty after term prelabour rupture of membranes, RANZCOG advises that a sterile speculum examination should be performed. If uncertainty remains, tests for amniotic fluid proteins in vaginal fluid may be used, although false positive and false negative results occur and these tests should not be part of routine assessment. Digital vaginal examination should be avoided unless immediate induction is planned, because it has been shown to increase the rate of neonatal infection. Neither transabdominal cervical ultrasound nor simply waiting 24 hours is an appropriate way to confirm the diagnosis.
- B. A digital examination before induction is avoided in this setting because it increases the rate of neonatal infection.
- C. Ultrasound assessment of the cervix is not the recommended first step when rupture of membranes needs to be confirmed.
- D. Delaying for 24 hours without confirming the diagnosis leaves a possible rupture unmanaged and does not answer the clinical question.
Sources: RANZCOG Term Prelabour Rupture of Membranes (Term PROM) Clinical Guidance Statement (C-Obs 36), July 2021
3 / 10
A 35-year-old G2P1 woman presents at 11 weeks gestation for her first antenatal visit. Her first pregnancy was complicated by early-onset preeclampsia requiring delivery at 32 weeks. She has no other chronic medical conditions, and her blood pressure is currently 118/74 mmHg.
What preventative treatment should be initiated, and at what gestation should it start?
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Answer: C. Low-dose aspirin (150 mg daily) starting from 12 weeks gestation
Why: Women with a high risk of preeclampsia (e.g., prior preeclampsia, chronic hypertension, pre-gestational diabetes, autoimmune disease, or multiple pregnancy) should be started on low-dose aspirin (150 mg nocte) from 12 weeks gestation until 36-37 weeks. Initiating aspirin after 16 weeks is significantly less effective.
- A. Calcium is recommended for women with low dietary calcium intake, but aspirin is the primary preventative agent for high-risk patients starting in early pregnancy.
- B. LMWH is not routinely used for preeclampsia prevention unless there is a co-existing thrombophilia or antiphospholipid syndrome.
- D. Antihypertensive therapy is indicated for treatment of hypertension (BP >= 140/90 mmHg), not for primary prevention of preeclampsia in a normotensive woman.
Sources: RANZCOG Guideline: Diagnosis and Management of Preeclampsia
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4 / 10
A 30-year-old woman at 38 weeks gestation reports a gush of clear fluid from the vagina two hours ago. She is not contracting and the fetal heart rate is normal.
Which statement about term prelabour rupture of membranes is correct?
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Answer: B. It occurs in about 8% of pregnancies, and around 70% of women start labour within 24 hours
Why: Term prelabour rupture of membranes is defined as rupture of the membranes before the onset of labour at or beyond 37 weeks gestation, and RANZCOG reports an incidence of 8%. About 70% of women commence labour spontaneously within 24 hours, 85% labour within 48 hours and 95% within 96 hours. The immediate but uncommon risks are cord prolapse, cord compression and placental abruption, while delayed risks are maternal and neonatal infection. Because planned early birth reduces infection without increasing caesarean section, induction within 24 hours is recommended where practical.
- A. Term prelabour rupture of membranes is rupture at or beyond 37 weeks, so a pre-37-week definition describes preterm rupture instead.
- C. Labour begins within 24 hours in about 70% of women, while 85% labour within 48 hours and 95% within 96 hours, so delivery within 24 hours is not usual for all.
- D. Guidance advises induction of labour within 24 hours where practical, not a delay to 96 hours.
Sources: RANZCOG Term Prelabour Rupture of Membranes (Term PROM) Clinical Guidance Statement (C-Obs 36), July 2021
5 / 10
A 29-year-old woman at 27 weeks gestation presents in active preterm labour with cervical dilation of 5 cm and bulging membranes. Delivery is anticipated within the next 4 hours. Corticosteroids have been administered.
What additional medication should be administered immediately for fetal benefit?
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Answer: B. Intravenous Magnesium Sulphate
Why: Magnesium sulphate administered intravenously to women immediately prior to preterm birth (<30 weeks gestation) reduces the risk of cerebral palsy and gross motor dysfunction in the infant. It should be given if birth is expected within 24 hours.
- A. Antibiotics are given for GBS prophylaxis during active labour, but Magnesium Sulphate is the specific drug for neuroprotection.
- C. Terbutaline is a tocolytic and will not prevent delivery in active labour at 5 cm dilation, nor does it provide neuroprotection.
- D. Corticosteroids are already administered, and Magnesium Sulphate is the primary agent for neuroprotection.
Sources: Australian Clinical Practice Guidelines: Magnesium sulphate for brains of upcoming babies; RANZCOG Guidelines
6 / 10
An 18-year-old female presents due to never having had a menstrual period. On examination, her height is 142 cm (below the 3rd percentile), she has a wide carrying angle of her elbows, and she has minimal breast development (Tanner Stage 2).
What is the most appropriate initial diagnostic investigation to confirm the underlying cause?
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Answer: D. Karyotype analysis
Why: The combination of short stature, primary amenorrhoea, and lack of secondary sexual characteristics (due to streak ovaries and estrogen deficiency) is typical of Turner syndrome (45,X or mosaicism). Karyotype analysis is the definitive diagnostic test.
- A. Pelvic ultrasound is useful, but her physical features (short stature, carrying angle) point strongly to a chromosomal etiology.
- B. Brain MRI is indicated for hypogonadotropic hypogonadism, but Turner syndrome causes hypergonadotropic hypogonadism.
- C. The progestogen challenge test requires adequate endogenous estrogen production, which is lacking in Turner syndrome due to streak ovaries.
Sources: RACP: Endocrine Guidelines for Primary Amenorrhoea; Harrison's Principles of Internal Medicine
7 / 10
A 27-year-old woman presents 12 days after a spontaneous vaginal birth with fever, lower abdominal tenderness and heavy vaginal bleeding. The uterus is tender on bimanual examination.
What is the most appropriate initial management?
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Answer: C. Antibiotic therapy, with surgical evacuation of retained products if bleeding is excessive or continues
Why: Secondary postpartum haemorrhage occurs between 24 hours and six weeks after delivery and is usually associated with endometritis, with or without retained products of conception. Conventional treatment therefore includes antibiotic therapy, with uterotonics used in some cases. Where bleeding is excessive or continues, surgical intervention, particularly evacuation of retained products, should be considered irrespective of ultrasound findings, because imaging does not reliably exclude retained tissue. Ergometrine alone, simple reassurance, or immediate hysterectomy all fail to match this approach: the first neglects infection, the second delays treatment, and the third is disproportionate to what is usually required.
- A. Uterotonics have only a limited supporting role at most, and sending a febrile woman home for review a week later would not treat the infective cause.
- B. Deferring treatment for a fortnight ignores the need to treat the presumed infection and would also delay control of continuing blood loss.
- D. Removing the uterus is far beyond what is needed first, because medical treatment and evacuation of retained tissue are effective in most cases.
Sources: RANZCOG Management of Postpartum Haemorrhage (C-Obs 43)
8 / 10
A 30-year-old Rh-negative pregnant woman at 24 weeks gestation is found to have anti-D antibodies with a titre of 1:32 (an increase from 1:4 at 12 weeks).
What is the most appropriate next step to assess the fetus for severe anaemia?
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Answer: B. Middle cerebral artery peak systolic velocity (MCA-PSV) Doppler ultrasound
Why: Fetal middle cerebral artery peak systolic velocity (MCA-PSV) Doppler is a highly sensitive, non-invasive method used to screen for fetal anaemia in pregnancies complicated by maternal red cell alloimmunisation. An elevated MCA-PSV (>1.5 MoM) suggests fetal anaemia and indicates the need for fetal blood sampling and intrauterine transfusion.
- A. Amniocentesis is invasive and has been replaced by non-invasive Doppler ultrasound monitoring.
- C. Cordocentesis carries a significant risk of fetal loss and is reserved for therapeutic transfusion rather than primary screening.
- D. Delivery at 24 weeks carries extreme neonatal prematurity risks; monitoring and in-utero transfusion are preferred.
Sources: RANZCOG: Management of Alloimmunisation in Pregnancy
9 / 10
A 36-year-old woman at 39 weeks gestation presents with spontaneous rupture of membranes six hours ago. She is not in labour, she is group B streptococcus negative, and ultrasound confirms a cephalic presentation with a normal fetal heart rate.
What is the most appropriate management?
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Answer: C. Induction of labour within 24 hours, where practical
Why: RANZCOG recommends that in women with ruptured membranes at term, induction of labour within 24 hours is recommended where practical, because planned early birth reduces maternal chorioamnionitis and early-onset neonatal infection without an increase in caesarean section. This woman is group B streptococcus negative with a cephalic presentation and a normal fetal heart rate, so she is suitable for induction. Expectant management at home increases neonatal infection, waiting 96 hours delays protective birth, and caesarean section is not indicated in this straightforward presentation.
- A. Expectant management at home is associated with an increase in neonatal infection, and she has not chosen that pathway after counselling.
- B. Waiting up to 96 hours is not advised, because planned early birth reduces maternal and neonatal infection without increasing caesarean birth.
- D. Caesarean section is not indicated because the presentation is cephalic, the fetal heart rate is normal and vaginal birth is planned.
Sources: RANZCOG Term Prelabour Rupture of Membranes (Term PROM) Clinical Guidance Statement (C-Obs 36), July 2021
10 / 10
A 26-year-old G2P0 woman at 19 weeks gestation has a routine transvaginal ultrasound showing a cervical length of 18 mm. Her first pregnancy ended in a painless second-trimester miscarriage at 18 weeks. She is asymptomatic and has no uterine contractions.
What is the most appropriate management to reduce the risk of preterm birth?
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Answer: C. Prophylactic cervical cerclage placement
Why: Cervical insufficiency is managed with cervical cerclage (McDonald or Shirodkar suture) or vaginal progesterone. In a patient with a history of a painless second-trimester loss and an ultrasound-detected short cervix (<25 mm) before 24 weeks, cervical cerclage placement is the standard of care in Australia.
- A. A cervical length of 18 mm at 19 weeks with a history of mid-trimester loss requires active management, not delayed monitoring.
- B. Strict bed rest is not recommended as it does not reduce preterm birth rates and increases the risk of venous thromboembolism.
- D. Vaginal progesterone can be used for isolated short cervix, but in a patient with a history of second-trimester loss and short cervix, cerclage is highly indicated.
Sources: RANZCOG: Cervical Cerclage and Progesterone for Preterm Birth Prevention
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