MCCQE Part I Obstetrics & Gynaecology Questions: 10 Free Practice MCQs
Ten MCCQE Part I-style obstetrics & gynaecology questions with the answer and the reasoning behind it. They come from the CA.med bank, which has 200 obstetrics & gynaecology questions and many more across every topic.
1 / 10
A 14-year-old in British Columbia who is immunocompetent and is not living with HIV is offered the HPV9 vaccine through the school based programme. The parent asks how many doses are needed.
Following the July 2025 BC programme change, what dose schedule applies to this teenager?
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Answer: D. One dose of 0.5 mL intramuscularly
Why: The BC guideline reports that in July 2025 the recommended HPV9 dose schedule changed to include a single-dose schedule for many patients, a shift in practice for providers. Immunocompetent individuals aged 9 to 20 receive one dose of 0.5 mL intramuscularly, immunocompetent individuals aged 21 to 45 receive two doses at 0 and 6 months, and immunocompromised individuals and those living with HIV receive three doses. HPV9 is routinely offered in grade 6.
- A. The two-dose schedule applies to immunocompetent individuals aged 21 to 45, not to a 14-year-old.
- B. Three doses are recommended for immunocompromised individuals, for those living with HIV and after post-colposcopy treatment, not for a healthy teenager.
- C. HPV9 is routinely offered to grade 6 students in BC through school based clinics, so this statement is not correct.
Sources: BC Ministry of Health (BC Guidelines and Protocols Advisory Committee). Cervical cancer prevention and screening (HPV primary screening, ages 25-69).
2 / 10
A 28-year-old woman at 34 weeks gestation with confirmed intrahepatic cholestasis of pregnancy reports intense itching that is disturbing her sleep. Her liver transaminases are mildly raised.
Which treatment is recommended for relief of the itching?
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Answer: B. Ursodeoxycholic acid 10 to 15 mg/kg per day in 2 to 3 divided doses
Why: Ursodeoxycholic acid 10 to 15 mg/kg per day, given in 2 to 3 divided doses, is the mainstay of symptomatic treatment for the itching of intrahepatic cholestasis of pregnancy and may also reduce the risk of preterm birth, although not stillbirth. Dexamethasone, cholestyramine and several other agents have been shown to be ineffective for this condition.
- A. Dexamethasone has been shown to be ineffective for this condition and should not be prescribed.
- C. Cholestyramine is among the therapies shown to be ineffective for intrahepatic cholestasis and should not be used.
- D. Dietary fat restriction alone does not treat the itching, and ursodeoxycholic acid is the recommended therapy.
Sources: SOGC CPG No. 452 - Diagnosis and management of intrahepatic cholestasis of pregnancy (medical disorder in pregnancy)
3 / 10
A 35-year-old pregnant woman at 20 weeks gestation presents for routine prenatal care. She has a history of smoking but has quit 5 years ago. Her family history is significant for breast cancer in her mother, diagnosed at age 50.
What is the most appropriate next step in screening for fetal aneuploidy in this patient?
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Answer: D. Offer non-invasive prenatal testing (NIPT) due to advanced maternal age
Why: The CTFPHC recommends offering NIPT to pregnant women of advanced maternal age (35 years or older at the time of delivery) as a screening test for fetal aneuploidy. This patient, being 35 years old, falls into this category, making NIPT the most appropriate next step in her care.
- A. While a detailed ultrasound is part of prenatal care, it is not the primary method for screening for fetal aneuploidy in this context.
- B. CVS is a diagnostic test for genetic abnormalities, but it is not indicated solely based on a family history of breast cancer, and it carries a higher risk of complications compared to NIPT.
- C. Screening for fetal aneuploidy can be performed earlier in pregnancy, and delaying until the second trimester may miss the optimal window for certain screening tests.
Sources: CTFPHC Guideline
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4 / 10
A 26-year-old woman is Rh D-negative with no anti-D antibodies. At 27 weeks of pregnancy the blood type of her baby is not known. She asks what is planned at the next visit.
What is the recommended plan?
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Answer: C. Anti-D immune globulin at 28 weeks, with postpartum prophylaxis if the baby is Rh D-positive
Why: Guideline 448 recommends anti-D immune globulin at 28 weeks for a non-sensitized Rh D-negative pregnant individual when the blood type of the pregnancy is unknown or known to be Rh D-positive. An unknown blood type is therefore not a reason to withhold prophylaxis. Postpartum prophylaxis depends on the blood type of the newborn and is not given regardless of it, and waiting until after delivery leaves the third trimester unprotected. The appropriate plan is therefore the 28-week dose with reassessment after delivery.
- A. An unknown blood type is not a reason to withhold prophylaxis; guideline 448 recommends treatment in this situation.
- B. The 28-week dose is planned, but postpartum prophylaxis depends on the blood type of the newborn rather than being given regardless.
- D. Waiting until after delivery leaves the later part of the pregnancy unprotected and does not follow the guideline.
Sources: SOGC Clinical Practice Guideline No. 448: Prevention of Rh D Alloimmunization, 2024
5 / 10
A 19-year-old woman who has been sexually active for one year attends a family physician office for a routine check-up. She has no symptoms, no previous abnormal cervical results and no immunosuppression.
According to the Canadian Task Force on Preventive Health Care, what is the appropriate approach to cervical cancer screening for this patient?
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Answer: A. No routine cervical cancer screening
Why: The Canadian Task Force on Preventive Health Care recommends against routine cervical cancer screening in women under age 20, a strong recommendation based on high quality evidence. Screening in this age group produces the largest number of false positive results and there is no protective effect, while the incidence of cervical cancer is very low. In this schedule, routine screening every 3 years begins at age 25.
- B. The three-yearly interval begins at age 25 in the Task Force schedule, so it does not apply to this teenager.
- C. Annual cytology is not the interval recommended at any age in this Canadian schedule.
- D. A five-year interval belongs to some HPV based programmes for eligible adults and not to the Task Force rule for this age group.
Sources: Canadian Task Force on Preventive Health Care. Cervical cancer screening (ages 20-69, 3-yearly screening, cessation at 70).
6 / 10
A 33-year-old woman at 36 weeks gestation is diagnosed with severe pre-eclampsia: BP 164/108 mmHg on two readings 15 minutes apart, urine protein-to-creatinine ratio 540 mg/mmol, severe headache, and visual disturbance. Platelet count is 98 × 10⁹/L. Fetal growth is normal on ultrasound.
What are the two most critical immediate interventions?
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Answer: A. IV magnesium sulphate for seizure prophylaxis AND antihypertensive therapy (IV labetalol or hydralazine) to reduce BP
Why: Severe pre-eclampsia features (any 1): BP ≥160/110 mmHg, platelets <100 × 10⁹/L, creatinine >88 µmol/L, elevated transaminases, pulmonary oedema, new-onset headache, visual disturbance. MgSO₄ toxicity monitoring: patellar reflexes (absent = toxicity), RR ≥12/min, urine output ≥25 mL/hr. Antidote: calcium gluconate 1 g IV. Maternal mortality prevention: aggressive BP control (first-line in Canada: IV labetalol or nifedipine PO), MgSO₄, and timely delivery are the three pillars.
- B. At 36 weeks, fetal lungs are mature and corticosteroids add minimal benefit. Deferring delivery for 1 week in severe pre-eclampsia with neurological symptoms is dangerous — it risks eclampsia, stroke, placental abruption, and maternal death. Delivery planning should be within 24–48 hours.
- C. Severe pre-eclampsia (BP ≥160/110 + severe features: headache, thrombocytopenia, heavy proteinuria) requires inpatient management with IV antihypertensives and MgSO₄. Home management risks undetected deterioration and eclampsia.
- D. Platelet transfusion is indicated for thrombocytopenia-related bleeding or pre-operatively if platelets <50 × 10⁹/L for C-section (or <80 for neuraxial anaesthesia). With platelets 98 × 10⁹/L and no active bleeding, it is not the immediate priority — BP control and seizure prophylaxis take precedence.
Sources: SOGC Hypertensive Disorders of Pregnancy Guideline No. 307 (2022 revised); MAGPIE Trial (Lancet 2002)
7 / 10
A 33-year-old woman has an uncomplicated vaginal birth at term and is discharged home with her healthy newborn. At the time of discharge she asks when the baby and she will next be seen.
Which follow-up schedule reflects Canadian guidance?
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Answer: D. Review within the first week, with a further checkup typically around 4 to 6 weeks
Why: Newborn infants and their mothers should be seen by a knowledgeable caregiver within the first week, and family doctors and midwives typically arrange a further checkup at around 4 to 6 weeks postpartum. Waiting until six weeks leaves the early assessment undone, and the mode of birth does not change the recommended early review. An annual visit is far later than either of the recommended contacts, so the schedule that includes both an early visit and a later checkup is correct.
- A. A six-week visit is part of postpartum care, but it does not replace the early assessment in the first week.
- B. The mode of birth does not change the recommendation for an early visit for the mother and the baby.
- C. An annual review is far later than the recommended early visit and the subsequent postpartum checkup.
Sources: SOGC PregnancyInfo.ca: Postpartum health care and 6-week postpartum visit
8 / 10
A 30-year-old woman requests a medical abortion. She is uncertain about her last menstrual period. Transvaginal ultrasound shows an empty uterus and her beta human chorionic gonadotropin is 4200 IU/L. She has no pain or bleeding.
What does the SOGC medical abortion guideline advise?
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Answer: D. Evaluate for ectopic pregnancy before proceeding
Why: The SOGC medical abortion guideline states that when the transvaginal ultrasound demonstrates an empty uterus and the beta human chorionic gonadotropin is above 2000 IU/L, the woman should be evaluated for an ectopic pregnancy with appropriate counselling, investigations and follow-up. A pregnancy of unknown location can represent an early intrauterine pregnancy, a failing pregnancy or an ectopic pregnancy, and ectopic pregnancy is an absolute contraindication to mifepristone and misoprostol. Proceeding with abortion drugs, delaying assessment or treating with methotrexate before the diagnosis is established would all be inappropriate.
- A. Proceeding is unsafe here, because an unrecognised ectopic pregnancy is a contraindication to these drugs and can be life threatening.
- B. Deferring assessment for 2 weeks risks a ruptured ectopic pregnancy, and the guideline requires evaluation now.
- C. Methotrexate is a treatment for a confirmed ectopic pregnancy, and the diagnosis has not yet been established in this patient.
Sources: SOGC Clinical Practice Guideline No. C14: Medical Abortion (2016)
9 / 10
A 22-year-old woman has decided to feed her newborn infant formula. She asks her family physician how formula compares with breast milk and whether her baby will miss anything important.
What should she be told, based on PregnancyInfo (SOGC)?
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Answer: D. Formula provides the basic nutrition for growth but does not contain the immune-boosting components of breast milk
Why: PregnancyInfo describes formula as different from breast milk but the closest available alternative that still gives the baby the basic nutrition needed to grow. It does not contain the many immune-boosting components of breast milk, and the long-term benefits of breastfeeding for mother and infant are not replicated with formula. The resource advises that the decision to use formula should be made carefully, that formula must be prepared, stored and sanitised correctly, and that bonding with the baby still occurs because other family members can share feeding.
- A. The resource stresses that formula is different from breast milk and that the long-term benefits of breastfeeding are not replicated by formula.
- B. The resource states that bonding still occurs and that the baby's other parent or family members can share feeding and closeness.
- C. Colostrum produced in the first days is described as the perfect food for the newborn, so discarding it would run against the advice.
Sources: PregnancyInfo.ca (SOGC): Feeding Your Baby
10 / 10
A 22-year-old woman at 9 weeks gestation presents with severe nausea and multiple daily vomiting episodes for 4 weeks, now with inability to tolerate any oral intake for 3 days. Weight loss is 6 kg from pre-pregnancy weight. Vital signs: HR 104 bpm, BP 102/68 mmHg (orthostatic drop), dry mucous membranes. Labs: sodium 130 mmol/L, potassium 2.8 mmol/L, creatinine 122 µmol/L. Urine dipstick: ketonuria 3+.
What is the most appropriate management?
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Answer: A. IV fluid resuscitation (normal saline with potassium), IV thiamine before dextrose, anti-emetics (dimenhydrinate or ondansetron), and hospital admission
Why: Hyperemesis gravidarum (HG) affects 0.3–3% of pregnancies. Diagnostic criteria: weight loss >5% pre-pregnancy weight, ketonuria, dehydration, electrolyte disturbances. Thiamine supplementation before dextrose is critical to prevent Wernicke encephalopathy in any malnourished/vomiting patient. Canadian first-line: pyridoxine/doxylamine (Diclectin) — safe in first trimester, only anti-emetic with Category A safety data in pregnancy. Ondansetron: effective but category B; some cardiac malformation data controversy — use after first-line failure. Nasogastric/nasojejunal feeding or TPN for refractory HG.
- B. Ginger and dietary measures (small frequent meals, avoiding triggers) are appropriate for mild nausea and vomiting of pregnancy. This patient has hyperemesis gravidarum (severe NVP with weight loss >5%, electrolyte disturbances, ketonuria) — oral therapy is insufficient; IV fluid resuscitation and hospital admission are needed.
- C. Termination is not indicated for hyperemesis gravidarum — effective medical management resolves symptoms in most patients. This option should not be presented as a treatment for NVP/HG.
- D. This patient's clinical picture (orthostatic hypotension, severe electrolyte disturbances, ketonuria, inability to tolerate any oral intake) indicates hyperemesis gravidarum requiring hospital admission for IV therapy — oral medications are insufficient acutely.
Sources: SOGC Clinical Practice Guideline No. 339 — NVP and HG 2016; ACOG Hyperemesis Practice Bulletin
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