Saudi Board Obstetrics and Gynecology Final Written Exam (SCFHS) Feed

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A 32-year-old G1P0 at 11 weeks of gestation presents to the clinic to discuss prenatal screening for fetal aneuploidies. She has no significant medical history. Which of the following screening tests offers the highest sensitivity and specificity for Down syndrome (trisomy 21)?

General Obstetrics

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A G2P1 at 38 weeks of gestation is undergoing a biophysical profile (BPP) for decreased fetal movements. The ultrasound demonstrates: 1 episode of fetal breathing lasting 45 seconds, 3 discrete body movements, 2 episodes of limb extension with return to flexion, and a deepest vertical pocket of amniotic fluid measuring 1.5 cm. The non-stress test (NST) is non-reactive. What is the total BPP score for this patient?

General Obstetrics

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A 25-year-old G1P0 at 39 weeks of gestation presents in active labor. On initial assessment, her cervix is 4 cm dilated, 80% effaced, and the fetal station is -1. Contractions are occurring every 3 minutes. Four hours later, her cervical exam is unchanged at 4 cm, but contractions have spaced out to every 5-6 minutes. She is comfortable with epidural analgesia. What is the most appropriate next step in management?

General Obstetrics

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During the vaginal delivery of a 4.1 kg infant to a G3P2 patient, the fetal head is delivered but immediately retracts against the perineum (turtle sign). Gentle downward traction fails to deliver the anterior shoulder. What is the immediate first step in the management of this obstetric emergency?

General Obstetrics

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A G2P1 patient is in the third stage of labor. To minimize the risk of postpartum hemorrhage (PPH), which component of the active management of the third stage of labor (AMTSL) is considered the most critical and effective?

General Obstetrics

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A G1P0 at 33 weeks of gestation is admitted with preterm labor and a prolonged second stage of labor. The fetal head is at +2 station, occiput anterior. Which of the following represents an absolute contraindication to performing a vacuum-assisted vaginal delivery in this patient?

General Obstetrics

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A pregnant patient with irregular menses presents for her first prenatal visit. An ultrasound at this visit measures a crown-rump length (CRL) corresponding to 9 weeks and 2 days. The patient's last menstrual period (LMP) suggests a gestational age of 10 weeks and 0 days. What is the most appropriate method to establish her final estimated date of delivery (EDD)?

General Obstetrics

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A G2P1 patient at 12 weeks of gestation is found to have asymptomatic bacteriuria with Group B Streptococcus (GBS) (>10^5 CFU/mL) on routine urine culture. She is treated with cephalexin and her symptoms resolve. What is the recommended management regarding GBS prophylaxis for her delivery?

General Obstetrics

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A 29-year-old G3P0 presenting at 8 weeks of gestation has a history of two consecutive second-trimester pregnancy losses, both characterized by painless cervical dilation followed by delivery of previable fetuses. Her physical exam is normal. What is the most appropriate management plan for this patient?

General Obstetrics

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A G1P0 patient delivers a healthy term infant. The third stage of labor is actively managed with immediate administration of IV oxytocin. How long should the third stage of labor be allowed to progress before a diagnosis of a retained placenta is officially made, necessitating consideration of manual removal?

General Obstetrics

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Following a normal vaginal delivery, a patient is found to have a perineal laceration. Examination reveals that the laceration extends through the perineal skin, vaginal mucosa, and perineal body muscles, and involves less than 50% of the thickness of the external anal sphincter (EAS). The internal anal sphincter is intact. How should this laceration be classified?

General Obstetrics

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A patient at her 24-week prenatal visit asks about the timing of the tetanus, diphtheria, and acellular pertussis (Tdap) vaccine during her pregnancy. According to the Saudi Ministry of Health and international guidelines, what is the optimal gestational age window for administering the Tdap vaccine?

General Obstetrics

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A 37-year-old G1P0 at 36 weeks of gestation is found to have a fetus in frank breech presentation. She is interested in attempting an external cephalic version (ECV). Which of the following findings is an absolute contraindication to performing an ECV in this patient?

General Obstetrics

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A 31-year-old G1P0 at 41 weeks of gestation is admitted for induction of labor due to post-term pregnancy. On examination, her cervix is 1 cm dilated, 30% effaced, firm, posterior, and the fetal station is -3. This gives her a Bishop score of 2. What is the most appropriate initial method for labor induction in this patient?

General Obstetrics

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A patient in active labor at 39 weeks of gestation has a fetal heart rate tracing showing a baseline of 140 bpm, moderate variability, no accelerations, and recurrent late decelerations occurring with more than 50% of contractions. How should this tracing be categorized according to the NICHD 3-tier system, and what is the initial management?

General Obstetrics

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On postpartum day 3, a patient who underwent a cesarean section for prolonged labor and chorioamnionitis develops a fever of 38.6 C, lower abdominal pain, and foul-smelling lochia. Her physical exam reveals exquisite uterine tenderness. What is the gold-standard antibiotic regimen for the treatment of this condition?

General Obstetrics

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A G2P1 patient at 35 weeks of gestation presents with generalized pruritus, which is most severe on the palms of her hands and soles of her feet. There is no associated skin rash. Her total serum bile acid level is 42 micromol/L (normal <10). What is the recommended delivery timing for this patient to minimize the risk of unexplained stillbirth?

General Obstetrics

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A patient with a twin gestation presents for a first-trimester scan at 11 weeks of gestation. The ultrasound shows two distinct gestational sacs with a thick, triangular projection of tissue extending into the intertwin membrane (lambda sign / twin-peak sign). What does this finding indicate regarding the chorionicity and amnionicity of this pregnancy?

General Obstetrics

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During a vaginal exam on a patient in active labor with ruptured membranes, you palpate a loop of the umbilical cord presenting ahead of the fetal head. The fetal heart rate tracing immediately drops to 70 bpm. What is the priority immediate intervention while preparing for emergency cesarean section?

General Obstetrics

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During normal pregnancy, maternal physiology undergoes significant adaptions. Which of the following changes in the renal system is characteristically observed in a normal singleton pregnancy?

General Obstetrics

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A 26-year-old G1P0 at 35 weeks of gestation is admitted with a blood pressure of 165/115 mmHg on two readings 4 hours apart. Urinalysis shows 2+ proteinuria. She has no headache, visual disturbances, or right upper quadrant pain. Her laboratory results show: platelets 105,000/microL, serum creatinine 1.2 mg/dL (baseline 0.5), and AST 45 U/L. Which of the following findings in this patient establishes a diagnosis of preeclampsia with severe features?

High Risk Pregnancy

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A G1P0 patient at 36 weeks of gestation with preeclampsia with severe features is receiving an intravenous magnesium sulfate infusion for seizure prophylaxis. On assessment, she is somnolent, has absent patellar reflexes, a respiratory rate of 8 breaths per minute, and oxygen saturation of 91% on room air. What is the immediate first-line management for this patient?

High Risk Pregnancy

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A G2P1 patient at 26 weeks of gestation undergoes a two-step screening for gestational diabetes mellitus (GDM). She has a blood glucose of 152 mg/dL after a 50g 1-hour glucose challenge test. She is scheduled for a diagnostic 100g 3-hour oral glucose tolerance test (OGTT). According to the Carpenter-Coustan criteria, what are the four diagnostic threshold values (fasting, 1-hour, 2-hour, and 3-hour) for this test?

High Risk Pregnancy

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A 28-year-old G1P0 at 31 weeks of gestation presents with sudden leakage of clear fluid from the vagina. Amniotic fluid leakage is confirmed by speculum exam showing pooling, positive nitrazine test, and ferning. Maternal vitals are normal. Fetal heart rate is Category I. There is no uterine tenderness or purulent discharge. What is the most appropriate management plan for this patient?

High Risk Pregnancy

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A 35-year-old G3P2 patient at 36 weeks of gestation is found to have complete placenta previa on routine ultrasound. She has been completely asymptomatic throughout her pregnancy with no episodes of vaginal bleeding. What is the recommended delivery plan for this patient?

High Risk Pregnancy

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A G3P2 patient with a history of two prior cesarean deliveries presents at 20 weeks of gestation. An ultrasound shows a complete placenta previa located anteriorly, with loss of the normal retroplacental hypoechoic zone and increased vascular lacunae within the placenta. What is the most appropriate definitive management strategy for this patient's delivery?

High Risk Pregnancy

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A 28-year-old Rh-negative, unsensitized G2P1 patient presents for her routine 28-week prenatal visit. Her antibody screen is negative. What is the correct protocol for administering RhO(D) immune globulin (RhoGAM) to prevent isoimmunization?

High Risk Pregnancy

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A 32-year-old G1P0 at 10 weeks of gestation has chronic hypertension. Her blood pressure is 148/96 mmHg. She is currently taking no medications. According to the Chronic Hypertension and Pregnancy (CHAP) trial and recent guidelines, what is the target blood pressure threshold to initiate treatment, and which medication is preferred?

High Risk Pregnancy

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A 24-year-old G1P0 at 28 weeks of gestation with known severe rheumatic mitral stenosis presents to the emergency department with acute onset of severe dyspnea, orthopnea, and a heart rate of 124 bpm. What is the most appropriate immediate medical management to stabilize this patient?

High Risk Pregnancy

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A G1P0 at 32 weeks of gestation is diagnosed with fetal growth restriction (FGR). The estimated fetal weight is at the 4th percentile. Umbilical artery Doppler assessment demonstrates absent end-diastolic flow (AEDF). What is the recommended delivery timing for this pregnancy?

High Risk Pregnancy

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A monochorionic diamniotic twin pregnancy at 20 weeks of gestation is evaluated. Twin A is found to have polyhydramnios (deepest vertical pocket of 9.5 cm) and a distended bladder. Twin B has severe oligohydramnios (deepest vertical pocket of 1.2 cm) and an empty, non-visualized bladder. Umbilical artery Dopplers are normal in both twins. What is the Quintero stage of this twin-to-twin transfusion syndrome (TTTS), and what is the preferred first-line treatment?

High Risk Pregnancy

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A 28-year-old pregnant school teacher at 16 weeks of gestation presents to the clinic after being exposed to a student diagnosed with erythema infectiosum (Fifth disease), caused by Parvovirus B19. She is asymptomatic. What is the most appropriate initial diagnostic step?

High Risk Pregnancy

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A G1P0 at 34 2/7 weeks of gestation is admitted with preeclampsia. Her blood pressures are stabilized at 145/92 mmHg on IV hydralazine. However, her platelet count is 75,000/microL. The fetus is in cephalic presentation with a Category I heart rate tracing. What is the most appropriate management plan for this patient?

High Risk Pregnancy

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A G1P0 at 38 weeks of gestation is in active labor and receiving IV magnesium sulfate (4g loading dose, then 2g/hr maintenance) for preeclampsia with severe features. Suddenly, she experiences a generalized tonic-clonic seizure lasting 60 seconds. What is the most appropriate first-line pharmacotherapy for this eclamptic seizure?

High Risk Pregnancy

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An HIV-positive G1P0 patient at 36 weeks of gestation has a plasma viral load of 1,200 copies/mL. She has been compliant with her antiretroviral therapy (ART). What is the recommended delivery management to minimize the risk of vertical transmission of HIV to the newborn?

High Risk Pregnancy

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A 28-year-old hypothyroid patient on a stable dose of Levothyroxine (100 mcg daily) presents with a positive home pregnancy test, confirmed by serum beta-hCG. According to the American Thyroid Association (ATA) guidelines, what is the most appropriate immediate adjustment to her Levothyroxine therapy?

High Risk Pregnancy

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A G2P1 patient at 16 weeks of gestation presents with acute left lower extremity swelling and pain. A compression ultrasound confirms a deep vein thrombosis (DVT) in the common femoral vein. What is the preferred anticoagulant regimen for this patient?

High Risk Pregnancy

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A G2P1 patient with systemic lupus erythematosus (SLE) is found to be positive for anti-SSA/Ro and anti-SSB/La antibodies at her initial prenatal visit. What is the primary fetal complication associated with these specific maternal autoantibodies?

High Risk Pregnancy

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A G2P1 patient with a history of a prior spontaneous preterm birth at 30 weeks of gestation presents for a routine anatomy ultrasound at 20 weeks. The transvaginal ultrasound reveals a cervical length of 20 mm. What is the most appropriate management plan to reduce her risk of recurrent preterm birth?

High Risk Pregnancy

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A G1P0 patient at 36 weeks of gestation presents with a 3-day history of nausea, vomiting, epigastric pain, and progressive jaundice. Laboratory evaluation reveals: AST 350 U/L, ALT 380 U/L, total bilirubin 6.2 mg/dL, platelets 85,000/microL, fibrinogen 150 mg/dL, glucose 48 mg/dL, and elevated serum ammonia. What is the most likely diagnosis, and what is the immediate treatment?

High Risk Pregnancy

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A 45-year-old G3P3 patient presents with heavy, irregular menstrual bleeding for the past 6 months. A transvaginal ultrasound reveals a normal-sized uterus with a 2 cm intramural lesion that does not distort the endometrial cavity. The endometrial biopsy shows secretory endometrium. According to the FIGO PALM-COEIN classification system, what is the most likely category of abnormal uterine bleeding (AUB) in this patient?

General Gynecology

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A 26-year-old nulliparous woman presents with severe dysmenorrhea, deep dyspareunia, and chronic pelvic pain that has progressed over the past 3 years. She has tried combined oral contraceptives and NSAIDs with minimal relief. What is the gold-standard method for the definitive diagnosis of endometriosis in this patient?

General Gynecology

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A 42-year-old G3P3 patient presents with worsening menorrhagia and severe dysmenorrhea. On physical exam, her uterus is symmetrically enlarged to approximately 12 weeks size, soft, and globally tender. A pelvic MRI is performed. Which of the following MRI findings is most characteristic of adenomyosis?

General Gynecology

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A 23-year-old patient presents with pelvic pain, fever (38.2 C), and vaginal discharge. On examination, she has cervical motion tenderness, bilateral adnexal tenderness, and mucopurulent cervical discharge. Pregnancy test is negative. She is hemodynamically stable and has no nausea or vomiting. What is the recommended outpatient empirical antibiotic regimen for Pelvic Inflammatory Disease (PID) according to the CDC and Saudi Ministry of Health guidelines?

General Gynecology

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A 28-year-old G2P1 presents with 6 weeks of amenorrhea, mild pelvic pain, and light vaginal bleeding. A transvaginal ultrasound reveals an unruptured right adnexal mass measuring 2.8 cm in diameter with no fetal cardiac activity. Her serum beta-hCG is 3,200 mIU/mL. Her liver and renal function tests are normal, and she is hemodynamically stable. What is the most appropriate management for this patient?

General Gynecology

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During a Pelvic Organ Prolapse Quantitation (POP-Q) examination, the examiner obtains the following measurements: Aa = -3, Ap = -3, Ba = +2, Bp = -3, C = -5, D = -7, gh = 4.5, pb = 3, tvl = 9. Based on these measurements, what is the stage of this patient's anterior vaginal wall prolapse?

General Gynecology

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A 54-year-old postmenopausal woman presents with urinary incontinence. She describes leaking urine when coughing, laughing, or lifting heavy objects. She denies urinary frequency or urgency. On examination, a cough stress test is positive. What is the first-line non-surgical management for this patient's condition, and what is the gold-standard surgical treatment if conservative measures fail?

General Gynecology

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