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100+ Free OB-GYN Shelf Practice Questions

Pass your NBME Clinical Science Subject Examination in Obstetrics and Gynecology exam on the first try — instant access, no signup required.

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A 26-year-old woman wants reliable contraception. She has migraine with aura and smokes no cigarettes. Which option is most appropriate?

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2026 Statistics

Key Facts: OB-GYN Shelf Exam

110

Official Exam Items

NBME Timing Chart

2h45m

Official Testing Time

NBME Timing Chart

40%-45%

Pregnancy/Childbirth/Puerperium Weight

NBME OB-GYN Outline

40%-45%

Female Reproductive System/Breast Weight

NBME OB-GYN Outline

45%-50%

Diagnosis Task Weight

NBME OB-GYN Outline

100

Practice Questions Here

Open Exam Prep

The official NBME Obstetrics and Gynecology Subject Exam is a 110-item, 2 hour 45 minute proctored exam. NBME's current public outline lists Pregnancy, Childbirth, and the Puerperium at 40%-45% and Female Reproductive System and Breast at 40%-45%. Diagnosis accounts for 45%-50% of physician tasks, pharmacotherapy/intervention/management for 20%-25%, and health maintenance/prevention/surveillance for 13%-17%.

Sample OB-GYN Shelf Practice Questions

Try these sample questions to test your OB-GYN Shelf exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 28-year-old woman comes for preconception counseling. She has no medical problems, takes no medications, and has never had a pregnancy affected by a neural tube defect. Which recommendation should be made now to reduce the risk of neural tube defects?
A.Begin folic acid after a positive pregnancy test
B.Take high-dose vitamin A daily
C.Take folic acid 400-800 mcg daily before conception
D.Avoid all exercise during the first trimester
Explanation: Folic acid supplementation should begin before conception because neural tube closure occurs early in pregnancy, often before pregnancy is recognized. Average-risk patients should take 400-800 mcg daily.
2A 24-year-old woman at 9 weeks' gestation presents for her first prenatal visit. She feels well and has no significant history. Which laboratory test should be included in routine initial prenatal evaluation?
A.ABO/Rh type and antibody screen
B.Fetal fibronectin testing
C.One-hour glucose challenge test
D.Group B streptococcus rectovaginal culture
Explanation: Initial prenatal labs include blood type, Rh status, antibody screen, complete blood count, rubella and varicella immunity when indicated, hepatitis B, HIV, syphilis, urine culture, and other risk-based testing.
3A 36-year-old woman at 12 weeks' gestation has cell-free DNA screening that is high risk for trisomy 21. Ultrasound shows a viable intrauterine pregnancy. She asks what should happen before making decisions about the pregnancy. What is the most appropriate next step?
A.Repeat cell-free DNA screening in the third trimester
B.No further testing because screening is diagnostic
C.Maternal serum alpha-fetoprotein testing now
D.Offer diagnostic testing with chorionic villus sampling or amniocentesis
Explanation: Cell-free DNA is a screening test, not diagnostic. A positive result should be confirmed with diagnostic testing such as chorionic villus sampling or amniocentesis before irreversible decisions are made.
4A 31-year-old woman with chronic hypertension wants to become pregnant. Her blood pressure is well controlled with lisinopril. Which medication change is most appropriate before conception?
A.Continue lisinopril because blood pressure control is the only priority
B.Switch to labetalol or extended-release nifedipine
C.Stop antihypertensive therapy until the third trimester
D.Add spironolactone to prevent preeclampsia
Explanation: ACE inhibitors are contraindicated in pregnancy because of fetal renal and skull abnormalities. Labetalol and extended-release nifedipine are commonly used pregnancy-compatible antihypertensives.
5A 26-year-old Rh-negative woman at 10 weeks' gestation has light vaginal bleeding. Ultrasound shows a viable intrauterine pregnancy. Antibody screen is negative. What is the most appropriate management to prevent alloimmunization?
A.Administer Rh(D) immune globulin
B.Administer intravenous immunoglobulin
C.Transfuse O-negative packed red blood cells
D.Delay prophylaxis until 28 weeks only
Explanation: Unsensitized Rh-negative patients should receive Rh(D) immune globulin after potentially sensitizing events, including first-trimester bleeding, pregnancy loss, invasive procedures, trauma, and delivery of an Rh-positive infant.
6A 22-year-old gravida 1 para 0 at 37 weeks' gestation has a positive rectovaginal group B streptococcus culture. She has no medication allergies. What management is indicated during labor?
A.No treatment unless she develops fever
B.Oral amoxicillin starting now
C.Intrapartum intravenous penicillin G
D.Cesarean delivery to prevent neonatal infection
Explanation: A positive group B streptococcus screen at 36-37 weeks is an indication for intrapartum intravenous antibiotic prophylaxis, typically penicillin G, to reduce early-onset neonatal disease.
7A 30-year-old woman at 14 weeks' gestation has a routine urine culture with 120,000 CFU/mL of Escherichia coli. She has no dysuria, fever, or flank pain. What is the best next step?
A.No treatment because she is asymptomatic
B.Treat with a pregnancy-appropriate antibiotic such as nitrofurantoin
C.CT scan of the abdomen and pelvis
D.Daily suppressive antibiotics for the remainder of pregnancy for all patients
Explanation: Asymptomatic bacteriuria in pregnancy should be treated because it increases the risk of pyelonephritis, preterm birth, and low birth weight. A test of cure is commonly performed after treatment.
8A 25-year-old woman at 10 weeks' gestation has persistent vomiting, 8% weight loss, ketonuria, and hypokalemia. She appears dehydrated. What should be included in initial management before giving dextrose-containing fluids?
A.Methimazole
B.Immediate delivery
C.Furosemide
D.Thiamine
Explanation: Hyperemesis gravidarum is treated with IV fluids, electrolyte repletion, antiemetics, and thiamine before dextrose to reduce the risk of Wernicke encephalopathy in malnourished patients.
9A 19-year-old woman has severe nausea and vaginal bleeding at 11 weeks' gestation. The uterus is larger than expected, serum hCG is markedly elevated, and ultrasound shows diffuse echogenic tissue with no fetus. What is the most appropriate treatment?
A.Methotrexate injection
B.Expectant management until spontaneous passage
C.Suction curettage with follow-up serial hCG
D.Oxytocin induction of labor
Explanation: A complete hydatidiform mole is treated with suction curettage followed by serial quantitative hCG monitoring to detect persistent gestational trophoblastic neoplasia.
10A 29-year-old woman at 26 weeks' gestation has a 1-hour 50-g glucose challenge test result of 158 mg/dL. She has no symptoms. What is the next step in diagnosis?
A.Start insulin immediately
B.Perform a diagnostic 3-hour oral glucose tolerance test
C.Repeat the 1-hour test after delivery
D.Diagnose pregestational type 2 diabetes
Explanation: In the two-step approach, an abnormal 1-hour glucose challenge test is followed by a diagnostic 3-hour oral glucose tolerance test for gestational diabetes.

About the OB-GYN Shelf Exam

The NBME Obstetrics and Gynecology Clinical Science Subject Exam is commonly used at the end of a medical school OB-GYN clerkship. The public NBME outline emphasizes pregnancy, childbirth, puerperium, female reproductive system and breast, preventive care, diagnosis, diagnostic testing, management, and applied foundational science.

Questions

110 scored questions

Time Limit

2 hours, 45 minutes

Passing Score

School-defined; NBME provides scaled scores and norms

Exam Fee

Institution-dependent (National Board of Medical Examiners (NBME))

OB-GYN Shelf Exam Content Outline

40%-45%

Pregnancy, Childbirth, and the Puerperium

Preconception care, prenatal screening, normal pregnancy, medical complications, obstetric emergencies, fetal assessment, labor, delivery, postpartum complications, lactation, and medication safety.

40%-45%

Female Reproductive System and Breast

Normal reproductive physiology, menstrual disorders, infertility, contraception, menopause, pelvic pain, vulvovaginal and cervical infections, breast complaints, and neoplasms of the cervix, ovary, uterus, vagina, and vulva.

5%-10%

Other Systems and Multisystem Processes

Systemic disease in pregnancy or gynecology, including endocrine, renal, cardiovascular, infectious, psychiatric, hematologic, and emergency overlap.

1%-5% each where listed by NBME

General Principles, Endocrine, and Social Sciences

Well-patient care, age-related findings, endocrine overlap, communication, ethics, confidentiality, consent, intimate partner violence, and health equity.

Task mix: diagnosis 45%-50%, management 20%-25%, prevention 13%-17%

Clinical Reasoning Tasks

Most questions require the next best diagnostic step, immediate stabilization priority, screening or prevention choice, pharmacotherapy, procedure selection, or recognition of obstetric and gynecologic complications.

How to Pass the OB-GYN Shelf Exam

What You Need to Know

  • Passing score: School-defined; NBME provides scaled scores and norms
  • Exam length: 110 questions
  • Time limit: 2 hours, 45 minutes
  • Exam fee: Institution-dependent

Keys to Passing

  • Complete 500+ practice questions
  • Score 80%+ consistently before scheduling
  • Focus on highest-weighted sections
  • Use our AI tutor for tough concepts

OB-GYN Shelf Study Tips from Top Performers

1Separate third-trimester bleeding causes by pain and placental location: previa is typically painless, abruption is painful with uterine tenderness, and vasa previa causes fetal distress after membrane rupture.
2For hypertensive disorders, decide first whether severe features or seizures are present; magnesium sulfate prevents or treats seizures, while delivery timing depends on gestational age and maternal-fetal status.
3Practice labor questions as next-step decisions: identify stage, contraction adequacy, station, presentation, fetal heart tracing category, and whether immediate delivery is required.
4Know common vaginitis patterns by discharge, pH, microscopy, and partner treatment requirements.
5For abnormal bleeding and amenorrhea, always anchor the algorithm on pregnancy testing, age, cancer risk, ovulatory status, and hemodynamic stability.
6Treat gynecologic oncology questions as diagnostic-sequence problems: biopsy visible cervical or vulvar lesions, sample the endometrium for postmenopausal bleeding, and refer suspicious adnexal masses for surgical staging.

Frequently Asked Questions

How many questions are on the official NBME OB-GYN shelf exam?

The NBME Subject Exam Timing Chart lists the Obstetrics and Gynecology Clinical Science Subject Exam as 110 items with a 2 hour, 45 minute testing time. This site's practice bank contains 100 original practice questions.

What topics are most important for the OB-GYN shelf?

NBME's public outline lists Pregnancy, Childbirth, and the Puerperium at 40%-45% and Female Reproductive System and Breast at 40%-45%. Students should be ready for prenatal care, labor and delivery, postpartum complications, gynecologic infections, menstrual disorders, infertility, contraception, menopause, oncology, pelvic pain, breast complaints, screening, diagnosis, and management.

Is the OB-GYN shelf mostly obstetrics?

No. Obstetrics and gynecology are both major parts of the public outline. Pregnancy, childbirth, and postpartum care form one 40%-45% band, while female reproductive system and breast topics form another 40%-45% band.

Who sets the passing score?

NBME provides equated scores and normative feedback, but medical schools determine how the score is used for clerkship grading, honors cutoffs, remediation, and retakes.

How should I use this qbank?

Work in timed mixed blocks, then review every explanation. For missed questions, identify whether the error was diagnosis, screening, urgent stabilization, medication choice, procedure selection, or longitudinal management.