Prometric Exam Questions for Obstetrics and Gynaecology Specialists 2026: 15 Practice MCQs with Answers and Rationale for the OBG5891 Paper

The obstetrics and gynaecology specialist paper (OBG5891) tests registrar-level decisions on the labour ward, in the antenatal clinic, in early pregnancy and in gynaecology: who to deliver and when, which drug and dose in an emergency, what the screening result means and what to do next. It is usually 100 to 150 single-best-answer questions in 2.5 to 3 hours, with a pass mark of about 60%.

The fifteen questions below follow that blueprint. Allow about 70 seconds each and read every rationale. Obstetric emergencies are asked as sequences of actions, and gynaecology leans on screening thresholds and first-line management.

For titles and the route, read the obstetrics and gynaecology specialist guide. For timed papers use the Obstetrics and Gynaecology bank.

Antenatal care and hypertensive disorders

Question 1

A woman at 12 weeks has a history of pre-eclampsia requiring delivery at 34 weeks in a previous pregnancy. The intervention that reduces her risk of recurrence is:

1. Low-dose aspirin from 12 weeks until delivery
2. Bed rest from 20 weeks
3. Prophylactic magnesium sulfate in the third trimester
4. Salt restriction

Answer: A. Low-dose aspirin started before 16 weeks reduces preterm pre-eclampsia in high-risk women. Calcium supplementation is added where dietary intake is low. Bed rest and salt restriction do not prevent pre-eclampsia.

Question 2

A woman at 36 weeks has a blood pressure of 165/112 mmHg, proteinuria and a headache. After starting magnesium sulfate, the first-line antihypertensive is:

1. Oral or intravenous labetalol, with hydralazine or oral nifedipine as alternatives
2. An ACE inhibitor
3. Furosemide
4. Atenolol

Answer: A. Severe hypertension in pregnancy is treated urgently with labetalol, hydralazine or nifedipine to protect the mother from stroke. ACE inhibitors are contraindicated in pregnancy. Delivery is planned once stabilised at this gestation.

Question 3

A 75 g oral glucose tolerance test at 26 weeks shows a fasting glucose of 5.4 mmol/L and a 2-hour value of 8.9 mmol/L. The diagnosis and first step are:

1. Normal; no action
2. Gestational diabetes; dietary advice, glucose monitoring, and metformin or insulin if targets are not met within one to two weeks
3. Type 1 diabetes; insulin immediately
4. Repeat the test at 36 weeks

Answer: B. Either value meets common gestational diabetes thresholds. Management is lifestyle first, then metformin or insulin, with growth scans and delivery planning by 40 to 41 weeks or earlier if complicated.

Labour and delivery

Question 4

A primigravida at term has been 6 cm dilated for 4 hours on an oxytocin infusion with adequate contractions and a reassuring CTG. The most likely cause and next step are:

1. Cephalopelvic disproportion or malposition; reassess position and pelvis and consider caesarean if no progress with adequate contractions
2. Normal labour; wait another 8 hours
3. Give more oxytocin regardless of contraction frequency
4. Immediate forceps

Answer: A. Arrest of the active first stage despite adequate contractions points to a mechanical problem. Instrumental delivery is not an option before full dilatation. Caesarean is indicated when progress stalls with adequate uterine activity.

Question 5

A CTG at 39 weeks shows a baseline of 150, reduced variability under 5 bpm for 50 minutes and repeated late decelerations. The classification and action are:

1. Normal; continue
2. Pathological; intrauterine resuscitation (position, stop oxytocin, fluids) and expedite birth, with fetal blood sampling if appropriate and available
3. Suspicious; recheck in an hour
4. Give the mother oxygen and wait

Answer: B. Reduced variability with repeated late decelerations is pathological and indicates likely hypoxia. Act now; the method of birth depends on cervical dilatation and the speed with which delivery can be achieved.

Question 6

A woman with one previous lower-segment caesarean section wants a vaginal birth. Which statement is correct?

1. Vaginal birth after caesarean is contraindicated
2. Planned vaginal birth is reasonable with continuous monitoring in a unit able to perform emergency caesarean; the risk of uterine rupture is about 1 in 200
3. Induction with prostaglandins is risk-free
4. She must have a caesarean at 37 weeks

Answer: B. VBAC succeeds in roughly 70 to 75% of women with one prior low transverse caesarean. Scar rupture risk is about 0.5%, higher with prostaglandin induction, so monitoring and facilities for immediate caesarean are required.

Obstetric emergencies

Question 7

Thirty minutes after a vaginal birth, a woman has lost 1,200 mL of blood, the uterus is atonic and oxytocin has been given. The next drug options, in the usual sequence, include:

1. Ergometrine (if not hypertensive), carboprost, misoprostol, and tranexamic acid early, while preparing for surgical measures such as balloon tamponade
2. Warfarin
3. Nifedipine
4. Magnesium sulfate

Answer: A. Primary postpartum haemorrhage from atony follows a stepwise uterotonic sequence with tranexamic acid within three hours, fluids and blood products, and escalation to balloon tamponade, compression sutures or hysterectomy if bleeding continues.

Question 8

The head delivers but the shoulders do not follow with gentle traction. After calling for help, the first manoeuvre is:

1. Fundal pressure
2. McRoberts' manoeuvre with suprapubic pressure
3. Immediate symphysiotomy
4. Strong downward traction on the head

Answer: B. Shoulder dystocia is managed with McRoberts' position and suprapubic pressure first, resolving most cases, then internal rotational manoeuvres or delivery of the posterior arm. Fundal pressure and traction cause injury.

Question 9

A woman at 32 weeks presents with painless bright-red vaginal bleeding and a soft, non-tender uterus. The most likely diagnosis and the examination to avoid are:

1. Placental abruption; avoid ultrasound
2. Placenta praevia; avoid digital vaginal examination until praevia is excluded by ultrasound
3. Labour; avoid CTG
4. Cervical ectropion; avoid speculum

Answer: B. Painless bleeding with a soft uterus suggests praevia; a digital examination can provoke torrential haemorrhage. Confirm placental site by ultrasound, give anti-D if RhD negative, and plan delivery by caesarean for major praevia.

Early pregnancy and gynaecology

Question 10

A woman with 6 weeks of amenorrhoea has lower abdominal pain, a positive pregnancy test, an empty uterus on transvaginal ultrasound and a serum hCG of 2,500 IU/L. She is haemodynamically stable. The most likely diagnosis and management are:

1. Early intrauterine pregnancy; repeat scan in two weeks
2. Ectopic pregnancy until proven otherwise; assess for methotrexate criteria or laparoscopic surgery depending on size, hCG trend and symptoms
3. Complete miscarriage; discharge
4. Molar pregnancy; evacuate

Answer: B. An hCG above the discriminatory zone with no intrauterine sac is an ectopic until proven otherwise. Stable women with a small unruptured ectopic and falling or low hCG may receive methotrexate; otherwise laparoscopic salpingectomy or salpingotomy.

Question 11

A 30-year-old's cervical screening shows high-risk HPV positive with low-grade cytology. The next step is:

1. Routine recall in three years
2. Referral for colposcopy
3. Immediate hysterectomy
4. Repeat the smear in six weeks

Answer: B. In HPV-primary screening programmes, a positive high-risk HPV test with any abnormal cytology is referred to colposcopy. HPV-positive with normal cytology is usually repeated in 12 months.

Question 12

A 24-year-old with oligomenorrhoea, hirsutism and polycystic ovaries on ultrasound wants to conceive. After weight optimisation, first-line ovulation induction is:

1. Letrozole (or clomifene) with ultrasound monitoring
2. Immediate IVF
3. Combined oral contraceptive
4. Gonadotrophins as first line

Answer: A. Letrozole is now the preferred first-line agent for ovulation induction in PCOS, with clomifene as an alternative, after lifestyle measures and metformin where indicated. Gonadotrophins and IVF are later steps.

Question 13

A 58-year-old woman reports a single episode of postmenopausal bleeding. The first investigation is:

1. Reassurance
2. Transvaginal ultrasound to measure endometrial thickness, with endometrial biopsy or hysteroscopy if thickened or if bleeding recurs
3. Hormone replacement therapy
4. CT abdomen

Answer: B. Postmenopausal bleeding is endometrial cancer until excluded. An endometrial thickness of about 4 mm or more, or persistent bleeding, requires tissue sampling.

Question 14

A 45-year-old has heavy menstrual bleeding with a normal pelvic ultrasound and a normal endometrial biopsy. She does not want to conceive. The most effective first-line medical treatment is:

1. Levonorgestrel intrauterine system
2. Tranexamic acid alone, long term
3. Iron tablets alone
4. Immediate hysterectomy

Answer: A. The LNG-IUS reduces menstrual blood loss by over 90% and is recommended first line. Tranexamic acid and NSAIDs are alternatives for women who decline hormonal treatment; hysterectomy is a last resort.

Postpartum

Question 15

Five days after a caesarean, a woman has a swollen, painful left calf. The investigation and immediate treatment are:

1. D-dimer only
2. Compression duplex ultrasound, and start treatment-dose low-molecular-weight heparin while awaiting the result
3. Warfarin
4. Bed rest and observation

Answer: B. The postpartum period, especially after caesarean, carries high thrombotic risk. D-dimer is unhelpful in pregnancy and the puerperium. Treat empirically with LMWH until imaging excludes DVT; LMWH is compatible with breastfeeding.

How to use these questions

• Learn the emergency sequences: PPH, shoulder dystocia, eclampsia, cord prolapse, maternal collapse.
• Know the thresholds: gestational diabetes values, endometrial thickness, hCG discriminatory zone, cervical screening pathways.
• Check current guidelines on aspirin prophylaxis, induction timing and VBAC counselling; the exam follows them.
• Practise under time in the Obstetrics and Gynaecology bank with the error-log method.

Midwives sit a separate paper: midwife sample questions. Other specialty banks are listed in specialty question banks for doctors. When you hold eligibility, join the doctor talent pool; obstetricians are among the most requested specialists in the Gulf.

Frequently asked questions

How many questions are in the obstetrics and gynaecology Prometric exam?

Usually 100 to 150 in 2.5 to 3 hours. Your eligibility notice states the exact format.

What is the pass mark?

About 60% for the specialist paper, scaled at some authorities, and higher for consultant titles.

Does the paper include gynaecological oncology and infertility?

Yes, at the level of recognising, investigating and referring, alongside first-line management.

Can an MD or MS in obstetrics and gynaecology skip the exam?

Sometimes, depending on the authority's recognition of the degree and the title applied for; see the exemptions guide.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.