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NBME Explanations

OBGYN NBME Form 1 Questions and Answers

Discussion in 'Shelf Exams' started by orthopod, Apr 14, 2016.

  1. orthopod

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    I will post the questions (in my own words) and answers here in case anyone has a question regarding one.
     
  2. orthopod

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    Part 1

    1. 32-year-old woman G1P1 with fever and right breast tenderness for 1 day. Breast-feeding her 14d old newborn. Has type 1 DM well controlled with insulin. T 39.3C, HR 122/min, Engorgement of the breasts bilaterally. Erythematous, nonfluctuant, tender area in the upper outer quadrant of the right breast. Dx?
    - Mastitis

    2. 17-year-old girl at student health services because of moderately severe pelvic pain with nausea and vomiting during menses since menarche at the age of 13yrs. Symptoms begin soon after onset of menses and last 48 hours. Ibuprofen provides moderate relief. No fever. Menses regular. Never sexually active. Pelvic exam normal. Dx?
    - Primary dysmenorrhea

    3. 32-year-old nulligravid has not had a menstrual period since she stopped taking OCP 6 months ago. Menses were regular. Has had increased libido, increased facial acne, increased facial hair growth that requires shaving every other day, and scalp hair loss. 11.3-kg weight gain. Sexually active with 1 partner. BMI 33. Has hair between breasts and above the umbilicus. Pelvic exam shows clitoris protruding completely from the clitoral hood. U/S shows 2-cm solid mass in right ovary. Measurement of which serum hormone will be abnormal?
    - Testosterone

    4. 32-year-old primigravid at 10 weeks’ gestation with 5-day history of nausea and vomiting and decreased appetite. Unable to keep solids or liquids down. No fever, chills, sweating, abdominal pain, or vaginal bleeding. NKDA. T 37C, HR 95/min, BP 100/65. Uterus consistent with 10wk gestation. Labs:
    Hb 11.5, WBC 8.5k, platelets 168k, Na 130, Cl 95, K 2.8, HcO3 30. Large Urine ketones.
    Serum thyroid-stimulating hormone and free thyroxine pending. Next step?
    - Admission to the hospital for intravenous hydration and parenteral antiemetic therapy

    5. 67-year-old woman with moderate vulvar itching for 2 years. Otherwise healthy. 1-cm areas of white epithelium over the left labium majus. No inguinal adenopathy or vulvovaginal discharge. Next step?
    - Punch biopsy of the affected areas

    6. 15-year-old girl with 1-week hx of severe abdominal pain. Has had 10 episodes of cramps, each lasts 3 to 5 days. No serious illness, no meds. Never had a menstrual period. Sexually active with one male, no contraception. 80th %ile for height/weight. Tanner stage 5. Mass is palpated in the suprapubic region at the midline. Pelvic exam shows normal-appearing external genitalia and lower vagina. Cervix cannot be visualized because of bluish bulging vaginal tissue that obscures the upper vagina. Urine pregnancy negative. Dx?
    - Hematocolpos

    7. 27-year-old G2P1 3 days after episode of bright red vaginal bleeding with no uterine contractions or cramping. Has had increasing breast size, morning sickness, and extreme fatigue. LMP 8 weeks ago. Vaginal ultrasonography shows normal fetal heart activity. Dx?
    - Normal pregnancy

    8. 42-year-old woman G3P3. Menses have occurred at regular 2- to 3-month intervals and have lasted 7 to 21 days. LMP 6 weeks ago. Has type 2 DM rx w/ metformin. BMI 32. Irregular enlarged uterus measuring 12 x 8 x 6 cm. Endometrial biopsy specimen shows atypical complex hyperplasia. Which is strongest predisposing factor to this condition?
    - Anovulation

    9. 47-year-old woman 2 weeks after found lump in left breast during self exam. Started estrogen replacement therapy 3 months ago and has had breast engorgement since that time. Left breast shows a 2-cm, tense, mobile cyst-like structure at 11 o-clock.No breast discharge or palpable axillary nodes. Mammography 3 mo ago normal. Next step?
    - Repeat mammography?
    - Answer is NOT discontinue estrogen replacement therapy

    10. 42-year-old G8P7 at 42 weeks’ admitted in labor. Contractions q3-4 hours, last 50 to 60 seconds, and have been uncomfortable for the last hour. Has urge to push. Uterus extends 36 cm above pubic symphysis. Fetal weight is 3500 g. Fetal heart tones 144/min. Vaginal exam shows pooling of copious fluid. Cervix completely dilated and effaced. Vertex +2 station in a left occiput anterior presentation. Fetal heart tracing shown. Explanation?
    - Umbilical cord compression

    11. Four weeks after low transverse c-section for cephalopelvic disproportion, 27yo G1P1 with pulling feeling on the right side of her incision for the past 4 days. Exacerbated by movement. Within the past 2 weeks, has initiated n exercise regimen to get back in shape, resumed sexual activity. BMI 29. T 37 C. Abdomen nontender without rebound. Tenderness to deep palpation just lateral to the right and left aspects of the incision. Wound is clear, dry, and intact. Explanation?
    - Normal postoperative course

    12. 23-year-old 3 weeks after diagnosed with a urinary tract infection. Rx with trimethoprim-sulfamethoxazole has relieved her symptoms. This is her third UTI over the past year. No serious illness. T 37 C. No flank tenderness. U/A normal. Daily administration of which is prophylaxis?
    - Trimethoprim-sulfamethoxazole

    13. 21-year-old woman has vaginal discharge and discomfort for 2 days. Sexually active w/ new partner for 2 weeks; he is asymptomatic. Pelvic exam shows a purulent cervical discharge and cervical motion tenderness. Gram stain shown. Organism?
    - Neisseria gonorrhoeae

    14. 22-year-old with 3-day history of pain with urination, intense vaginal itching, and a watery discharge. Smoked one pack of cigarettes daily for 5 years. Sexually active and does not use contraception. T 37C. GU exam shows erythema of the vulva and vagina; there is a yellow-gray frothy discharge with a mildly fishy odor. Cervix normal. pH of the vaginal discharge is 5. A wet mount will show?
    - Flagellated protozoa

    15. 67-year-old woman with 9-month hx of persistent vulvar itching despite rx with OTC zinc oxide, vitamin E, hydrocortisone cream, and miconazole. Has type 2 DM and hypercholesterolemia. BMI 53. Erythematous, swollen vulva, papules and pustules on the medial aspect of the thights, and several excoriations. KOH shows pseudohyphae and budding yeast. Underlying cause of Rx failure?
    - Type 2 diabetes mellitus

    16. 32-year-old woman G5P4 at 18 weeks' gestation for prenatal visit. Rh-negative, hx of c-section for premature labor and breech presentation. Father with HTN, mother has type 2 DM, vitals normal. Ultrasonography shows an intrauterine pregnancy of a single fetus with normal anatomy in breech presentation, uterus is bicornuate. Patient is at risk for which?
    - Preterm labor and delivery

    17. 57-year-old woman routine exam. HTN, Type 2 DM, and generalized anxiety disorder. Great-aunt has a history of breast cancer. Pt receiving hormone therapy with conjugated estrogen and medroxyprogesterone daily since menopause 5 years ago. On HCTZ, metformin, and various herbal medications. Breast shows no masses or nipple discharge. Greatest risk factor for breast cancer?
    - Hormone therapy

    18. 11-year-old girl. Has had recent mood changes, and mother concerned menstural periods will start soon. 75th %ile for height and 90%ile for weight. Tanner stage 3. Recent pubic hair is most predictive of which?
    - Mehnarche is imminent
     
  3. orthopod

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    Part 2
     
  4. Argentsly

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    do you have the rest?
     
    Cara gray likes this.

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