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NBME Explanations

OBGYN NBME Form 2 Questions and Answers

Discussion in 'Shelf Exams' started by orthopod, Jun 4, 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. Asymptomatic 37yo F with 5-year history of HIV infection. Last visit 6 mo ago was normal. Pap smear 2 years ago normal. CD4+ T count 2 weeks ago was 425, plasma HIV viral load undetectable. Currently on antiretroviral Rx. Lipisd normal 3 years ago. Most appropriate screening test?
    - Pap smear

    2. Three days after cesarean for cephalopelvic disproportion, 27yo with T 38.4. No cough, SOB, urinary frequency or urgency, or dysura. Labor lasted 18 hours. Lungs clear. Incision shows erythema and induration. No CVA tenderness. Labs show WBC 14.8K (87% PMNs), 5-10 urine WBCs. Cause of fever?
    - Wound infection

    3. 57-yo F with 2-month history of vulvar itching. Asymptomatic, no meds. Menopause 7 years ago. Not been sexually active for 10 years. 1 x 1½-cm ulcerated lesion on the inner right labium majus surrounded by mild erythema. No inguinal adenopathy, Dx?
    – Vulvar carcinoma

    4. 47-year-old G2P2 with 9-mo hx of irregular periods and bleeding between menses, which occurs at 2- to 3-month intervals and last 1- days. Has HTN. Smoked two packs of cigarettes daily for 30 years. BP 160/50. Endometrial biopsy specimen show proliferative endometrium. Next step?
    - Cyclic progestin therapy

    5. Three days after cesarian for fetal distress, 42-year-old found unconscious. BMI 31. T 38C, pulse 120/min, resp 26/min, BP 60/40. Bilateral wheezing heard. Cardiac exam shows pleural friction rub. Fundus is firm. Labs show: Hb 11, WBC 11k, plates 175k, plasma fibrinogen 300, fibrin split products < 10 ug/mL. ABG shows pH 7.26, PCO2 28, PO2 60. CXR shows atelectasis. ECG shows tachycardia with cor pulmomale. Dx?
    - Pulmonary embolism

    6. 32-year-old G3P2 at term admitted in labor. Contractions every minutes for the past 8 hours. VSS. Cervix 100% effaced and 4 cm dilated, vertex at -2 station. Membranes suddenly rupture, yielding a large amount of clear fluid. FHR decreases to 90/min. Next step?
    - Pelvic examination

    7. 15-year-old girl with nausea/vomiting, and lower abdominal pain for 4 days. LMP 9 days ago. Sexually active and does not use contraception. Pulse 105/min. Bilateral lower abdominal tenderness and peritoneal signs. Copiouis yellow cervical discharge and exquisite uterine tenderness. Next step?
    - Admission to the hospital for intravenous antibiotic therapy

    8. 19-year-old primi in labor for 16 hours. Membranes been ruptured for 11 hours, and she has had nine vaginal examinations. T 38.4C. Fetal heart tracing shown. Cause of tracing?
    - Maternal fever

    9. 22-year-old G3P1A1, at 33 weeks’. Ultrasonography at 24 weeks’ normal. Has type 1 diabetes mellitus, and her postrandial serum glucose concentration was 95 at 28 weeks’ gestation. Fundal height is 38 cm. Blood group is Rh-positive. Dx?
    - Polyhydramnios? NOT Error in gestational age

    10. 12-year-old girl with 1-year hx of progressive facial hair growth and acne. She has grown 4 inches during the past 4 months. Breast development Tanner 1, and axillary and pubic hair development Tanner 3. Dark hair over upper lip, cheeks, and chin. Acne vulgaris over the cheeks. 2-cm vaginal canal, significant clitoromegaly, posterior laboscrotal fusion, and no cervix or palpable uterus. Abdominal U/S shows bilateral gonads without follicles. No uterus. Chromosomal analysis will show?
    - 46, XY

    11. 28-ear-old G2P1 at first prenatal visit. LMP 10 weeks ago. First child was 10-lb male. During this rpenancy, she is at increased risk for?
    - Gestational diabetes

    12. 22-year-old F with bump on vulva for 1 week. Sexually active with 1 partner. Uses OCP. Multiple 0.25-cm raised, crusty papules on the posterior fourchette. Pap smear shows low-grade squamous intraepithelial lesions. Dx?
    - Condylomata acuminata

    13. 32-yo G3P2 delivers 9-lb 1oz newborn at term following 2-hr second stage of labor assisted by a medial episiotomy. Placenta delivers 12 minutes later using gental cord traction. Following delivery of placenta, firm pale mass noted in lower vagina. Moderate vaginal bleeding. Pt develops SOB, HR 68/min, BP 60/40. Uterus cannot be palpated. Dx?
    - Uterine inversion

    14. 27-year-old primi at 30 weeks’ delivers 1530-g newborn. Complicated by premature rupture of the membranes at 25 weeks’; observation prior to spontaneous labor showed little to absent amniotic fluid. Apgar scores at 3 and 1 and 1 and 5 min. Explanation for the neonatal condition?
    - Pulmonary hypoplasia

    15. 37-year-old G2P2 wants contraceptive advice. Sexually active with husband, and use condoms, wbut would like to switch. Smoked one pack of cigarettes daily for 20 years. No STDs, HTN, headaches, venous thromboembolism, or depression. Neisseria gonorrhoeae and Chlamydia trachomatis negative. Which contraceptive is contraindicated?
    - Triphasic oral contraceptives

    16. 25-year-old nulligravid has not had a menstrual period for 1 year. Menarche at 13, menses at regular 2-d intervals. 2 years ago, period irregular, 45- to 90-day intervals until she became amenorrheic. No illness, no meds, no tobacco/etoh/drugs. Runs 7 miles daily. BMI 17. Serum hormone concentration will show?
    - Decreased estrogen and follicle-stimulating hormone (FSH) concentrations

    17. 57-year-old with 6-month history of urinary urgency and loss of urine that requires use of absorbent pad. Rarely leaves her house because she is afraid of having loss of urine in public. Awakens once each night to void. No fever, pain with urination, or blood in urine. Urine stream normal. U/A normal. Pelvic u/s shows a 3-cm, anterior uterine mass consistent with a benign leomyoma uteri. Cause of incontinence?
    - Detrusor instability

    18. 32-year-old nulligravid with 34-year-old husband unable to conceive for 3 years. Menarche at 12, menses regular. Used OCPs for 3 years. Has had multiple sex partners. Cervical cultures are negative. Semen analysis normal. Next step?
    - Hysterosalpingography?

    19. 27-year-old primi at 14 weeks’. Endovaginal exam shows a viable twin gestation consistent in size with an 8-week gestation. There are two yolk sacs and a thick dividing membrane. Ultrasound is shown. Most likely has which of the following types of twin gestation?
    - Dichorionic

    20. 24-yo primi African American at 11 weeks’. Only medication is prenatal vitamins. BP 120/70. No peripheral edema. FHR is 150/min. At first visit 4 weeks ago, labs showed: Hb 10.2, MCH 20, MCV 72, WBC 10.9k, plates 140k. U/A today shows no glucose, protein, or ketones. Cause of these lab findings?
    - Iron deficiency

    21. 5-yo girl brought in by father 1 day after he noticed blood on her underpants. Had been rubbing and scratching her genital area for the past 5 days. Has had a foul-smelling discharge and burning and itching in that area, worse when she urinates. Also had runny nose. No fever, no illness. Green vaginal discharge and diffuse inflammation of the vulva. Hymen intact. Wet mount shows occasional erythrocytes and numerous leukocytes. Polymicrobial infection. Cause?
    - Vaginal foreign body

    22. 27-year-old nulligravid with dyspareunia and dysmenorrhea for 2 years. Menses regular. Nodularity over the uterosacral area. Uterus is retroverted. Adnexa are normal-sized but tender. Next step?
    - Laparoscopy

    23. 42yo F undergoes amniocenteses and is informed that the fetal karyotype is 46,CC. At birth, the full-term newborn has a phallus and scrotum. Explanation b/w amnio and physical finding?
    - ACTH oversecretion

    24. 16-year-old girl has never had a menstrual period. Otherwise healthy. Breast Tanner 3, no axillary or pubic hair. Vagina is 2 cm in length. Pelvic ultrasonography shows no uterus. Dx?
    – Androgen insensitivity syndrome

    25. 18-year-old primi at 10 weeks’ follow-up exam. At first prenatal visit 2 weeks ago, HIV was positive. Lungs are clear. No axillary or cervical lymphadenopthy. PPD shows 9 mm of induration. Next step?
    - X-ray of the chest
     
  3. donaldbobby

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    #3 donaldbobby, Jul 17, 2017
    Last edited: Jul 24, 2017
    Halp plz!


    23yo goes to ER, acute onset intense RLQ abd. pain for 18 hours; intermittent initially, now constant for 3 hours. LMP was 6 weeks ago, Menses irregular, 32-50 days apart, 3 weeks ago, 5x5x4 cm mass in right adnexa found after a brief episode.
    No sexual activity for 5 months, temp 100F, pulse 100, 138/92, abd. tender w/ rebound and guarding, cannot perform pelvic exam due to pain, U/S shows 10x8x7 cm right-sided mass w/ cystic and solid components

    a. appendiceal abscess
    b. chronic ectopic pregnancy
    c. tubo-ovarian abscess
    d. torsion of an ovarian cyst
     
  4. donaldbobby

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    For past 4 months, perimenopausal 48yo has spontaneous intermittent serosanguineous discharge from left nipple. No palpable mass, mamography normal, what's the cause?

    a. ductal ectasia (wrong)
    b. fibrocystic changes
    c. intraductal carcinoma
    d. intraductal papilloma
    e. recurrent periareolar duct infection
     

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