NBME OB/GYN form 1 and 2 questions
Hey guys, just a few questions I got wrong and googled around and couldn't find answers for these ones in particular.
32yo G5P4 at 18WGA comes for routine visit. Rh negative. Previous pregnancies required C sections between 33-35WGA for premature labor and breech presentation. Otherwise uncomplicated. Received RhoGam during each pregnancy. No medical history, current pregnancy uncomplicated. Her father has HTN, mother had DM2. HR 68, BP 110/60. Physical and pelvic exam normal. US shown intrauterine pregnancy of single fetus with normal anatomy in breech presentation. Uterus is bicornate. Pt is at increased risk for:
A) Abruptio placentae
D) Preterm labor and delivery
E) Rh isoimmunization (WRONG)
Previously health 18yo comes in with 1 day of fever, nausea, vomiting, diarrhea, diffuse rash. No medical or surgical hx. Menses at 30 day intervals. LMP started 3 days ago. Uses tampons and pads during periods. Sexually active with one male partner and started using the patch. Appears ill. Temp 102.2 (39), HR 96, RR 22, BP 90/60. Exam shows diffuse erythematous maculopapular rash over perineum and thighs. Pelvic shows cervical motion, uterine, and bilateral adnexal tenderness with no masses. Most likealy agent:
A) Chlamydia trachomitis
B) Haemophylus Ducrei
D) Neisseria gonorrhoeae (WRONG)
E) Staphyloccocus aureus
47 yo comes in 2 weeks after finding breast lump on self exam. Started estrogen replacement therapy 3 months ago and has had breast engorgement since that time. Exam of left brest shows 2cm tense, mobile, cyst like structure at 11oclock position. No breast discharge of palpable axillary nodes. Right breast is normal. Mammography 3 months ago showed normal findings. Next step:
A) Repeat mammography (WRONG)
B) Decrease dose of estrogen
C) Discontinue estrogen replacement therapy
D) FNA biopsy of cyst
E) Excisional biopsy
3 days after C section at term because of failure to progress, a 27yo woman has temp of 101.8 (38.8) and mild pain with urination. Has not had urinary urgency or frequency She is bottle feeding. Physical shows clean intact incision site with no erythema. Lungs CTAB. Breasts are tense, erythematous, and tender. Uterus is firm, nontender, and consistent in size with 20WGA. Labs:
WBC: 6500 with normal diff
A) Breast engorgement
B) Cystitis (WRONG)
E) Wound cellulitis
27 yo primigravid at 14WGA comes in to ED for 24hr history of nausea and right sided abdominal pain. Also has loss of appetite x2days. Has not had vomiting, pregnancy is uncomplicated. TEmp is 100.8 (38.2), HR 94, RR 20, BP 120/80. Fetal heart tones are heard. Abdomen exam shows RLQ tenderness with no rigidity or rebound. Labs:
WBC: 16500 (80% neutron)
E) Salpingitis (WRONG)
42yo G3P3 comes in for routine exam. Over past year menses have occurred at irregular 2 to 3 month intervals and have lasted 7-21 days. LMP was 6 weeks ago. Has DM2 treated with metformin. BMI 32. Physical exam shows no other abnormalities. Pelvic exam shows an irregular enlarged uterus measureing 12x8x6cm. Endometrial biopsy shows atypical complex hyperplasia. Which of the following is stronges predisposing factor for this patients condition?
A) Age (WRONG)
C) Leiomyomata uteri
D) Metformin therapy
7. 25yo woman who is HIV+ comes in because of thin, clear vaginal discharge and increased urinary frequency for 2 weeks. LMP was 6 weeks ago. MEnses occurred at regular 28 day interbals. Meds include antiretrovirals but she has been noncompliant. Uses condoms occasionally. Exam shows friable cervix. Uterus slightly enlarged and the adnexa are normal bilaterally. Diagnosis?
A) Cervical cancer (WRONG)
B) Cervical dysplasia
D) Endometrial hyperplasia
E) Hypothalamic amenorrhea
8. 3 days after C section because of CPD a 27yo woman has temp of 101.1 (38.4). /no cough, SOB, urinary frequency, urgency, or dysuria. Labor lasted 18 hours. Lungs CTAB. Abd soft nontender without rebound. Exam of incision shows erythema and induration. Minimal tenderness of uterus on palpation and no CVA tenderness. Labs:
WBC: 14,800 (87% neutron)
Urine WBC: 5-10/hpf
B) Calculous cholecystitis
C) Diverticular abscess
E) Postpartum endometriris (WRONG)
G) Septic pelvic thrombophlebitis
I) Viral gastroenteritis
J) Wound infection
32 yo primigravid at 6WGA comes in for 3 day history of moderate vaginal bleeding. Last seen in ED 1 week ago with similar symptoms. Pelvic US at that time showed thickened endometrial stripe and no fetal pole. BHCG was 450. Today HR is 80, BP 110/60. Pelvic exam shows closed cervix and nontender uterus consistent in size with 6WGA. No palpable adnexal masses. Today hgb is 11.8, BHCG is 90. Next step?
A) Third measurement of BHCG in 1 week
B) Administration of methotrexate (WRONG)
C) Progesterone suppositories
D) Admission to hospital
E) Endometrial biopsy
Previously healthy 57yo woman comes in 2 month history of vulvar itching. Otherwise asymptomatic takes no meds. Menopause occurred 7 years prior. Not bee sexually active for 10 years. Exam shows a 1x1.5cm ulcerated lesion in inner right labium majus surrounded by mild erythema. No other lesions noted. No inguinal adenopathy. Diagnosis?
B) Hypertrophic vulvar dystrophy
C) Lichen sclerosus (WRONG)
D) Primary syphilis
E) Vulvar carcinoma
F) Vulvar condylomata acuminate
22 yo G3P1A1 at 33WGA comes in for routine care. Pregnancy uncomplicated, received care since 7WGA. US at 24WGA was normal. DM1 and postprandial serum glucose was 95 at 28WGA. BP 110/72. Fundal height 38cm. Blood A+. Diagnosis?
A) Error in gestational age (WRONG)
B) Multiple gestation
C) Pelvic tumor
E) Normal pregnancy variation of fundal height
36hr post C section due to prolonged labor 22yo woman has abdominal cramping and nausea and vomiting. Temp 101.8 (38.8) HR 98 BP 110/64. Exam shows diffuse lower abdomen tenderness with some coluntary guarding but no rebound. Incision is CDI. WBC is 15000. Urine cath in place, urinalysis shows multiple RBS. Next step?
A) CT of pelvis
B) IM methylergonovine
C) IV ampicillin and gentamycin
E) Surgical exploration (WRONG)
13. 21yo primigravid at 40WGA admitted in labor. Cervix 100% effaced 5cm dilated. Leopold maneuvers show fetus in transverse presentation with back towards pelvis. Next step?
A) Await spontaneous vaginal delivery (WRONG)
D) Internval version and breech extraction
E) C section
16 yo girl brought in by mom for never having a period. Otherwise healthy. 5'9" (175cm) and 135lbs (61kg). Breasts are tanner stage 3. No axillary or pubic hair. Pelvic exam shows vagina 2cm in length. Pelvic US shows no uterus. Diagnosis?
A) Adrenal insufficiency
B) Androgen insensitivity syndrome
C) Imperforate hymen
D) PAramesonephric (mullerian) duct agenesis (WRONG)
E) Premature ovarian failure
15. 24yo woman G3P3 comes in for not having a period since birth of third child 13 months ago via vaginal delivery. Delivery complicated by postpartum hemorrhage requiring D%C. Breast fed infant for 4 months. Long standing hx of bloating and mood changes with menses. Sexually active with husband, uses condoms. No other med hx. BMI 28. Remp 98.5, HR 64, BP 120/70. Normal sized thyroid. Breast, abdomen, pelvic exam normal. TSH, FSH, prolactin levels normal. BHCG negative. Progestin challenge test shows no withdrawal bleeding. Diagnosis?
A) Asherman syndrome
C) HPA dysfunction (WRONG)
E) Premature ovarian failure
47 yo woman comes in for routine exam. Sometimes feels hot at night and sometimes during day. No other symptoms. No med hx no medications. LMP was 4 months ago. Sexually active with one male partner, no contraception. BMI 24. Temp 98.7 (37.1, HR 70, RR 12, BP 90/50. Moderate discomfort during pelvic exam due to vaginal dryness. Uterus enlarged and mildly boggy. No vulvar, cervical, vaginal lesions, or adnexal masses. Remainder of exam normal. FOBT negative. Next step?
B) Measure FSH (WRONG)
C) Measure BHCG
D) Mesure prolactin
E) Measure TSH
Last edited by petrok; 08-19-2015 at 10:31 AM.
1.) 27 yo primigravid @ 30wks delivers a 1530g (3lb 6oz) newborn. Pregnancy was complicated by premature rupture of the membranes at 25 weeks' gestation; observation prior to spontaneous labor showed little to absent amniotic fluid. Apgar scores are 3 and 1 at 1 and 5 minutes respectively. Which is the most likely explanation for the neonatal condition?
b. down syndrome
c. fetal growth restriction
d. gonadal dysgenesis (45X, Turner)
e. Hydrops (WRONG)
f. pulmonary hypoplasia
2.) Three days after cesarean delivery because of fetal distress, a hospitalized 42yo woman is found unconscious. She is 5'4" 180lbs, BMI 31. Temp 100.4, pulse 120, RR 26, BP 60/40. Bilateral wheezing is heard. Cardiac exam shows a pleural friction rub. The fundus is firm. Labs show Hemoglobin 11; Leukocytes 8000; Platelet 175,000; Bleeding time 5min; PT 14sec/PTT 35sec; Thrombin time 1sec; Plasma fibrinogen 300 (N=200-400); Fibrin split products <10 (N<10). ABG shows respiratory acidosis.
A blood smear shows no abnormalities. Xray shows atelectasis. ECG shows tachycardia w/ cor pormonale. What is the most likely diagnosis?
a. amniotic fluid embolism
b. cardiac arrythmia
c. cerebral hemorrhage
f. hypovolemic shock
i. pulmonary acid aspiration syndrome
j. pulmonary embolism
k. seizure d/o
l. septic shock
3. An asymptomatic 37yo w/ 5year history of HIV comes in for follow up. Her last visit 8 months ago showed normal findings. A pap smear 2 years ago was normal. Cd4 count 2 weeks ago was 425; HIV viral load was undetectable. She is currently receiving antiretroviral therapy. Serum lipid studies were within normal limits 3 years ago. Examination shows no abnormalities. Which of the following is the most appropriate screening test for this patient?
a. pap smear
b. serum lipid studies (WRONG)
c. X-ray of chest
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