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  #1  
Old 03-17-2016
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Default NBME OBGYN Form 3

I have answers to all but these eight Q's. Can anyone help?


1. 32 yoF with Type 1 diabetes increasingly severe perineal pain over the past 3 days. Pelvic examination shows a 5 x 5-cm tense cystic mass in posterior right labium majus with cellulitis extending past the right pubic hairline. Which is the most serious complication of this condition?

a) Bartholin gland abscess
b) Chlamydial sepsis
c) Gram-positive sepsis
d) Necrotizing fasciitis
e) Perirectal abscess

*C is incorrect
-----------------------------------------------------------------------------------------

2. 37 yoF g1p1, with recently diagnosed breast cancer comes to the physician for advice regarding contraception. She will begin chemotherapy and radiation therapy in 6 weeks. Had been using OCPs for 3 years but stopped 8 weeks ago on advice of her oncologist and began using condoms. Since disctonuing OCP therapy, she had one menstrual period that lasted 4 days. Previously, menses occurred at regular 27-day intervals and lasted 3 to 4 days. Delivered 1st chidl 18 months ago, wishes to have another child in future. No hx of serious illness, takes no meds. BP is 115/72. Pelvic exam normal. Which is the most appropriate contraception for this patient?

a) Progestin-only oral conraceptive
b) Diaphragm
c) Placement of a copper IUD
d) Depot medorxyprogesterone
e) Etonogestrel implant

*B is incorrect
-----------------------------------------------------------------------------------------

3. healthy 32 yoF comes because of 2-day hx of vaginal bleeding and lower abdominal cramps. LMP was 7 wks ago. Sexually active with one partner, use condoms consistently. Takes no meds. Pulse 90, BP 100/65. Phsy exam shows soft abdomen and LQ tenderness. Speculum exam shows moderate vaginal bleeding and a closed cervical os. Preg test is negative. Transvaginal US shows fluid-filled endometrial cavity and no gestational sac. Her quantitative serum B-hCG is 2500 → 48 hours later, BhCG is 2800. Which is most likely diagnosis?

a) Blighted ovum
b) Complete spontaneous abortion
c) ectopic pregnancy
d) Hydatidiform mole
e) normal intrautrein pregnancy

*A is incorrect
-----------------------------------------------------------------------------------------

4. 18 yoF comes bc of irregular menses over the past 3 months; menses occur at 14- to 40-day intervals. Menstrual flow varies from spotting to heavy cramping and bleeding; the latter sxs have caused her to miss shool. Her LMP was 3 weeks ago. Menarche was at age 12 and menses had occurred at regular 28-day intervals for 6 years. She has sedentary lifestyle. She is 165cm (5ft5in) and weighs 63kg (139lb); BMI is 23. Pelvic exam is normal. Urine preg test negative. Which is the best next step in management?

a) Conjugated estrogen therapy
b) Cyclic progesterone therapy
c) Hysteroscopy
d) Endometrial biopsy
e) Dilation and currettage

*C is incorrect
-----------------------------------------------------------------------------------------

5. A 27 yoF G2P1 at 30 weeks gestation comes bc of chronic fatigue for 2 months; she has had a 10lb weight loss during this period. Had no prenatal care. Hx of ETOH and drug abudse. 5ft6in tall, 130lm; BMI is 21. Apperas chronically ill. Examination shows pallor. Uterine fundal heigh is 28cm. Fetal heart rate is 140/min. Labs show
Hgb → 6
Mean corpusc hgb → 30
Mean corpusc volume → 101
Leukocyte count → 4300
Reticu count → 0.1%
Platelet count → 130k
Prothrombin time → 13sec
Serum
- bilirubin → 1
- ALT → 16

Which is the most likely cause of patients anemia?

a) Bone marrow hypoplasia
b) Cirrhosis
c) folic acid deficiency
d) hepatitis
e) iron deficiency
f) vitamin b12 (cobalamin) deficiency

*A is incorrect
-----------------------------------------------------------------------------------------

6. 42 yoW with lupus comes for followup. 2 weeks ago, prednisone therapy was begun bc of flare up; this is her 3rd course of prednisone during past 18 months. Today patient feeling well. Menses occur at reg 28-day intervals. Only other med are vitmain D and calcium. She has no other hx of serious illness, no fam hx of serious illness. No known allergies. Does not smoke cigarettes or drink alcohol. She is 5ft5in and weighs 140; BMI is 23. Pulse is 70, BP is 108/64. Exam shows no abnormalilites. Which is the most appropriate pharmacotherapy to prevent osteoporosis in this patient?

a) Alendronate now
B) Calcitonin now
C) Estrogen and progesterone now
D) Estrogen alone at onset of menopause
E) Raloxifene now

*D is incorrect
-----------------------------------------------------------------------------------------

7. 47 yoF comes to ED because of 4 day hx of increasing pain with urination. 5 days ago, began treatment with a sulfonamide abx by her primary phsyician after a phone consultation; she has not had relief of her sxs. Has no hx of serious illness, abnomral Pap smears, or STIs. Currently takes no meds. States shes been having ↑ stress during pass month. Pelvic exam sows an exquisitely tender ulcer on the lower labium minus. Photograph shown. Which is the most likely diagnosis?

a) Candidiasis
b) Condyloma acuminatum
c) Herpes simplex virus 1
d) Molluscum contagiousum
e) Paget disease

*E is incorrect
-----------------------------------------------------------------------------------------

8. 27 yoF nullgiravid comes because unable to conceive for 3 years. Menses occur at irregular 35- to 42- day intervals and last 8 days. Laparoscopy 8 weeks ago showed spill from both fallopian tubes after methylene blue dye was instilled into the cervix; no evidence of endometriosis. Husband has two children from previous marriage. Pelvic exam shows normal-sized uterus and no palpable masses. Postcoital test shows many motile sperm. Which is the most appropriate pharm?

a) Clomiphene
b) Danazol
c) Leuprolide
d) Levothyroxine
E) Menotropins
F) Progesterone

*C is incorrect
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  #2  
Old 03-27-2016
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Quote:
Originally Posted by usmle41967 View Post
I have answers to all but these eight Q's. Can anyone help?


1. 32 yoF with Type 1 diabetes increasingly severe perineal pain over the past 3 days. Pelvic examination shows a 5 x 5-cm tense cystic mass in posterior right labium majus with cellulitis extending past the right pubic hairline. Which is the most serious complication of this condition?

a) Bartholin gland abscess
b) Chlamydial sepsis
c) Gram-positive sepsis
d) Necrotizing fasciitis
e) Perirectal abscess

*C is incorrect
-----------------------------------------------------------------------------------------

2. 37 yoF g1p1, with recently diagnosed breast cancer comes to the physician for advice regarding contraception. She will begin chemotherapy and radiation therapy in 6 weeks. Had been using OCPs for 3 years but stopped 8 weeks ago on advice of her oncologist and began using condoms. Since disctonuing OCP therapy, she had one menstrual period that lasted 4 days. Previously, menses occurred at regular 27-day intervals and lasted 3 to 4 days. Delivered 1st chidl 18 months ago, wishes to have another child in future. No hx of serious illness, takes no meds. BP is 115/72. Pelvic exam normal. Which is the most appropriate contraception for this patient?

a) Progestin-only oral conraceptive
b) Diaphragm
c) Placement of a copper IUD
d) Depot medorxyprogesterone
e) Etonogestrel implant

*B is incorrect
-----------------------------------------------------------------------------------------

3. healthy 32 yoF comes because of 2-day hx of vaginal bleeding and lower abdominal cramps. LMP was 7 wks ago. Sexually active with one partner, use condoms consistently. Takes no meds. Pulse 90, BP 100/65. Phsy exam shows soft abdomen and LQ tenderness. Speculum exam shows moderate vaginal bleeding and a closed cervical os. Preg test is negative. Transvaginal US shows fluid-filled endometrial cavity and no gestational sac. Her quantitative serum B-hCG is 2500 → 48 hours later, BhCG is 2800. Which is most likely diagnosis?

a) Blighted ovum
b) Complete spontaneous abortion
c) ectopic pregnancy
d) Hydatidiform mole
e) normal intrautrein pregnancy

*A is incorrect
-----------------------------------------------------------------------------------------

4. 18 yoF comes bc of irregular menses over the past 3 months; menses occur at 14- to 40-day intervals. Menstrual flow varies from spotting to heavy cramping and bleeding; the latter sxs have caused her to miss shool. Her LMP was 3 weeks ago. Menarche was at age 12 and menses had occurred at regular 28-day intervals for 6 years. She has sedentary lifestyle. She is 165cm (5ft5in) and weighs 63kg (139lb); BMI is 23. Pelvic exam is normal. Urine preg test negative. Which is the best next step in management?

a) Conjugated estrogen therapy
b) Cyclic progesterone therapy
c) Hysteroscopy
d) Endometrial biopsy
e) Dilation and currettage

*C is incorrect
-----------------------------------------------------------------------------------------

5. A 27 yoF G2P1 at 30 weeks gestation comes bc of chronic fatigue for 2 months; she has had a 10lb weight loss during this period. Had no prenatal care. Hx of ETOH and drug abudse. 5ft6in tall, 130lm; BMI is 21. Apperas chronically ill. Examination shows pallor. Uterine fundal heigh is 28cm. Fetal heart rate is 140/min. Labs show
Hgb → 6
Mean corpusc hgb → 30
Mean corpusc volume → 101
Leukocyte count → 4300
Reticu count → 0.1%
Platelet count → 130k
Prothrombin time → 13sec
Serum
- bilirubin → 1
- ALT → 16

Which is the most likely cause of patients anemia?

a) Bone marrow hypoplasia
b) Cirrhosis
c) folic acid deficiency
d) hepatitis
e) iron deficiency
f) vitamin b12 (cobalamin) deficiency

*A is incorrect
-----------------------------------------------------------------------------------------

6. 42 yoW with lupus comes for followup. 2 weeks ago, prednisone therapy was begun bc of flare up; this is her 3rd course of prednisone during past 18 months. Today patient feeling well. Menses occur at reg 28-day intervals. Only other med are vitmain D and calcium. She has no other hx of serious illness, no fam hx of serious illness. No known allergies. Does not smoke cigarettes or drink alcohol. She is 5ft5in and weighs 140; BMI is 23. Pulse is 70, BP is 108/64. Exam shows no abnormalilites. Which is the most appropriate pharmacotherapy to prevent osteoporosis in this patient?

a) Alendronate now
B) Calcitonin now
C) Estrogen and progesterone now
D) Estrogen alone at onset of menopause
E) Raloxifene now

*D is incorrect
-----------------------------------------------------------------------------------------

7. 47 yoF comes to ED because of 4 day hx of increasing pain with urination. 5 days ago, began treatment with a sulfonamide abx by her primary phsyician after a phone consultation; she has not had relief of her sxs. Has no hx of serious illness, abnomral Pap smears, or STIs. Currently takes no meds. States shes been having ↑ stress during pass month. Pelvic exam sows an exquisitely tender ulcer on the lower labium minus. Photograph shown. Which is the most likely diagnosis?

a) Candidiasis
b) Condyloma acuminatum
c) Herpes simplex virus 1
d) Molluscum contagiousum
e) Paget disease

*E is incorrect
-----------------------------------------------------------------------------------------

8. 27 yoF nullgiravid comes because unable to conceive for 3 years. Menses occur at irregular 35- to 42- day intervals and last 8 days. Laparoscopy 8 weeks ago showed spill from both fallopian tubes after methylene blue dye was instilled into the cervix; no evidence of endometriosis. Husband has two children from previous marriage. Pelvic exam shows normal-sized uterus and no palpable masses. Postcoital test shows many motile sperm. Which is the most appropriate pharm?

a) Clomiphene
b) Danazol
c) Leuprolide
d) Levothyroxine
E) Menotropins
F) Progesterone

*C is incorrect
3c 4b 5c 7c 8a

I put the same thing on one and six. Number 2, I put depo-provera, think it might be copper-IUD.
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  #3  
Old 03-27-2016
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thank you
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  #4  
Old 03-28-2016
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1.) A 24yo primigravid at 42wks is admitted to the hospital for labor induction. Her pregnancy has been uncomplicated. She has no history of serious illness. On admission, her temp is 36.9C, pulse is 64/min, BP 130/72. Fetal nonstress testing is reactive. Pelvic examination shows a closed, long, posterior cervix. The amniotic fluid index is 3.2cm (N=9-31). Which of the following is the most appropriate next step in management?
A. Discharge home and readmit in 1 week
B. Administer betamethasone
C. Administer a prostaglandin
D. Begin amnioinfusion (Wrong)
E. Perform an immediate C-section

2.) A 21yo primigravida woman at 10 wks gestation has severe nausea and has been unable to keep anything in her stomach for 48 hrs. She has had mild nausea and vomiting for 6 weeks. Examination shows normal findings. Ultrasound shows a normal 10-week gestation. Which of the following is the most appropriate next step in diagnosis?
A. CBC (wrong)
B. Measurement of serum billirubin concentration
C. Measurement of serum glucose concentration
D. Measurement of urinary ketones
E. Measurement of urinary protein

3.) A 17 yo is brought to the physician by her mother because she has never had her menstrual period. She is otherwise healthy. Both of her older sisters had normal pubertal development. Examination shows absent breast development and scant pubic hair. Her serum FSH is 105. Which of the following is the most appropriate next step in diagnosis?
A. GnRH stimulation test
B. Karyotype Analysis
C. Measurement of serum electrolyte concentrations
D. LH concentration (wrong)
E. TSH concentration
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  #5  
Old 03-29-2016
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Quote:
Originally Posted by camilia View Post
thank you
What'd you get on those^^^?
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