OB/GYN NBME Form 2
Terms in this set (8)
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
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
D) Primary syphilis
E) Vulvar carcinoma
F) Vulvar condylomata acuminate
22 yo G3P1Ā 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
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
C! She has endometritis (dx by maternal fever and WBC >= 15k)
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
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
E) Premature ovarian failure
B! Tricky question!
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
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
C) Measure BHCG
D) Mesure prolactin
E) Measure TSH
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