NBME OBGYN Comprehensive
Questions (Frequently Tested) with
Verified Answers Graded A+
18 hs after an uncomplicated CS for breech presentation, a 23F, G1P1, has fever. Temp is 100.4F,
BP is 112/74. Decreased breath sounds are heard bilaterally w/ no crackles pr rhonchi. CV exam
shows a regular rhythm w/ no murmurs, rubs, or clicks. The fundus is non-tender and 2cm
below the umbilicus. The incision site is dry, intact, & mildly tender. Exam of the LE shows 2+
pitting edema to the mid calves bilaterally w/ no cyanosis or clubbing. Foley & right IV
antecubital catheters are in place.
Which of the following is the most likely Dx?
(Atelecatsis
OR
Thrombophlebitis) - Answer: Atelectasis
> The most common cause of atelectasis in hospitals is inadequate respirations >> *can be seen
in post-operative pts in whom atelecatsis is very common*
> *Classically considered the most common cause of post-op fever during post-op day 1*
> Pt presents w/:
1- *Decreased breath sounds*
2- *Lower leg edema*
Thrombophlebitis
> Common cause of post-op fever *>/= 1 wk after surgery*
A 20F, primigravid, at 40 wks is admitted to the hospital in labor. The cervix is 4cm dilated; the
vertex is at 0 station. Two liters of lactated ringer solution are administered. An epidural
catheter is placed, and a test dose of lidocaine & epi is injected. She immediately has tinnitus &
a metallic taste in her mouth. Her pulse is now 110/min, BP is 140/100.
,Which of the following is the most likely cause of these findings?
(Anesthetic-induced anaphylactic reaction
OR
Intravascular injection of anesthetic) - Answer: Intravascular injection of anesthetic
> Most common cause of toxic levels >> can cause:
--1) CNS excitation >> *tinnitus*, disorientation, seizures
--2) Light headedness, visual & auditory disturbances
--3) *Metallic taste*, Tongue numbness
--4) CV → *HTN*, peripheral vasodilation
Anesthetic induced anaphylactic reaction
> Pt would have presented w/
1- *Bronchospasm*
2- Hypotension
-----[pt has HTN]
3- Angioedema
A 23F, primigravid, at 30 wks is brought to ER b/c of headache, blurred vision, & constant RUQ
pain for 12 hrs. Pulse is 92/min, RR 14/min, BP is 138/95. Exam shows moderate edema of the
face & fingers. Deep tendon reflexes are 3+. Labs show:
- Plts. -------40K
- AST. ------1200
- ALT --------365
- LDH -------1954
Which of the following is the most likely Dx?
,(Immune thrombocytopenic purpura
OR
Severe preeclampsia) - Answer: Severe preeclampsia (severe features)
- Low Pts *<100K*
- Transaminitis → (severe RUQ pain)
- *Blurred vision and headache* (visual or cerebral disturbances)
- Impaired deep tendon reflexes
-Creatinine > 1.1 mg/dL or 2x baseline
- HTN → presents as
---SBP ≥ 140* OR
---DBP ≥ 90*
Immune thrombocytopenic purpura
- Usually presents w/ decreased plts ONLY
-----[Pt has Many more symptoms]
- Also presents w/:
--1) IgG antibodies Pt would present w/
--2) Petechial rash, Easy bruising, Bleeding
> pt would have Hx of gingival hemorrhage, menorrhagia, easy bruising, epistaxis
3 days after a CS at term b/c of failure to progress, a 27F has a temp of 101.8F & mild pain w/
urination. She has not had urinary urgency or frequency. She is bottle-feeding. PE shows a clean
intact incision site w/ no erythema. The lungs are clear to auscultation. The breasts are tense,
erythematous, & tender. The uterus is firm, nontender, & consistent w/ in size w/ a 20-wk
gestation. Labs show:
- Hb---------------10.5
- Leukocyte-------6500
, Urine
- RBC--------------10-15
- WBC-------------1-2
Which of the following is the most likely Dx?
(Breast Engorgement
OR
Cystitis
OR
Mastitis) - Answer: Breast engorgement
> On days 2-5 *1st wk* after birth >> progesterone levels fall as milk is produced >> most
common times for breast engorgement if breasts not drained properly during nursing or
mechanical pumping >> presents as
1- *warm swollen breasts* (painful breast fullness)
2- *Transient Low grade fever*
Mastitis
> presents in *2nd or 4th* post- partum week
- Fever > 38.3C (pt has 101.8 so does qualify)
- *Unilateral red, tender, swollen breast*
- Constitutional symptom (myalgia, chills, malaise)
Cystitis
> pt would have presented with
1- Frequency & urgency
2- Dysuria
3- Suprapubic pain
Questions (Frequently Tested) with
Verified Answers Graded A+
18 hs after an uncomplicated CS for breech presentation, a 23F, G1P1, has fever. Temp is 100.4F,
BP is 112/74. Decreased breath sounds are heard bilaterally w/ no crackles pr rhonchi. CV exam
shows a regular rhythm w/ no murmurs, rubs, or clicks. The fundus is non-tender and 2cm
below the umbilicus. The incision site is dry, intact, & mildly tender. Exam of the LE shows 2+
pitting edema to the mid calves bilaterally w/ no cyanosis or clubbing. Foley & right IV
antecubital catheters are in place.
Which of the following is the most likely Dx?
(Atelecatsis
OR
Thrombophlebitis) - Answer: Atelectasis
> The most common cause of atelectasis in hospitals is inadequate respirations >> *can be seen
in post-operative pts in whom atelecatsis is very common*
> *Classically considered the most common cause of post-op fever during post-op day 1*
> Pt presents w/:
1- *Decreased breath sounds*
2- *Lower leg edema*
Thrombophlebitis
> Common cause of post-op fever *>/= 1 wk after surgery*
A 20F, primigravid, at 40 wks is admitted to the hospital in labor. The cervix is 4cm dilated; the
vertex is at 0 station. Two liters of lactated ringer solution are administered. An epidural
catheter is placed, and a test dose of lidocaine & epi is injected. She immediately has tinnitus &
a metallic taste in her mouth. Her pulse is now 110/min, BP is 140/100.
,Which of the following is the most likely cause of these findings?
(Anesthetic-induced anaphylactic reaction
OR
Intravascular injection of anesthetic) - Answer: Intravascular injection of anesthetic
> Most common cause of toxic levels >> can cause:
--1) CNS excitation >> *tinnitus*, disorientation, seizures
--2) Light headedness, visual & auditory disturbances
--3) *Metallic taste*, Tongue numbness
--4) CV → *HTN*, peripheral vasodilation
Anesthetic induced anaphylactic reaction
> Pt would have presented w/
1- *Bronchospasm*
2- Hypotension
-----[pt has HTN]
3- Angioedema
A 23F, primigravid, at 30 wks is brought to ER b/c of headache, blurred vision, & constant RUQ
pain for 12 hrs. Pulse is 92/min, RR 14/min, BP is 138/95. Exam shows moderate edema of the
face & fingers. Deep tendon reflexes are 3+. Labs show:
- Plts. -------40K
- AST. ------1200
- ALT --------365
- LDH -------1954
Which of the following is the most likely Dx?
,(Immune thrombocytopenic purpura
OR
Severe preeclampsia) - Answer: Severe preeclampsia (severe features)
- Low Pts *<100K*
- Transaminitis → (severe RUQ pain)
- *Blurred vision and headache* (visual or cerebral disturbances)
- Impaired deep tendon reflexes
-Creatinine > 1.1 mg/dL or 2x baseline
- HTN → presents as
---SBP ≥ 140* OR
---DBP ≥ 90*
Immune thrombocytopenic purpura
- Usually presents w/ decreased plts ONLY
-----[Pt has Many more symptoms]
- Also presents w/:
--1) IgG antibodies Pt would present w/
--2) Petechial rash, Easy bruising, Bleeding
> pt would have Hx of gingival hemorrhage, menorrhagia, easy bruising, epistaxis
3 days after a CS at term b/c of failure to progress, a 27F has a temp of 101.8F & mild pain w/
urination. She has not had urinary urgency or frequency. She is bottle-feeding. PE shows a clean
intact incision site w/ no erythema. The lungs are clear to auscultation. The breasts are tense,
erythematous, & tender. The uterus is firm, nontender, & consistent w/ in size w/ a 20-wk
gestation. Labs show:
- Hb---------------10.5
- Leukocyte-------6500
, Urine
- RBC--------------10-15
- WBC-------------1-2
Which of the following is the most likely Dx?
(Breast Engorgement
OR
Cystitis
OR
Mastitis) - Answer: Breast engorgement
> On days 2-5 *1st wk* after birth >> progesterone levels fall as milk is produced >> most
common times for breast engorgement if breasts not drained properly during nursing or
mechanical pumping >> presents as
1- *warm swollen breasts* (painful breast fullness)
2- *Transient Low grade fever*
Mastitis
> presents in *2nd or 4th* post- partum week
- Fever > 38.3C (pt has 101.8 so does qualify)
- *Unilateral red, tender, swollen breast*
- Constitutional symptom (myalgia, chills, malaise)
Cystitis
> pt would have presented with
1- Frequency & urgency
2- Dysuria
3- Suprapubic pain
