Ob-Gyn NBME Form 4
14 yo - painful episodes of menstrual cramping over beyond five months
menarche: 12 yo
LMP: 5 days in the past
PE: gucci
most possibly motive of ache? - ANS-prostaglandin manufacturing
inc intracellular ranges of Ca and beautify myometrial gap jxn fxn
used to enhance contractions
PGs produced through uterus throughout menses
NSAIDs dec stages of PGs - why those are beneficial w/ cramping
*number one dysmenorrhea idea to result from inc degrees of endometrial PG
manufacturing*
15 yo - 1 wk steady intense abd pain
10 episodes of cramps; ultimate 3-5 days
no PMHx; no meds; no duration
sex active w/ 1 partner; no contraception
eightieth top/weight
100F
P: 120/min
BP: 90/50 mmHg
Tanner degree five
abd examination: mod tenderness; mass palp suprapubic location at midline
pelvic examination: everyday-appearing ext genitalia and decrease vagina; cervix cannot be
seen due to bluish bulging vag tissue that obscures upper vag
next step in mgnt? - ANS-transvaginal incision and drainage
prob has imperforate hymen incomplete degeneration of hymen
capabilities: cyclic lower abd pain, bulk symptoms (defecatory and urinary dysfxn), primary
amenorrhea, suprapubic mass (uterus), and blue-tinged vag mass
mgnt: hymen I&D
15 yo - 3 days of fever, abd pain, and nausea
thick, white vag discharge
menarche: thirteen yo
menses irregular
sex energetic 1 month in the past; condoms inconsistently
103.2F
P: 108/min
PE: decrease abd tenderness
pelvic exam: ache w/ cervical movement and adnexal tenderness w/ 3 cm mass
Gram stain of discharge: gram neg diplococci
most probable reason behind pt's susceptibility to this circumstance? - ANS-increased
cervical mobile vulnerability to infections
she just became intercourse energetic approximately 1 month in the past and she or he's
only had her duration for about 2 yrs - sexually immature
,has gonorrhea infection > PID
17 yo - primigravid - dec fetal motion over beyond 2 days
would not consider LMP; best 1 preceding prenatal go to
PE: uterus 32 wks gest size
US: biparietal diameter constant w/ 31 wks gest; duodenal bubble and flaccid tone of fetus
most likely cause? - ANS-Down syndrome
duodenal bubble suggests duodenal atresia
flaccid tone suggests hypotonia
18 yo - primigravid - 39 wks gest
gives you new child 2 days after developing chickenpox
maximum app take care of newborn? - ANS-varicella-zoster Ig therapy
primary viremia hurts baby at the same time as secondary reactivation handiest hurts if
toddler touches a lesion
mom must are becoming the vaccine PRIOR to pregnancy - can not provide it throughout bc
stay vaccine (MMRV)
if child receives it in utero > zig-zag skin lesions, small eyes, and small extremities
VZIG can ameliorate maternal dz but does not prevent transmission to fetus
19 yo - mod decrease abd ache and vag spotting
started after LMP: 2 wks ago
menses reg
1st trimester non-obligatory abortion 8 months in the past; on OCP
intercourse active w/ 1 partner for 1 year
abd exam: no tenderness
pelvic exam: blood-tinged discharge at os; cervical movement and moderate uterine
tenderness
preg: neg
most possibly reason? - ANS-Chlamydia trachomatis contamination
functions of cervicitis: yellow-green mucopurulent discharge; CMT; no PID symptoms
dx of PID: acute decrease abd/pelvic pain + uterine/adnexal/cervical motion tenderness
guess we are speculated to count on she isn't for careful - greater susceptible to getting
cervicitis
20 yo - 1 wk of vag discharge
sex active w/ 1 companion; condoms erratically
companion these days tx for syphilis
PE: gucci
pelvic examination: white verrucous lesions over higher vag and cervix
Pap: bizarre squamous cells
HPV: neg for excessive-danger kinds
most possibly dx? - ANS-condyloma acuminata
despite the fact that HPV high chance types had been neg > genital warts aka acuminata is
due to the low risk types 6 and 11
gift as smooth papules or sessile, *verrucous growths*
wager you need to disregard the "white" descriptor on the grounds that that factors you to
condyloma lata
additionally Pap is showing extraordinary squamous cells aka inc danger for cervical most
cancers
21 yo - primigravid - 8 wks gest
PMHx: sickle cell dz
, worried about chance for transmitting dz to fetus
PE: uterus consistent w/ eight wks gest
hubby's Hgb electrophoresis: HgA 42% (ninety five-98%), HgA2 3% (2-three%), HgF 2%
(zero.8-2%), HgS fifty three% (0%)
chance that her fetus could have sickle cell dz? - ANS-50%
mom has sickle mobile dz so she's SS
dad has sickle cell trait so he's Ss - has mod dec HgA and inc HgS
50% chance of getting dz and 50% danger of having the trait
21 yo primigravid - 41 wks gest - exertions
contractions q3min
cervix one hundred% effaced and four cm dilated; vertex +1 station
ROM > thick meconium-stained fluid
fetal HR: a hundred thirty/min w/ variable decelerations lasting 45 sec and dec to 60/min
next step in mgnt? - ANS-amnioinfusion
instillation of saline into uterine cavity for tx of recurrent variable decelerations because of
umbilical twine compression throughout labor
22 yo - 2 wks of inc excessive vag burning/discharge
intercourse active w/ 1 associate for 1 year; condoms
PE: everyday ext genitalia and gray frothy vag discharge
vag pH: 5
micro examination: squamous epi cells covered w/ bacteria
most app pharmacotherapy? - ANS-vaginal metronidazole gel
prob has bacterial vaginitis - confirmed w/ micro examination ("clue cells")
discharge: grayish-white w/ fishy scent
+whiff check (on KOH prep)
tx: PO or vag metro; vag clindamycin
22 yo - G2P1 - 38 wks gest
intermittent, moderate, low lower back pain
BP: one hundred thirty/90 mmHg
PE: gucci
EFW: 3629 g
fetal HR: one hundred twenty/min
cervix - 4 cm dilated and 100% effaced; vertex -1 station
most probably reason? - ANS-regular exertions
OME talked about how contractions are regular labor and the way no contractions are pROM
I guess "intermittent, mild, low returned ache" are contractions?
22 yo primigravid - 39 wks gest - ROM for five hrs w/o contractions
cervix 80% effaced and a pair of cm dilated
fetal function: R.OP
fetal HR sample proven: HR round 155/min; minimal variability; no
decelerations/accelerations seen
most possibly rationalization? - ANS-fetal sleep kingdom
if mother isn't have contractions > infant isn't always going to be wakeful
everyday variability: 6-25 bpm
minimum variability indicates fetal hypoxia or consequences of opioids, Mg, or sleep cycle
23 yo primigravid - 33 wks gest - admitted bc no fetal motion for 2 days
no PMHx
sister: three spontaneous abortions
14 yo - painful episodes of menstrual cramping over beyond five months
menarche: 12 yo
LMP: 5 days in the past
PE: gucci
most possibly motive of ache? - ANS-prostaglandin manufacturing
inc intracellular ranges of Ca and beautify myometrial gap jxn fxn
used to enhance contractions
PGs produced through uterus throughout menses
NSAIDs dec stages of PGs - why those are beneficial w/ cramping
*number one dysmenorrhea idea to result from inc degrees of endometrial PG
manufacturing*
15 yo - 1 wk steady intense abd pain
10 episodes of cramps; ultimate 3-5 days
no PMHx; no meds; no duration
sex active w/ 1 partner; no contraception
eightieth top/weight
100F
P: 120/min
BP: 90/50 mmHg
Tanner degree five
abd examination: mod tenderness; mass palp suprapubic location at midline
pelvic examination: everyday-appearing ext genitalia and decrease vagina; cervix cannot be
seen due to bluish bulging vag tissue that obscures upper vag
next step in mgnt? - ANS-transvaginal incision and drainage
prob has imperforate hymen incomplete degeneration of hymen
capabilities: cyclic lower abd pain, bulk symptoms (defecatory and urinary dysfxn), primary
amenorrhea, suprapubic mass (uterus), and blue-tinged vag mass
mgnt: hymen I&D
15 yo - 3 days of fever, abd pain, and nausea
thick, white vag discharge
menarche: thirteen yo
menses irregular
sex energetic 1 month in the past; condoms inconsistently
103.2F
P: 108/min
PE: decrease abd tenderness
pelvic exam: ache w/ cervical movement and adnexal tenderness w/ 3 cm mass
Gram stain of discharge: gram neg diplococci
most probable reason behind pt's susceptibility to this circumstance? - ANS-increased
cervical mobile vulnerability to infections
she just became intercourse energetic approximately 1 month in the past and she or he's
only had her duration for about 2 yrs - sexually immature
,has gonorrhea infection > PID
17 yo - primigravid - dec fetal motion over beyond 2 days
would not consider LMP; best 1 preceding prenatal go to
PE: uterus 32 wks gest size
US: biparietal diameter constant w/ 31 wks gest; duodenal bubble and flaccid tone of fetus
most likely cause? - ANS-Down syndrome
duodenal bubble suggests duodenal atresia
flaccid tone suggests hypotonia
18 yo - primigravid - 39 wks gest
gives you new child 2 days after developing chickenpox
maximum app take care of newborn? - ANS-varicella-zoster Ig therapy
primary viremia hurts baby at the same time as secondary reactivation handiest hurts if
toddler touches a lesion
mom must are becoming the vaccine PRIOR to pregnancy - can not provide it throughout bc
stay vaccine (MMRV)
if child receives it in utero > zig-zag skin lesions, small eyes, and small extremities
VZIG can ameliorate maternal dz but does not prevent transmission to fetus
19 yo - mod decrease abd ache and vag spotting
started after LMP: 2 wks ago
menses reg
1st trimester non-obligatory abortion 8 months in the past; on OCP
intercourse active w/ 1 partner for 1 year
abd exam: no tenderness
pelvic exam: blood-tinged discharge at os; cervical movement and moderate uterine
tenderness
preg: neg
most possibly reason? - ANS-Chlamydia trachomatis contamination
functions of cervicitis: yellow-green mucopurulent discharge; CMT; no PID symptoms
dx of PID: acute decrease abd/pelvic pain + uterine/adnexal/cervical motion tenderness
guess we are speculated to count on she isn't for careful - greater susceptible to getting
cervicitis
20 yo - 1 wk of vag discharge
sex active w/ 1 companion; condoms erratically
companion these days tx for syphilis
PE: gucci
pelvic examination: white verrucous lesions over higher vag and cervix
Pap: bizarre squamous cells
HPV: neg for excessive-danger kinds
most possibly dx? - ANS-condyloma acuminata
despite the fact that HPV high chance types had been neg > genital warts aka acuminata is
due to the low risk types 6 and 11
gift as smooth papules or sessile, *verrucous growths*
wager you need to disregard the "white" descriptor on the grounds that that factors you to
condyloma lata
additionally Pap is showing extraordinary squamous cells aka inc danger for cervical most
cancers
21 yo - primigravid - 8 wks gest
PMHx: sickle cell dz
, worried about chance for transmitting dz to fetus
PE: uterus consistent w/ eight wks gest
hubby's Hgb electrophoresis: HgA 42% (ninety five-98%), HgA2 3% (2-three%), HgF 2%
(zero.8-2%), HgS fifty three% (0%)
chance that her fetus could have sickle cell dz? - ANS-50%
mom has sickle mobile dz so she's SS
dad has sickle cell trait so he's Ss - has mod dec HgA and inc HgS
50% chance of getting dz and 50% danger of having the trait
21 yo primigravid - 41 wks gest - exertions
contractions q3min
cervix one hundred% effaced and four cm dilated; vertex +1 station
ROM > thick meconium-stained fluid
fetal HR: a hundred thirty/min w/ variable decelerations lasting 45 sec and dec to 60/min
next step in mgnt? - ANS-amnioinfusion
instillation of saline into uterine cavity for tx of recurrent variable decelerations because of
umbilical twine compression throughout labor
22 yo - 2 wks of inc excessive vag burning/discharge
intercourse active w/ 1 associate for 1 year; condoms
PE: everyday ext genitalia and gray frothy vag discharge
vag pH: 5
micro examination: squamous epi cells covered w/ bacteria
most app pharmacotherapy? - ANS-vaginal metronidazole gel
prob has bacterial vaginitis - confirmed w/ micro examination ("clue cells")
discharge: grayish-white w/ fishy scent
+whiff check (on KOH prep)
tx: PO or vag metro; vag clindamycin
22 yo - G2P1 - 38 wks gest
intermittent, moderate, low lower back pain
BP: one hundred thirty/90 mmHg
PE: gucci
EFW: 3629 g
fetal HR: one hundred twenty/min
cervix - 4 cm dilated and 100% effaced; vertex -1 station
most probably reason? - ANS-regular exertions
OME talked about how contractions are regular labor and the way no contractions are pROM
I guess "intermittent, mild, low returned ache" are contractions?
22 yo primigravid - 39 wks gest - ROM for five hrs w/o contractions
cervix 80% effaced and a pair of cm dilated
fetal function: R.OP
fetal HR sample proven: HR round 155/min; minimal variability; no
decelerations/accelerations seen
most possibly rationalization? - ANS-fetal sleep kingdom
if mother isn't have contractions > infant isn't always going to be wakeful
everyday variability: 6-25 bpm
minimum variability indicates fetal hypoxia or consequences of opioids, Mg, or sleep cycle
23 yo primigravid - 33 wks gest - admitted bc no fetal motion for 2 days
no PMHx
sister: three spontaneous abortions
