Ob-Gyn NBME Form 3 Comprehensive
Questions (Frequently Tested) with
Verified Answers Graded A+
22 yo primigravid - 24 wks gest - fullness in lower pelvic area for 12 hrs
no contractions
fundal height: 20 cm
fetal heart tones good
PE: breech; no cervix palpated
most likely dx? - Answer: incompetent cervix
considering no cervix was palpated
32 yo - G3P2
LMP: 17 wks ago
PE: uterine funds palpated midway bet pubic symphysis and umbilicus
serum AFP: 2.6 multiples of median
next step in mgnt? - Answer: US
umbilicus - 20 cm
if palpated midway - 10 cm aka 10 wks gest
discrepancy in gest age (10 vs 17)
US in first trimester - most accurate in dating (w/in 1 wk)
inc AFP (>2.5 MoMs) - open NTDs, abd wall defects, mult gest, *incorrect gest dating*, fetal
death, placental abnormalities
dec AFP - trisomy 21 and 18, fetal demise, inaccurate gest dating
77 yo - G2P2 - 1 month of int episodes of vag bleeding
,episodes last 3-4 days; no association w/ trauma/sex
menopause: 26 yrs ago; no HRT
last gyn exam: 38 yrs ago w/ birth of youngest kid
no meds
smokes 2 packs of cig qd for 50 yrs - 100 pack yr
PE: gucci
pelvic exam: 2 cm, exophytic lesion on cervix; no enlargement of uterus or evidence of blood in
vagina
results of biopsy specimen of lesion will show what? - Answer: squamous cell CA
never got a good sign w/ postmenopausal bleeding - assume cancer until proven otherwise
HPV infection > dysplasia > CIS and HSIL > squamous cell CA
risk factors: sex, *smoking*, STDs
27 yo nulligravid - unable to conceive for 3 yrs
menses: irregular 35-42 days; last 8 days
lap 8 wks ago: spill from both Fallopian tubes after methylene blue dye was instilled into the
cervix; no evidence of endometriosis
husband has 2 kids from previous marriage
pelvic exam: normal-sized uterus and no palp masses
postcoital test: many motile sperm
most app pharmacotherapy? - Answer: clomiphene
used to help w/ ovulation
acts to disinhibit GnRH
"spill from both Fallopian tubes" suggests that the tubes are intact and open
aka her anatomy is fine and husband's sperm is viable
37 yo primigravid - 31 wks gest - 4 days of mild difficulty breathing (esp in reclining position)
, no PMHx; takes prenatal vitamin
fundal height: 37 cm
pelvic exam: no cervical dilation or effacement
US: normal-appearing fetus
AFI: 35 (N: 10-20)
next step in mgnt? - Answer: antenatal testing
baby prob has polyhydramnios
evaluation: US for fetal anomalies, glucose testing for DM, and Rh screen
risk for malpresentation - should be carefully evaluated through pregnancy
inc risk for cord prolapse
17 yo - no period
older sisters - normal pubertal development
PE: absent breast development; scant pubic hair
FSH: 105 (inc) - premenopausal 4-30
next step in dx? - Answer: karyotype analysis
primary amenorrhea: absence of menses by 15 yo w/ secondary sex developmental present or
absence of sex characteristics by 13 yo
prob has Turner's syndrome (46,XO)- no breasts; inc FSH, LH; streak ovaries
MC cause of primary ovarian insufficiency
other causes of primary amenorrhea + absence of secondary sex characteristics: central
hypogonadism - undernourishment, stress, hyperPRL, or exercise; CNS tumor
(craniopharyngioma) or cranial irradiation; Kallman's syndrome (w/ anosmia)
21 yo primigravid - 10 wks gest - severe nausea
can't keep anything in stomach for 48 hrs
mild N/V for 6 wks
Questions (Frequently Tested) with
Verified Answers Graded A+
22 yo primigravid - 24 wks gest - fullness in lower pelvic area for 12 hrs
no contractions
fundal height: 20 cm
fetal heart tones good
PE: breech; no cervix palpated
most likely dx? - Answer: incompetent cervix
considering no cervix was palpated
32 yo - G3P2
LMP: 17 wks ago
PE: uterine funds palpated midway bet pubic symphysis and umbilicus
serum AFP: 2.6 multiples of median
next step in mgnt? - Answer: US
umbilicus - 20 cm
if palpated midway - 10 cm aka 10 wks gest
discrepancy in gest age (10 vs 17)
US in first trimester - most accurate in dating (w/in 1 wk)
inc AFP (>2.5 MoMs) - open NTDs, abd wall defects, mult gest, *incorrect gest dating*, fetal
death, placental abnormalities
dec AFP - trisomy 21 and 18, fetal demise, inaccurate gest dating
77 yo - G2P2 - 1 month of int episodes of vag bleeding
,episodes last 3-4 days; no association w/ trauma/sex
menopause: 26 yrs ago; no HRT
last gyn exam: 38 yrs ago w/ birth of youngest kid
no meds
smokes 2 packs of cig qd for 50 yrs - 100 pack yr
PE: gucci
pelvic exam: 2 cm, exophytic lesion on cervix; no enlargement of uterus or evidence of blood in
vagina
results of biopsy specimen of lesion will show what? - Answer: squamous cell CA
never got a good sign w/ postmenopausal bleeding - assume cancer until proven otherwise
HPV infection > dysplasia > CIS and HSIL > squamous cell CA
risk factors: sex, *smoking*, STDs
27 yo nulligravid - unable to conceive for 3 yrs
menses: irregular 35-42 days; last 8 days
lap 8 wks ago: spill from both Fallopian tubes after methylene blue dye was instilled into the
cervix; no evidence of endometriosis
husband has 2 kids from previous marriage
pelvic exam: normal-sized uterus and no palp masses
postcoital test: many motile sperm
most app pharmacotherapy? - Answer: clomiphene
used to help w/ ovulation
acts to disinhibit GnRH
"spill from both Fallopian tubes" suggests that the tubes are intact and open
aka her anatomy is fine and husband's sperm is viable
37 yo primigravid - 31 wks gest - 4 days of mild difficulty breathing (esp in reclining position)
, no PMHx; takes prenatal vitamin
fundal height: 37 cm
pelvic exam: no cervical dilation or effacement
US: normal-appearing fetus
AFI: 35 (N: 10-20)
next step in mgnt? - Answer: antenatal testing
baby prob has polyhydramnios
evaluation: US for fetal anomalies, glucose testing for DM, and Rh screen
risk for malpresentation - should be carefully evaluated through pregnancy
inc risk for cord prolapse
17 yo - no period
older sisters - normal pubertal development
PE: absent breast development; scant pubic hair
FSH: 105 (inc) - premenopausal 4-30
next step in dx? - Answer: karyotype analysis
primary amenorrhea: absence of menses by 15 yo w/ secondary sex developmental present or
absence of sex characteristics by 13 yo
prob has Turner's syndrome (46,XO)- no breasts; inc FSH, LH; streak ovaries
MC cause of primary ovarian insufficiency
other causes of primary amenorrhea + absence of secondary sex characteristics: central
hypogonadism - undernourishment, stress, hyperPRL, or exercise; CNS tumor
(craniopharyngioma) or cranial irradiation; Kallman's syndrome (w/ anosmia)
21 yo primigravid - 10 wks gest - severe nausea
can't keep anything in stomach for 48 hrs
mild N/V for 6 wks
