OBGYN NBME Exam Comprehensive
Questions (Frequently Tested) with
Verified Answers Graded A+
mom @ 26wks gestation come for f/u.
her daughter had flu-like Sx 2mths ago.
US: polyhydramnios, fetal ascites, and skin thickening.
what is causal infection? - Answer: Parvovirus B19:
-Sx: flu-like Sx, rash that spreads from cheek to body. (adults: arthritic joint pain)
-Fetal US: hydrops fetalis (polyhydramnios, fetal ascites, skin thickening)
CMV:
-Sx: Mono-like Sx or aSx
-Fetal US: periventricular calcifications, microcephaly, hydrops fetalis
*Parvovirus B19 is the most common infection associated with hydrops, followed by
cytomegalovirus, toxoplasmosis, and syphilis.
pt@42wk gestation admitted for labor induction.
vitals nl & NST reactive.
cervix is closed.
amniotic fluid index is 3.2cm (nl=9-31)
Next step? - Answer: Administer prostaglandin to ripen cervix = induce labor
,NST is reactive & there are no other complications (e.g. no previa or indications for cesarean).
Thus try Vaginal delivery
*Patient is at post-term (>42wks); mgmt:
₀ membrane sweeping to induce prostaglandin release
₀ induce labor btw 41wks1/7-7/7days by admin prostaglandin
baby with shoulder dystonia via labor
PE: forearm pronation, arm is adducted & internally rotated at shoulder.
Dx? which nerve was damaged? - Answer: Erb's Duchenne palsy (waiter's tip)
C5-C6
*Klumpke: C8-T1 (can also have horner syndrome; bc symp fibers run along c8-t1)
pt @30wk gestation with CC of fatigue for 2mths. Hx of ETOH abuse.
Labs show:
Hb 6 & MCV 101.
what is the cause of anemia? - Answer: Ans: Folic Acid deficiency
Macrocytic Anemia→ B12 OR Folate(FA) deficiency.
-B12: in meats; stores depleted 2-5yrs
-FA: in green leafy veg; stores depleted wks
Also, with B12 def, you get neuro Sx, which this pt does NOT have
,38wks gestation w/ ROM 2days ago.
PE shows:
-exquisite tenderness of uterine funuds
-mucopurulent cervical d/c
-pt's temp is 102F
FHR: 180
what is the causal organism of pt's fever? - Answer: Chorioamnionitis is usually caused by
polymicrobial infx (from vaginal flora)
chorioamnionitis:
Maternal fever + ≥1 of:
₀Maternal
-Tachycardia (>100)
-Uterine tenderness
-WBC>15k
-malodorous amniotic fluid or vaginal d/c
₀fetal tachycardia (>160/min)
37wk gestation w/ gestational diabetes [glucose serum]= 180-200.
New born is 4.5kg & develops hyaline membrane dz.
Macrosomnia & pulmonary disease is closely related to ↑in which serum concentration in
fetus?
A. Cortisol
, B. GH
C.Insulin - Answer: Insulin(of fetus) antagonizes Cortisol action→ No cortisol = no surfactant→
so fetus get RDS
In GDM, a higher amount of blood glucose passes through the placenta into the fetal
circulation. As a result, extra glucose in the fetus is stored as body fat causing macrosomia.
(mother's insulin does not cross placenta)
*Hyaline membrane disease is the old word for respiratory distress syndrome (RDS); different
from ARDS
pt @33wks have pyelonephritis. - Answer: Maternal fever itself can directly lead to fetal
tachycardia.
Pt has chorioamnionitis:
maternal fever + fetal tachycardia (>160/min)
-Fetal hypoxia: would lead to bradycardia
*Uworld says antipyretics & IV fluids are administered to reduce maternal fever→improves fetal
tachycardia.
27yo female pt CC of unable to conceive for 3yrs. menses are irregular 35-42day intervals.
assuming everything else is normal, which medical is appropriate?
A. Clomiphene
B. Danazol
Questions (Frequently Tested) with
Verified Answers Graded A+
mom @ 26wks gestation come for f/u.
her daughter had flu-like Sx 2mths ago.
US: polyhydramnios, fetal ascites, and skin thickening.
what is causal infection? - Answer: Parvovirus B19:
-Sx: flu-like Sx, rash that spreads from cheek to body. (adults: arthritic joint pain)
-Fetal US: hydrops fetalis (polyhydramnios, fetal ascites, skin thickening)
CMV:
-Sx: Mono-like Sx or aSx
-Fetal US: periventricular calcifications, microcephaly, hydrops fetalis
*Parvovirus B19 is the most common infection associated with hydrops, followed by
cytomegalovirus, toxoplasmosis, and syphilis.
pt@42wk gestation admitted for labor induction.
vitals nl & NST reactive.
cervix is closed.
amniotic fluid index is 3.2cm (nl=9-31)
Next step? - Answer: Administer prostaglandin to ripen cervix = induce labor
,NST is reactive & there are no other complications (e.g. no previa or indications for cesarean).
Thus try Vaginal delivery
*Patient is at post-term (>42wks); mgmt:
₀ membrane sweeping to induce prostaglandin release
₀ induce labor btw 41wks1/7-7/7days by admin prostaglandin
baby with shoulder dystonia via labor
PE: forearm pronation, arm is adducted & internally rotated at shoulder.
Dx? which nerve was damaged? - Answer: Erb's Duchenne palsy (waiter's tip)
C5-C6
*Klumpke: C8-T1 (can also have horner syndrome; bc symp fibers run along c8-t1)
pt @30wk gestation with CC of fatigue for 2mths. Hx of ETOH abuse.
Labs show:
Hb 6 & MCV 101.
what is the cause of anemia? - Answer: Ans: Folic Acid deficiency
Macrocytic Anemia→ B12 OR Folate(FA) deficiency.
-B12: in meats; stores depleted 2-5yrs
-FA: in green leafy veg; stores depleted wks
Also, with B12 def, you get neuro Sx, which this pt does NOT have
,38wks gestation w/ ROM 2days ago.
PE shows:
-exquisite tenderness of uterine funuds
-mucopurulent cervical d/c
-pt's temp is 102F
FHR: 180
what is the causal organism of pt's fever? - Answer: Chorioamnionitis is usually caused by
polymicrobial infx (from vaginal flora)
chorioamnionitis:
Maternal fever + ≥1 of:
₀Maternal
-Tachycardia (>100)
-Uterine tenderness
-WBC>15k
-malodorous amniotic fluid or vaginal d/c
₀fetal tachycardia (>160/min)
37wk gestation w/ gestational diabetes [glucose serum]= 180-200.
New born is 4.5kg & develops hyaline membrane dz.
Macrosomnia & pulmonary disease is closely related to ↑in which serum concentration in
fetus?
A. Cortisol
, B. GH
C.Insulin - Answer: Insulin(of fetus) antagonizes Cortisol action→ No cortisol = no surfactant→
so fetus get RDS
In GDM, a higher amount of blood glucose passes through the placenta into the fetal
circulation. As a result, extra glucose in the fetus is stored as body fat causing macrosomia.
(mother's insulin does not cross placenta)
*Hyaline membrane disease is the old word for respiratory distress syndrome (RDS); different
from ARDS
pt @33wks have pyelonephritis. - Answer: Maternal fever itself can directly lead to fetal
tachycardia.
Pt has chorioamnionitis:
maternal fever + fetal tachycardia (>160/min)
-Fetal hypoxia: would lead to bradycardia
*Uworld says antipyretics & IV fluids are administered to reduce maternal fever→improves fetal
tachycardia.
27yo female pt CC of unable to conceive for 3yrs. menses are irregular 35-42day intervals.
assuming everything else is normal, which medical is appropriate?
A. Clomiphene
B. Danazol
