NBME -OB/Gyn F4 (2023/ 2024 Update) Questions and Verified Answers|100% Correct| Grade A

NBME -OB/Gyn F4 (2023/ 2024 Update) Questions and Verified Answers|100% Correct| Grade A Q: 57 yo - G3P3 - loss of urine for 2 wks kids delivered vaginally PMHx: 3 yrs ago: radiation therapy for cervical ca, cancer free since no meds PE: gucci GU exam: thin, atrophic, moist vaginal mucosa; pool of fluid in vag canal post void residual volume < 10 mL most likely dx? Answer: vesicovaginal fistula consequence of ext prolonged labor or gyn surgery presents w/ continuous leakage moist vag mucosa and pool of fluid in vag canal confirm this Q: widowed 37 yo - G3P3 - inc heavy but reg periods for past 3 yrs youngest kid is 10 yo LMP: 2.5 wks ago 2 days of labor-like pains w/ vag bleeding speculum exam: cervix mod effaced and 2 cm dilated w/ some beefy red tissue at os most likely dx? Answer: pedunculated submucous leiomyoma uteri submucosal = beneath the endometrium commonly associated w/ heavy or prolonged bleeding can become pedunculated (as in this instance) pelvic pain common pedunculated fibroids Q: 36 yo - G2P1 - 41 wks gest - ROM w/o contractions for 8 hrs 1st infant: 4422 g gest DM dx 26 wks - controlled w/ diet fundal height at 40 cm US: 3714 g cervix 2 cm dilated and 50% effaced fetal HR: WNL labor induced w/ IV oxytocin 4 hrs later > cervix 4 cm dilated and 100% effaced cont epidural administered 2 hrs later > late decelerations w/ each contraction contractions: qmin, 45 seconds long, 77 mmHg at their peak most likely explanation? Answer: oxytocin administration uterine tachysystole (>5 cont/10 min) - mom is having 1 contraction qmin should be >40 sec can cause fetal compromise (hypoxemia, anemia) due to interruption of intervillous blood flow and inadequate recovery time bet contractions mgnt: supportive; *dec uterotonic agents (oxytocin)* Q: 14 yo - painful episodes of menstrual cramping over past 5 months menarche: 12 yo LMP: 5 days ago PE: gucci most likely cause of pain? Answer: prostaglandin production inc intracellular levels of Ca and enhance myometrial gap jxn fxn used to enhance contractions PGs produced by uterus during menses NSAIDs dec levels of PGs - why these are helpful w/ cramping *primary dysmenorrhea thought to result from inc levels of endometrial PG production* Q: mod obese 27 yo - G1P1 - pain/tenderness in L.thigh for 2 days healthy newborn 6 days ago PE: tenderness/swelling over L.thigh/calf; pain in L.calf w/ dorsiflexion of L.foot next step to *confirm* dx? Answer: duplex venous US most likely has DVT - +Homan's sign more prone to get DVT/PE bc pregnancy causes hypercoagulable state dx made clinically but can be confirmed w/ Doppler studies or venography venography: gold standard; rarely used bc more invasive than Doppler duplex venous US = Doppler + traditional US Q: 24 yo - G2P2 - 1 month of pain w/ sex 3 months after uncomplicated vag delivery of newborn at term breast-feeding; feeds q3 hrs baby recently tx for thrush menses haven't returned PE: gucci pelvic exam: erythematous vagina w/ no discharge; cervix closed; uterus normal in size next step in mgnt? Answer: recommendation for use of a lubricant she literally just had a baby - prob gonna be a little tender down there Q: 21 yo - primigravid - 8 wks gest PMHx: sickle cell dz concerned about risk for transmitting dz to fetus PE: uterus consistent w/ 8 wks gest hubby's Hgb electrophoresis: HgA 42% (95-98%), HgA2 3% (2-3%), HgF 2% (0.8-2%), HgS 53% (0%) probability that her fetus will have sickle cell dz? Answer: 50% mom has sickle cell 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% chance of getting the trait Q: 30 yo - G3P2 - 10 wks gest - fever, minimal vag bleeding, and severe pelvic pain for 36 hrs unintended pregnancy