Ob-Gyn NBME Form 2 Comprehensive
Questions (Frequently Tested) with
Verified Answers Graded A+
15 yo - ED bc of N/V and lower abd pain for 4 days
LMP: 9 days ago
sex active; no contraception
103.5F
P: 105/min
BP: 110/75 mmHg
PE: BL lower abd tenderness and peritoneal signs
pelvic exam: copious yellow cervical discharge and exquisite uterine tenderness
next step in mgnt? - Answer: admission to the hospital for IV antibiotic therapy
homegirl def has some sort of infection
24 yo primigravid - labor
not been screened for GBS
cervix - 80% effaced
vertex - +1 station
contractions q10 min
membranes ruptured 12 hrs ago
PE: areas of vag erythema
cx for GBS: pending
next step to prevent GBS sepsis in newborn? - Answer: antibiotic therapy if delivery hasn't
occurred 18 hrs after rupture of membranes
inc risk of infection when ROM is prolonged (>18 hrs)
,in case of labor or ROM before 37 wks - pts should be screened and tx empirically until delivery
or neg cx results
tx: ampicillin; cefazolin or clindamycin if allergic
12 yo girl - 1 yr hx of progressive facial hair growth and acne
grown 4 in past 4 months
Tanner stage 1 - breast
Tanner stage 3 - axillary and pubic hair development
PE: dark hair over upper lip, cheeks, and chin; acne vulgaris over cheeks
pelvic exam: 2 cm vag canal, significant clitoromegaly, post labioscrotal fusion, and no
cervix/palpable uterus
abd US: BL gonads w/o follicles; no uterus
chromosomal analysis will show what karyotype? - Answer: 46,XY
testicular feminization aka androgen insensitivity syndrome
MIF secreted early in development > absence of all Mullerian-derived structures
primary amenorrhea - bc no uterus
vagina that ends as blind pouch
*in absence of both uterus and breasts > think 46,XY*
57 yo - 6 month hx of urinary urgency and loss of urine
rarely leaves house bc afraid of loss of urine in public
wakes 1x/night to pee
no fever, pain w/ urination, or hematuria
urine stream normal
PE and pelvic exam: gucci
UA: gucci
pelvic US: 3 cm ant, uterine mass - benign leiomyoma uteri
, most likely cause of incontinence? - Answer: detrusor instability
think she has urge incontinence - caused by detrusor hyperactivity
57 yo - 2 months of vulvar itching
menopause - 7 yrs ago
sex active - 10 yrs
PE: 1x1.5 cm ulcerated lesions on inner R.labium majus surrounded by mild erythema
no inguinal adenopathy
most likely dx? - Answer: vulvar carcinoma
MC: squamous cell carcinoma
presents w/ pain, pruritus, and ulceration of mass
early lesions: white, pigmented, raised, thickened, nodular, or ulcerative
late: large, cauliflower-like or hard ulcerated area in vulva
primarily spread via lymphatics to superficial inguinal LNs
dx: vulvar punch biopsy
32 yo primigravid - 32 wks gest
PMHx: HTN - nifedipine; hypoT - levothyroxine
4 wks ago: fundal height was lagging
started on 1800-cal diet after 3 hr GTT showed abnormalities
20 lb weight gain during pregnancy
BP: 160/96 mmHg
PE: fundal height of 27 cm
past 2 wks: bG < 120 1 hr after meals
US: estimated fetal weight at 5th percentile for 32 wks gest
most likely cause of fetal growth restriction? - Answer: uteroplacental insufficiency
Questions (Frequently Tested) with
Verified Answers Graded A+
15 yo - ED bc of N/V and lower abd pain for 4 days
LMP: 9 days ago
sex active; no contraception
103.5F
P: 105/min
BP: 110/75 mmHg
PE: BL lower abd tenderness and peritoneal signs
pelvic exam: copious yellow cervical discharge and exquisite uterine tenderness
next step in mgnt? - Answer: admission to the hospital for IV antibiotic therapy
homegirl def has some sort of infection
24 yo primigravid - labor
not been screened for GBS
cervix - 80% effaced
vertex - +1 station
contractions q10 min
membranes ruptured 12 hrs ago
PE: areas of vag erythema
cx for GBS: pending
next step to prevent GBS sepsis in newborn? - Answer: antibiotic therapy if delivery hasn't
occurred 18 hrs after rupture of membranes
inc risk of infection when ROM is prolonged (>18 hrs)
,in case of labor or ROM before 37 wks - pts should be screened and tx empirically until delivery
or neg cx results
tx: ampicillin; cefazolin or clindamycin if allergic
12 yo girl - 1 yr hx of progressive facial hair growth and acne
grown 4 in past 4 months
Tanner stage 1 - breast
Tanner stage 3 - axillary and pubic hair development
PE: dark hair over upper lip, cheeks, and chin; acne vulgaris over cheeks
pelvic exam: 2 cm vag canal, significant clitoromegaly, post labioscrotal fusion, and no
cervix/palpable uterus
abd US: BL gonads w/o follicles; no uterus
chromosomal analysis will show what karyotype? - Answer: 46,XY
testicular feminization aka androgen insensitivity syndrome
MIF secreted early in development > absence of all Mullerian-derived structures
primary amenorrhea - bc no uterus
vagina that ends as blind pouch
*in absence of both uterus and breasts > think 46,XY*
57 yo - 6 month hx of urinary urgency and loss of urine
rarely leaves house bc afraid of loss of urine in public
wakes 1x/night to pee
no fever, pain w/ urination, or hematuria
urine stream normal
PE and pelvic exam: gucci
UA: gucci
pelvic US: 3 cm ant, uterine mass - benign leiomyoma uteri
, most likely cause of incontinence? - Answer: detrusor instability
think she has urge incontinence - caused by detrusor hyperactivity
57 yo - 2 months of vulvar itching
menopause - 7 yrs ago
sex active - 10 yrs
PE: 1x1.5 cm ulcerated lesions on inner R.labium majus surrounded by mild erythema
no inguinal adenopathy
most likely dx? - Answer: vulvar carcinoma
MC: squamous cell carcinoma
presents w/ pain, pruritus, and ulceration of mass
early lesions: white, pigmented, raised, thickened, nodular, or ulcerative
late: large, cauliflower-like or hard ulcerated area in vulva
primarily spread via lymphatics to superficial inguinal LNs
dx: vulvar punch biopsy
32 yo primigravid - 32 wks gest
PMHx: HTN - nifedipine; hypoT - levothyroxine
4 wks ago: fundal height was lagging
started on 1800-cal diet after 3 hr GTT showed abnormalities
20 lb weight gain during pregnancy
BP: 160/96 mmHg
PE: fundal height of 27 cm
past 2 wks: bG < 120 1 hr after meals
US: estimated fetal weight at 5th percentile for 32 wks gest
most likely cause of fetal growth restriction? - Answer: uteroplacental insufficiency
