OB GYN NBME #1

[MudPhud20XX]

A 22 year old woman comes to the physician because of a second episode of painful vesicular genital lesions. She says that her new sexual partner has similar lesions on his penis. If left untreated, which of the following is the most likely clinical course?

A. Development of severe systemic illness over the next 3 days
B. Development of an exfoliative dermatitis within 1 week
C. Increasing symptoms for 3 weeks, then a gradual decrease
D. Persistence of the lesions for 3 months or more
E. Spontaneous disappearance of the lesions within 1 week
--> So this is herpes right? I am leaning toward C since it is self limited most cases right? any thoughts?

A 42 yo woman G3P3 comes to the physician for a routine exam. Over the past year, menses have occurred at irregular 2-3 month intervals and have lasted 7-21 days. Her last menstrual period was 6 weeks ago. She has type 2 DM treated with metformin. She is 168 cm (5ft 6in) and weights 88kg (195lb); BMI is 32 kg/m2. Physical exam shows an irregular enlarged uterus measuring 12 x 8 x 6cm. An endometrial biopsy specimen shows atypical complex hyperplasia. Which of the following is the strongest predisposing factor for this patient's condition?

A. Age
B. Anovulation
C. Leiomyomata uteri
D. Metformin therpay
E Multiparity


A healthy 18-year-old nulligravid woman comes to the physician for a routine health maintenance examination. She states that she typically has pain in one of the adnexal region that occurs during days 13 and 14 of her menstrual cycle. She describes the pain as brief and sharp. Menarche was at the age of 13 years, and menses occur at regular 28-day intervals with moderate flow for the next 2 days. She has never been sexually active. Physical and pelvic examination show no abnormalities. Which of the following is the most appropriate next step in management?
A) Reassurance
B) Testing for Neisseria gonorrhea and Chlamydia trachomatis
C) Pelvic ultrasonography
D) Leuprolide therapy
E) Laparoscopy
--> I am debating between A and B, any thoughts?

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[MudPhud20XX]

Anyone???

 

[MudPhud20XX]

previously healthy 27 yr old woman, gravida 2, para 1, at 36 wks gestation comes to the physician b/c of a 2 hrs hx of intermittent vaginal bleeding. she has received no prenatal care. the fundal height is 35 cm, fetal HR is 135, exam of the lower genital tract and cervix shows the bleeding to be of uterine origin. lab studies are within the reference range. her blood is type O, Rh neg, antibody screening is neg. fetal nonstress testing is reactive, and fetal biophysical profile is 8/8, which of the following is the most appropriate next step management?

A. coagulation studies
B. measurement of fetal hemoglobin conc
C. contraction stress test
D. administration of betamethasone
E. administration of Rh0(D) immune globulin

 

[doyouhaveaflag]

A 22 year old woman comes to the physician because of a second episode of painful vesicular genital lesions. She says that her new sexual partner has similar lesions on his penis. If left untreated, which of the following is the most likely clinical course?

A. Development of severe systemic illness over the next 3 days
B. Development of an exfoliative dermatitis within 1 week
C. Increasing symptoms for 3 weeks, then a gradual decrease
D. Persistence of the lesions for 3 months or more
E. Spontaneous disappearance of the lesions within 1 week
--> So this is herpes right? I am leaning toward C since it is self limited most cases right? any thoughts?

A 42 yo woman G3P3 comes to the physician for a routine exam. Over the past year, menses have occurred at irregular 2-3 month intervals and have lasted 7-21 days. Her last menstrual period was 6 weeks ago. She has type 2 DM treated with metformin. She is 168 cm (5ft 6in) and weights 88kg (195lb); BMI is 32 kg/m2. Physical exam shows an irregular enlarged uterus measuring 12 x 8 x 6cm. An endometrial biopsy specimen shows atypical complex hyperplasia. Which of the following is the strongest predisposing factor for this patient's condition?

A. Age
B. Anovulation
C. Leiomyomata uteri
D. Metformin therpay
E Multiparity


A healthy 18-year-old nulligravid woman comes to the physician for a routine health maintenance examination. She states that she typically has pain in one of the adnexal region that occurs during days 13 and 14 of her menstrual cycle. She describes the pain as brief and sharp. Menarche was at the age of 13 years, and menses occur at regular 28-day intervals with moderate flow for the next 2 days. She has never been sexually active. Physical and pelvic examination show no abnormalities. Which of the following is the most appropriate next step in management?
A) Reassurance
B) Testing for Neisseria gonorrhea and Chlamydia trachomatis
C) Pelvic ultrasonography
D) Leuprolide therapy
E) Laparoscopy
--> I am debating between A and B, any thoughts?

A 22 year old woman comes to the physician because of a second episode of painful vesicular genital lesions. She says that her new sexual partner has similar lesions on his penis. If left untreated, which of the following is the most likely clinical course?
A. Development of severe systemic illness over the next 3 days
B. Development of an exfoliative dermatitis within 1 week
C. Increasing symptoms for 3 weeks, then a gradual decrease
D. Persistence of the lesions for 3 months or more
E. Spontaneous disappearance of the lesions within 1 week
--> So this is herpes right? I am leaning toward C since it is self limited most cases right? any thoughts?

Answer = E. (edited answer here) You're right, it's herpes. The gift that keeps on giving. See later response for explanation.
_________

A 42 yo woman G3P3 comes to the physician for a routine exam. Over the past year, menses have occurred at irregular 2-3 month intervals and have lasted 7-21 days. Her last menstrual period was 6 weeks ago. She has type 2 DM treated with metformin. She is 168 cm (5ft 6in) and weights 88kg (195lb); BMI is 32 kg/m2. Physical exam shows an irregular enlarged uterus measuring 12 x 8 x 6cm. An endometrial biopsy specimen shows atypical complex hyperplasia. Which of the following is the strongest predisposing factor for this patient's condition?
A. Age
B. Anovulation
C. Leiomyomata uteri
D. Metformin therpay
E Multiparity

Answer = B. Biggest risk factor listed for endometrial hyperplasia/anovoluation is anovulation because of the unopposed estrogen and lack of regular shedding. I think overall, obesity is the biggest risk factor given the increased estrogen from peripheral conversion of androgens to estrone if I remember correctly. There are a butt ton of risk factor questions on this shelf.
_________

A healthy 18-year-old nulligravid woman comes to the physician for a routine health maintenance examination. She states that she typically has pain in one of the adnexal region that occurs during days 13 and 14 of her menstrual cycle. She describes the pain as brief and sharp. Menarche was at the age of 13 years, and menses occur at regular 28-day intervals with moderate flow for the next 2 days. She has never been sexually active. Physical and pelvic examination show no abnormalities. Which of the following is the most appropriate next step in management?
A) Reassurance
B) Testing for Neisseria gonorrhea and Chlamydia trachomatis
C) Pelvic ultrasonography
D) Leuprolide therapy
E) Laparoscopy
--> I am debating between A and B, any thoughts?

Answer = A. This is classic Mittelshmerz, which is totally benign. Some women perceive pain when the ovulate that can last hours to days. Given that her cycles are 28 days, ovulation would be expected to occur around days 13-14. You do screen women under 25 for gonorrhea and chlamydia but she is not sexually active (and on exams patients don't lie).

 

[doyouhaveaflag]

previously healthy 27 yr old woman, gravida 2, para 1, at 36 wks gestation comes to the physician b/c of a 2 hrs hx of intermittent vaginal bleeding. she has received no prenatal care. the fundal height is 35 cm, fetal HR is 135, exam of the lower genital tract and cervix shows the bleeding to be of uterine origin. lab studies are within the reference range. her blood is type O, Rh neg, antibody screening is neg. fetal nonstress testing is reactive, and fetal biophysical profile is 8/8, which of the following is the most appropriate next step management?

A. coagulation studies
B. measurement of fetal hemoglobin conc
C. contraction stress test
D. administration of betamethasone
E. administration of Rh0(D) immune globulin

Answer = E. Her blood type is O neg and she is not current immunized to Rh(D). Given that she's bleeding, this is an indication for Rhogam prophylaxis. Anytime you think there may be maternal/fetal blood mixing it's an indication. Baby seems fine, so no fetal Hb or contraction stress test indicated. Most wouldn't administer betamethasone at 36 weeks.

 

[jpwsurf21]

A 22 year old woman comes to the physician because of a second episode of painful vesicular genital lesions. She says that her new sexual partner has similar lesions on his penis. If left untreated, which of the following is the most likely clinical course?
A. Development of severe systemic illness over the next 3 days
B. Development of an exfoliative dermatitis within 1 week
C. Increasing symptoms for 3 weeks, then a gradual decrease
D. Persistence of the lesions for 3 months or more
E. Spontaneous disappearance of the lesions within 1 week
--> So this is herpes right? I am leaning toward C since it is self limited most cases right? any thoughts?

Answer = C. You're right, it gets worse and then it gets better. The gift that keeps on giving.

The answer is actually E - someone showed me this exact question like 2 weeks ago and put C and it was marked as incorrect. It's a recurrent outbreak, not the initial one, so it won't take nearly as long to resolve.

 

[doyouhaveaflag]

The answer is actually E - someone showed me this exact question like 2 weeks ago and put C and it was marked as incorrect. It's a recurrent outbreak, not the initial one, so it won't take nearly as long to resolve.

Oh haha, you're right. This one I didn't actually go back and check my answer here vs what I put on the actual test. I put E and it was not among the incorrects. Sorry about that.

I will edit the original so it's clear.