OB-Gyn Shelf Exam

[NewYorkDoctors]

Anyone heard anythign about pretest? I know some people who used it and liked it, but they tend to like pretest for everything (and we all know pretest isn't strong for every subject). I was planning on doing UW and Uwise, but does anyone recommend adding in pretest or just focusing on those?

Get it on iPhone/iPad and you can do qbanks even as your life goes on outside or during clinical rotations

(When my wife went shopping, I doubled as the coat hanger while I studied)


Not the best qbank, but it's something

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[netminder]

For those who recommend/have done UWise, do you guys recommend going through the UWise objectives on that site first, or just doing the questions? Do the objectives seem like a good use of time? Thanks.

 

[evilbooyaa]

I'm just doing the questions. Actually in the middle of some right now. Some of the stuff that is on UWise questions is really out there (like knowing that Paxil is the specific SSRI that is contraindicated in pregnancy, not all SSRIs). I think there is some stuff that I should know that I'm learning from UWise, and some other stuff that is kind of esoteric and might snag me a few questions on the exam. Maybe.

That being said, I have other materials to read if I get sick of doing questions. I'm doing questions b/c I'd rather do questions than read blueprints or case files anymore.

 

[corbis11]

For those who recommend/have done UWise, do you guys recommend going through the UWise objectives on that site first, or just doing the questions? Do the objectives seem like a good use of time? Thanks.

I only did the questions (all of them and it took a long time to get through them) and used the answers as my study material (it was my last block of third year and motivation was low!). I scored 81 which was higher than I really imagined given my lack of preparation.

 

[tco]

Read most of FA and did all of Uwise. 87th percentile.

 

[ijn]

93 scaled score, whatever percentile

Kaplan Step 2 CK obstetrics and gynecology video series (~27 total hrs, watched 'em slowly over the course of 4 weeks)
Case Files for OB/Gyn
UWise questions
UWorld OB/Gyn questions
Kaplan QBank OB/Gyn questions
Required school didactics were decent, but I learned jack **** while on the actual L&D, postpartum, and gyn wards

I really liked Case Files. I tried Pretest but gave up in frustration after about 100 quetsions. I didn't bother with Blueprints. I mostly learn by questions and videos. The Kaplan Step 2 CK videos for ob/gyn are pretty dull in comparison to the internal medicine and pediatrics sections. UWise is decent for preparation but definitely has a lot bull**** questions you'd never see on the shelf (i.e. percentages.) UWorld's questions were of much higher quality than Kaplan's QBank.

 

[tco]

I just don't understand how you guys go through so much material. I got through UWise once, UWorld once + incorrects again, and most of First Aid once.

 

[ijn]

8 week rotation + 14 hour L&D days where you sit around for most of it doing absolutely nothing waiting for primes to get ready to get ready + new iPad = efficient question environment

 

[kaleerkalut]

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[kaleerkalut]

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[evilbooyaa]

I'm just doing the questions. Actually in the middle of some right now. Some of the stuff that is on UWise questions is really out there (like knowing that Paxil is the specific SSRI that is contraindicated in pregnancy, not all SSRIs). I think there is some stuff that I should know that I'm learning from UWise, and some other stuff that is kind of esoteric and might snag me a few questions on the exam. Maybe.

That being said, I have other materials to read if I get sick of doing questions. I'm doing questions b/c I'd rather do questions than read blueprints or case files anymore.

So I really slacked off for studying on this.

UWorld x 1, UWise x 1
~ Half of case files
~ 1/5th of blue prints

Just couldn't be really arsed to do much more than that.

Anyways, shelf score = 76. I'll take it considering my lack of discipline in the final week. Minimum passing at my school was 62 :O

 

[kaleerkalut]

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[evilbooyaa]

Not sure why you got rid of the initial questions. Now I can't go back and check the question stem. Decreasing hCG? Abortion. Bleeding? Likely an incomplete or inevitable abortion. Unless there was a U/S showing nothing in the uterus.

As to your new questions. I would say:
1. HSV won't cause a diffuse rash. I think the best way to answer this is PoE. This isn't PID (no rash in PID). H. Ducreyi = chancres and adenopathy. HSV = genital lesions, no diffuse rash. I would be close between D and E. Disseminated gonorrhea can have lesions like this, but generally also has joint involvement. Toxic Shock syndrome does not (to my knowledge).

2. I don't know how often blood is part of chorioamniotis, and they don't give you a temperature.

3. I read the first line and thought anti-phospholipid Ab syndrome. I read the second line and thought vesicoureteral reflux. I read the 3rd and 4th line and wasn't sure what to think. With so much stuff wrong, it's something congenital. She has an ovary, so it's not Mullerian agenesis. I don't know what intrauterine synechiae are, but I don't think it would cause a single kidney and recurrent UTIs.

4. I don't think they'd make it an -itis without a fever. I wouldn't be confident in either answer choice, but the fact she wasn't having pain... I don't know if that would lead me towards one. It'd likely be a 50-50 choice for me.

5. Odd looking new lesion down there? Biopsy that ****. If you see a lesion, I don't think you have to pap smear (and even that is primarily for cervix stuff). This lady is in the proper age category for either VIN or vulvar cancer.

MODERATOR EDIT: took out references to copyright issues

 

[ijn]

1.... toxic shock syndrome from staph. the rash of gonococcemia is more nodulopustular than maculopapular/desquamative
2... dark red blood + intense contractions + preterm = abruption until proven otherwise
3. .. yea uterine anomalies (e.g. unicornate) are associated with renal anomalies. mullerian agenesis also has renal anomalies but she clearly has a uterus, so that isn't the correct.
4. .. normal... a seroma is going to be palpable and may have a draining tract... nothing suggests anything exceedingly abnormal. c-section is an invasive surgery, medium term pain is going to be expected.
5.... always biopsy skin **** as a general rule with board exams. everything's always possibly cancer. in real life you'd probably see a lot of docs go straight to steroids... but this is the nbme.


Edited by mod staff due to copyright issues.

 

[kwel]

Doing UWise questions and just wanted to check something with y'all. If you have an arrest of active phase of labor or Stage 2, you should first check contraction pressure with IUPC to determine if the "powers" are adequate, right (per blueprints)? Two questions I encountered seemed to suggest you would do an amniotomy or administer Pitocin before using an IUPC. Which way is correct?

 

[kwel]

between UW, Uwise, and pretest, how should I prioritize them?

 

[ijn]

UWorld and Uwise are great. UWorld mabye felt more like the test. Pretest is terribad.

If possible, get through Case Files.

 

[netminder]

Has anyone used the Beckmann/ACOG text? I see that the new 7th edition is available as a Kindle e-book. Does anyone have an opinion on this resource? Thanks.

 

[ijn]

Has anyone used the Beckmann/ACOG text? I see that the new 7th edition is available as a Kindle e-book. Does anyone have an opinion on this resource? Thanks.

Way overkill even if you need to rape this exam for whatever grade you want. Unless you're pre-studying for a 4th year subinternship in OB/GYN or something...

 

[netminder]

Way overkill even if you need to rape this exam for whatever grade you want. Unless you're pre-studying for a 4th year subinternship in OB/GYN or something...

Good to know; thanks for the fast reply, bro.This will save me a huge amount of time.

 

[jdmd1student]

Have anyone used HY Ob/Gyn? Is it enough if you combined it w/ UW and APGO?I've been reading it and I like it a lot. Some things are outdated but I'm writing the new guidelines and new changes provided by UW and APGO on it. Do you guys think that I should read anyways CF or Blueprints? Thanks in advance.

 

[ijn]

The newest guidelines probably aren't going to be on your exam. NBME doesn't work that fast. I wouldn't sweat it. Also if it's controversial it's honestly probably not even on there.

 

[kwel]

A 23-year-old G2P0 woman at 32 6/7 weeks presents to Labor and Delivery with acute nausea, vomiting and epigastric pain. Her blood pressure is 145/90; she has 1+ protein on a urinalysis, and the following labs:
normal: Hematocrit, glucose, bilirubin, lipase, creatinine, fibrinogen (low normal).
Elevated: White blood count (slightly elevated), Uric acid (slightly elevated), AST (very elevated), ALT (very elevated)
Low: platelets Platelets

Which of the following is the most likely diagnosis in this patient?

The answer is HELLP. Why? No hemolytic anemia, right?

Edited by moderator due to copyright issues.

 

[evilbooyaa]

Depends on what the other answer choices are. Her platelets are 11 (not 110, but 11, that's low!) and her AST/ALT is elevated. I'm relatively confident LJN is going to come in and mention something about how her uric acid and Bili are elevated = signs of mild hemolysis or something, but I don't remember enough to confidently make that connection.

What else would you call this? Pre-eclampsia? Not with platelets that low. I can't think of another diagnosis I would have for this, besides maybe ELLP syndrome.

 

[netminder]

What else would you call this? Pre-eclampsia? Not with platelets that low. I can't think of another diagnosis I would have for this, besides maybe ELLP syndrome.

I believe if a diagnosis of HELLP syndrome is made, then this allows you to also make the diagnosis of severe pre-eclampsia. This makes the classifications a little more confusing -- at least to me.

 

[evilbooyaa]

While HELLP syndrome is an example of severe pre-eclampsia, I don't know if I would put pre-eclampsia as the answer here.

According to UpToDate, severe pre-eclampsia includes times when there is hemolysis, elevated liver enzymes, and low platelets (obviously amongst other things).


OK - Since my last post didn't get vetted, did some googling myself. Increased uric acid and increased bilirubin are both signs of hemolysis. Can't believe I forgot about intravascular hemolysis.

This is HELLP syndrome, even without pt being anemic.

 

[BeastInfection]

Im sure this has been addressed and I'm just clueless, but but is the UWorld that everyone talks about for shelf exams the same UWorld QBank set you use for Step I? Do you just buy the full year access?

 

[netminder]

Im sure this has been addressed and I'm just clueless, but but is the UWorld that everyone talks about for shelf exams the same UWorld QBank set you use for Step I? Do you just buy the full year access?

It's from the same company, but it's the UWorld QBank for USMLE Step 2, rather than the UWorld QBank we used for Step 1 last year. This ensures that we spend another bucketload of money.

 

[evilbooyaa]

Im sure this has been addressed and I'm just clueless, but but is the UWorld that everyone talks about for shelf exams the same UWorld QBank set you use for Step I? Do you just buy the full year access?

http://www.usmleworld.com/step2ck/step2ck_qbank.aspx

 

[BeastInfection]

Ha, cool, thanks guys. Starting ob tomorrow but been so consumed by step one stuff up until now, trying to figure out what's going on.

Is the qbank useful for most rotations? just wondering if I should buy the full year...

 

[netminder]

Ha, cool, thanks guys. Starting ob tomorrow but been so consumed by step one stuff up until now, trying to figure out what's going on.

Is the qbank useful for most rotations? just wondering if I should buy the full year...

Totally buy it now. Start doing the questions tonight. Serious. I haven't taken Step 2 yet, but it's been money for the shelves so far.

 

[evilbooyaa]

Totally buy it now.

Good advice.

Start doing the questions tonight. Serious.

Not good advice. Get a better fundamental understanding of OB/GYN (Blueprints/CaseFiles/Hands-on experience/Lectures) before you start cranking out questions. Also, it's the first week after you take Step 1. Take a small break from studying for a week or two if you need it.

I haven't taken Step 2 yet, but it's been money for the shelves so far.

True statement.

 

[BeastInfection]

^^^thanks for the advice. Hoping you guys can help me narrow down sources. I've read through the thread, but it seems most people who have posted were working with 8+ week rotations, whereas mine is essentially 5. I'll try to get through UWorld and Uwise, but am not sure where to go beyond that. Ideally I'd like to do Casefiles and Blueprints but I see they're both close to 500 pages, so that's not likely to happen. I also have Beckman which a friend gave me, but it sounds like that's not worth it (even though it's no longer than Blueprints so not sure why...Blueprints a much easier read or something?)

 

[evilbooyaa]

I had it for 6 weeks. OB-Gyn was my 2nd to last rotation of 3rd year and immediately after surgery, so I had kind of lost studyin motivation. I think if you get through Case Files or Blueprints and then do UWise and UWorld you will comfortably pass. I think if you do both and do UWise and UWorld, you should do enough to honor.

I got through about 1/3 case files and 1/5th blue prints, did all UWise and UWorld questions and got enough for a high-pass. Your experience may vary as it seems like this is going to be (one of) your first rotation.

 

[BeastInfection]

I had it for 6 weeks. OB-Gyn was my 2nd to last rotation of 3rd year and immediately after surgery, so I had kind of lost studyin motivation. I think if you get through Case Files or Blueprints and then do UWise and UWorld you will comfortably pass. I think if you do both and do UWise and UWorld, you should do enough to honor.

I got through about 1/3 case files and 1/5th blue prints, did all UWise and UWorld questions and got enough for a high-pass. Your experience may vary as it seems like this is going to be (one of) your first rotation.

Sounds good, thanks. Anyone know the advantage of Blueprints over Beckman?

 

[predmed123]

Awesome, uWise is running at a snail's pace today. Guess a ton of students have their shelf tomorrow.

 

[SillyNaegleria]

Awesome, uWise is running at a snail's pace today. Guess a ton of students have their shelf tomorrow.

Same for me! Tho my shelf isn't until July 3. I thought it was just my crappy Internet.

So I've read almost all of Blueprints, a number of chapters from Beckmann, and I'm planning to do uWise over the next 2-3 weeks until the shelf + Blueprints questions + Beckmann's questions online.

OBGYN is my 1st rotation and I'd really like to honor it. I can't afford to purchase uWorld until the next set of living expenses aid in July. Anyone have thoughts on this study plan?

Any other free / very low cost question resources I'm overlooking?

 

[MonsterAddict]

Figured I would chime in since I looked at this before taking the shelf.

Studying:
Case files x2, first read it throughly, second read the end of the chapter summaries
Blueprints x1 just read end of the chapter summaries and took the 100 question test. It was too wordy for me
Uworld OB/GYN questions
Uwise comprehensive 50 and 100 question test
Skimmed through first aid the day before the test

Scaled score: 99

 

[futuredoctor10]

For anyone reading Blueprints who finds it too dense or too wordy (as MonsterAddict describes it above), I would try another source like Case Files. I like some of the Blueprints series (Psych, Family Med) but definitely not Blueprints OB/GYN.

 

[BeastInfection]

Same question as above...did all of you who have used uwise read the apgo sections/lessons before answering the corresponding questions, or just tackle the questions alone?

 

[MonsterAddict]

just started taking the questions...

 

[metallica81788]

Any recommendations for last minute things to do? Taking this one tomorrow.

 

[evilbooyaa]

Cant seem to figure the answer out for this NBME question

A 24 yo primigravid @ 28 wks gestation is brought to the ER 4 hrs after she felt a sudden gush of fluid from her vagina. She is concerned that her membranes have ruptured. Her pregnancy has been uncomplicated and she has had good fetal movement and no contractions. She has no history of medical or gyn illness or abnormal paps. Her temp is 98.5, P is 64/min, BP is 110/60. fundal height is 28cm. The fetus is breech presentation. External monitoring shows a fetal heart rate of 150/min with moderate variability. No uterine contractions. The uterus is nontender to palpation. Sterile speculum examination shows pooling of fluid in vagina and closed cervix. Nitrazine testing of the fluid is positive and ferning is seen under the microscope. Pelvic US shows AFI of 5cm (N=8-24). After administration of IM corticosteroids and IV antibiotics, which of the following is the most appropriate next step in management?

A: Second administration of corticosteroids in 24 hours
B: IV oxytocin
C: External cephalic version
D: Amniocentesis
E: Immediate c-section


I guessed amniocentesis bc I figured you would want to make sure the lungs are mature before delivering. "Immediate" c-section made me not want to pick it even though the baby is breech. Any thoughts?

This is PPROM, but the baby isn't in any distress. Amniocentesis has no role here. Once the membranes rupture you have to get the baby out one way or the other or risk a lawsuit when the mom gets a bad infection. You can deliver a baby in breech... so it'd probably be IV oxytocin.

As to your concern about lung maturity, they got one dose of corticosteroids. There is no indication for further corticosteroids at this time.

 

[VisionaryTics]

This is PPROM, but the baby isn't in any distress. Amniocentesis has no role here. Once the membranes rupture you have to get the baby out one way or the other or risk a lawsuit when the mom gets a bad infection. You can deliver a baby in breech... so it'd probably be IV oxytocin.

As to your concern about lung maturity, they got one dose of corticosteroids. There is no indication for further corticosteroids at this time.

Correct answer was steroids. Betamethasone is given as two shots, 24 hours apart. The point of tocolysis is to hold birth off long enough to get 2 shots of steroids in.

 

[kaleerkalut]

How about this one:

A 20 to woman comes to the physician because of a 3-year history of mild to moderate hair growth over her face, breasts, and lower abdomen that has become slightly worse during the past 2 years. She has no history of serious illness and takes no meds. Menses occur every 28 days. Exam shows excessive hair growth over upper lip, chin, lower abdomen, and pubic area. Three days after the onset of her menstrual periods, serum studies show:

FSH - 10
LH - 12
DHEAS - 1.5 (N=0.5-5.4)
17alpha-hydroxyprogesterone - 25 (N=20-300)
Testosterone - 2.8 (N<3.5)

Which of the following is the most likely cause of the patient hair growth?

A. Decreased aromatase activity
B. Decreased progesterone concentration
C. Increased estrogen concentration
D. Increased 5alpha reductase activity
E. increased testosterone concentration

I guessed A which was wrong. So I assume the answer is E, but not sure what the diagnosis is and why. Any explanation would be very helpful.

Also this one:

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

I chose D like an idiot. thinking if could be A or B, but more likely B. Wanted to know if thats right. I know age is a risk factor, but usually the hyperplasia is post menopausal.

I get the feeling the first one is D and the second one is B. Are these from the shelf practice? They seem familiar.

 

[tco]

Correct answer was steroids. Betamethasone is given as two shots, 24 hours apart. The point of tocolysis is to hold birth off long enough to get 2 shots of steroids in.

100% this.

You don't want to have to deliver breech if you don't have to, but you absolutely want the second dose of steroids in before delivery regardless of how the kid is delivered. At 28 weeks, those lungs are definitely not developed, so amnio is pointless.

 

[netminder]

Took the test this morning.

Blueprints 1x
Casefiles 1x
Uwise 2x + incorrects
Uworld 1x + incorrects
Pretest - 1x
Lange - did questions from 4 chapters

Pretest and Lange were definitely the worst resources I used. I think Lange was a bit worse than pretest

The test was not super hard. Lots of OB as expected. I found that I only had like 4-5 questions down to 2 questions were I wasnt sure. The NBME still considers yearly pap smears the norm. Several well woman questions that you couldnt really prepare for unless you had some medicine knowledge and knew the indications for different tests. 4-5 Urogyn (one pt with MS) but not too hard. Overall a pretty fair test. Will post my score when I get it, probably thursday or Friday.

Thanks a lot for posting this. Your posts have been helpful to those of us who are still studying. I hope you crushed it. Good luck, and keep us posted.

 

[evilbooyaa]

Correct answer was steroids. Betamethasone is given as two shots, 24 hours apart. The point of tocolysis is to hold birth off long enough to get 2 shots of steroids in.

Derp on my part. Good call. Guess I missed that question (if I had something like it on my shelf).

 

[VisionaryTics]

Took it last Friday. 99 (not sure raw or scaled).

First Aid for Ob/Gyn x2
UWise
Uworld
Blueprints (finished like 80%, about half the questions)

My test was very heavy on urogynecology and GU infections. OB had lots of management/diagnosis of antepartum complications (preterm labor, PPROM, bleeding).

I thought the test was much easier than the practice tests. I did poorly on both practice tests just a few days out from taking the shelf.

 

[netminder]

Nice job, VisionaryTic. Which of the resources you used did you feel was the most valuable? Thanks.