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
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