NBME -OB\/Gyn F1 (2023\/ 2024 Update) Questions and Verified Answers|100% Correct| Grade A<\/p>\n\n\n\n
NBME -OB\/Gyn F1 (2023\/ 2024 Update)
Questions and Verified Answers|100%
Correct| Grade A
Q: 57 yo – routine exam
PMHx: HTN, T2DM, gen anxiety disorder
great aunt: hx of breast cancer
tx: hormone therapy w\/ estrogen and medroxyprogesterone daily since menopause 5 yrs ago
meds: HCTZ, metformin, herbal meds
breasts: no masses\/nipple discharge
what historical finding is greatest risk factor for breast cancer in this pt?
Answer:
hormone therapy
pt has been taking estrogen and medroxyprogesterone daily for 5 yrs
slightly inc risk w\/ combo HRT for 5 yrs
no risk has been shown w\/ estrogen-only HRT
Q: 18 hrs after uncomplicated C-section for breech presentation – 23 yo G1P1 – 100.4 F
dec breath sounds BL
fundus nontender, 2 cm below umbilicus
incision site: dry, intact, and mildly tender
PE: lower ext 2+ pitting edema to midcalves BL
foley and R. IV antecubital catheters in place
most likely dx?
Answer:
atelectasis
one of the MC complications post abd surgery
Q: 57 yo – small blood stains on underwear for past 6 months
menopause: 5 yrs ago, no HRT
sex painful
no urinary or GI symptoms
PE: atrophic, friable vag mucosa; scant blood in vag canal
bimanual exam: normal-sized uterus<\/p>\n\n\n\n
most likely cause of symptoms? tx: hydralazine to lower BP; MgSO4 for hyperreflexia and seizure ppx
Answer:
hypoestrogenic state
menopause: inc LH and FSH due to dec estrogen production
dec estrogen > hot flashes, mood changes, insomnia, depression, osteoporosis, and vaginal atrophy<\/em>
Q: 25 yo – thin, clear vag discharge and inc urinary freq over past 2 wks
HIV pos
LMP: 6 wks ago
menses reg
meds: antiretroviral agents – not compliant
uses condoms occasionally
PE: friable cervix; uterus slightly enlarged; adnexa normal BL
most likely dx?
Answer:
pregnancy
has missed period and enlarged uterus
signs of pregnancy: bluish discoloration of vagina\/cervix (Chadwick sign); softening\/cyanosis of
cervix around 4 wks (Goodell sign); softening of uterus after 6 wks (Ladin sign); breast
swelling\/tenderness; linea nigra from umbilicus to pubis; telangiectasias; palmar erythema
symptoms: amenorrhea; N\/V; breast pain; quickening – fetal movement
Q: 23 yo primigravid – 30 wks gest – ER for HA, blurred vision, and constant RUQ pain for 12
hrs
BP: 138\/95 mmHg
PE: mod edema of face\/fingers
DTR: 3+
platelets dec (40,000)
AST, ALT, LDH inc
most likely dx?
Answer:
severe preeclampsia
bc multiple organ systems are involved – neuro, ophthalmic, GI (weirdly enough RUQ pain), inc
liver enzymes, thrombocytopenia
close to eclampsia aka having a seizure since DTR 3+<\/p>\n\n\n\n
Q: 32 yo nulligravid – no period since stopping OCP 6 months ago
menses reg
inc libido, inc facial acne, inc facial hair growth (requires shaving), scalp hair loss (esp on
crown)
25 lb weight gain
sex active – condoms
BMI: 33
PE: development of upper shoulder muscles; hair bet breasts and above umbilicus
pelvic exam: clitoris protruding completely from clitoral hood
US: 2 cm solid mass in R.ovary
measurement of which serum hormone conc will most likely be abnormal?
Answer:
testosterone
homegirl is going through virilization – most severe form of testosterone influence
includes symptoms of hirsutism (fat and hairy) along w\/ clitoris enlarging, amenorrhea, inc muscle mass,<\/em> and voice deepening
once she stopped taking OCP – she stopped getting estrogen
mass in R.ovary – probably Sertoli-Leydig (germ cell) tumor; produces inc testosterone; normal
DHEAS (since adrenals are fine)
tx: resection
Q: 32 yo – G1P1 – fever and R.breast tenderness for 1 day
breastfeeding 14 day old newborn
T1DM – insulin
102.7 F
P: 122\/min
PE: engorgement of breasts BL
erythematous, nonfluctuant, tender area in upper outer quadrant of R.breast
abd exam: gucci
most likely dx?
Answer:
mastitis
breast feeding moms are prone to getting this
BL warm, diffusely tender, and firm breasts
tx: dicloxacillin (S.aureus is usually organism in charge); cont breastfeeding
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