NBME -OB\/Gyn F3 (2023\/ 2024 Update) Questions and Verified Answers|100% Correct| Grade A<\/p>\n\n\n\n
NBME -OB\/Gyn F3 (2023\/ 2024 Update)
Questions and Verified Answers|100%
Correct| Grade A
Q: 23 yo – 3 days of pain and burning w\/ urination
PMHx: 2 yrs ago UTI tx w\/ TMP-SMX
sex active; OCP
PE: no CVT
UA: bacteria and pus
advice about preventing future episodes
most appropriate recommendation?
Answer:
voiding immediately after coitus
doesn’t need AB ppx if doesn’t categorize under “recurrent UTI” (3+ w\/in 6 months or 4+ w\/in 12
months)
cont nightly AB ppx – women w\/ 2+ UTIs during pregnancy
Q: 47 yo – inc fatigue, constipation, night sweats, anxiety, and mood lability over past yr
5 lb weight gain
LMP: 6 months ago
PE and pelvic exams: gucci
what hormone will be inc?
Answer:
FSH
she’s transitioning into menopause – suggesting low estrogen levels
FSH will be inc – trying to stimulate the estrogen from the ovaries
Q: 21 yo – 2 wks of small amount of vag discharge and itching
began immediately before LMP
2 sex partners over last 2 months; OCP
PMHx: UTI tx w\/ 7 day course of cephalexin
PE: red introitus and vulva; erythematous vag walls w\/ normal amount of vag discharge; cervix
and cervical discharge normal<\/p>\n\n\n\n
vag pH 4.5 postvoid residual volume: 50 mL
KOH prep – no odor
wet mount – no motile organisms
most likely causal organism?
Answer:
Candida albicans
since she was on broad-spectrum ABs a month ago – leaves her predisposed to getting a fungal
infection
erythematous, excoriated vulva\/vagina<\/em>
discharge: thick, white, curdy texture w\/o odor
KOH prep: hyphae
tx: topical azalea or PO fluconazole
no motile organisms – suggests that this isn’t Trichomonas
neg whiff test – suggests that this isn’t Gardnerella
Q: 21 yo – requests OCP
sex active
Pap smear + what screening test is appropriate?
Answer:
test for Chlamydia trachomatis
gold standard: NAAT
sexually active women < 25 yo should be screened annually
Q: 52 yo – 6 months of urinary urgency
stronge urge to void but passes only small amount of urine
sometimes unable to get to the bathroom in time
hot at night and occasionally during the day
no PMHx, no meds
LMP: 12 months ago
no sex active
BMI: 24
BP: 90\/50 mmHg
pelvic exam: mod tenderness and vag atrophy; uterus normal sized; no
vulvar\/vag\/cervical\/adnexal masses
PE including rectal: gucci
stool for occult blood: neg
wet mount of vag fluid: numerous leukocytes
urine cx: neg<\/p>\n\n\n\n
most likely underlying cause?
Answer:
estrogen def
homegirl is in menopause
symptoms: hot flashes, vag atrophy, insomnia, anxiety\/irritability, poor concentration, mood
changes, dyspareunia, and loss of libido
can have urinary symptoms: stress\/urge incontinence, freq UTIs, urogenital atrophy
Q: 62 yo – 2 episodes of vag bleeding during last 3 wks
menopause: 12 yrs ago
PMHx: HTN (ACEi), T2DM (oral hypoglycemic agents); no hx of abnormal Pap smears
BMI: 25
pelvic exam: normal cervix and uterus w\/ blood at cervical os; 6×8 cm L.ovarian mass palp
pelvic US confirms this
endometrial biopsy: atypical complex hyperplasia
most likely dx?
Answer:
granulosa cell tumor
produce estradiol and inhibin A\/B
feminization, precocious puberty, menstrual irregularities, secondary amenorrhea, or
postmenopausal bleeding estrogen stimulation > endometrial hyperplasia and\/or endometrial CA do endometrial sampling<\/em>
tx; UL salpingo-oophorectomy; TAH + BSO
Q: 42 yo – irregular menses for last 7 months
intense mood changes and occasional hot flashes
LMP: 6 wks ago
sex active w\/ 1 partner; barrier contraception
PE including pelvic: gucci
next step in dx?
Answer:
pregnancy test
this should always be your first go-to test in reproductive age women
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