NBME -OB\/Gyn F2 (2023\/ 2024 Update) Questions and Verified Answers|100% Correct| Grade A<\/p>\n\n\n\n
NBME -OB\/Gyn F2 (2023\/ 2024 Update) Q: 32 yo primigravid – 6 wks gest – 3 days of mod vag bleeding cervical cultures – neg
Questions and Verified Answers|100%
Correct| Grade A
Q: 28 yo – G2P1
LMP: 10 wks ago
1st child: 10 lb male newborn – born by C-section due to arrest of descent
during this pregnancy, she’s at an inc risk for what?
Answer:
gestational diabetes
since her first child was clearly had macrosomia (10 lb) – there had to be a reason why the baby
got this big aka DM
macrosomia – birth weight > 4500 g
most classically associated risk factor: preexisting\/gest DM<\/em>
Q: 3 days after C-section – due to fetal distress
42 yo hospitalized – unconscious
BMI: 31
100.4F
P: 120\/min
RR: 26\/min
BP: 60\/40 mmHg
PE: BL wheezing; pleural friction rub
CBC: dec Hgb; WNL WBC and plts
coag: PT inc; bleeding time, PTT, thrombin time, plasma fibrinogen, and fibrin split products
WNL
ABG: low pH, pO2, pCO2
blood smear: gucci
CXR: atelectasis
ECG: tachy w\/ cor pulmonale
most likely dx?
Answer:
pulmonary embolism
pregnant women and hospitalized pts are predisposed to this condition
why we check for DVTs all the damn time
pregnancy is a hypercoagulable state
dec values on ABG suggest pt is having trouble keeping gases<\/p>\n\n\n\n
ED: 1 wk ago for similar symptoms
pelvic US: thickened endometrial stripe and no fetal pole
previous b-hCG: 450
pelvic exam: closed cervix; nontender uterus consistent in size w\/ 6 wks gest; no palpable
adnexal masses
today’s b-hCG: 90
Hgb: 11.8
next step in mgnt?
Answer:
third measurement of serum b-hCG conc in 1 wk
want to make sure the b-hCG is downtrending downward
pregnancy confirmed by US: gest sac as early as 5 wks or b-hCG of 1500-2000
fetal heart motion on US: 6 wks or b-hCG of 5000-6000
levels of hCG double every 48 hrs until 10-12 wks (where they peak); decline to reach steady
state by wk 15
Q: 27 yo primigravid – 14 wks gest
endovaginal exam: viable twin gest consistent in size w\/ 8 wks gest: 2 yolk sacs and thick
dividing membrane
US is shown (shows “twin peak sign”)
most likely has what type of twin gestation?
Answer:
dichorionic
twins – aka multiple gest
Di-Di twins: thickness of membrane and “twin peak sign” (2 placentas fusing together)
Mo-Di twins: single chorion and 2 amniotic sacks
Q: 32 yo nulligravid w\/ 34 yo hubby – unable to conceive for 3 yrs
menarche – 12 yo
menses reg
OCP for 3 yrs
multiple sex partners
pelvic exam: gucci<\/p>\n\n\n\n
semen analysis WNL
next step in dx?
Answer:
hysterosalpinography
first step is to check the dude – already done since semen analysis WNL
in chicks, check for: hostile mucus, anovulation, and anatomic issues
ddx: endometriosis once r\/o everything else; dx scope w\/ laser ablation
tests: mucus workup (need to achieve >6 m on smush test and have fern sign\/sperm present);
basal temp rising 1 deg, endometrial biopsy days 14-28, prog level at day 22;
hysterosalpingogram
Q: 32 yo primigravid – 14 wks gest – fever, lower pelvic pressure, and vag spotting for 7 days
3 yrs ago – 2 LEEP of cervical transformation zone for CIS
pelvic exam: closed cervix that is flush against upper vag – 2 cm
uterus: consistent in size w\/ 14 wks gest
pelvic US: confirms uterine size; funneled lower uterine segment; int cervical os – 2 cm
most likely cause of vag bleeding?
Answer:
cervical incompetence
LEEP used when ecto+ and endo- during screening – problem is outside the cervix
MC cause of cervical incompetence: surgery or other cervical trauma<\/em>
cervical excision procedures – remove cervical tissue w\/o causing extensive damage to stroma of
cervix
complications: cervical stenosis, cervical insufficiency, infection, or bleeding
Q: 47 yo primigravid – 10 wks gest
conceived following oocyte donation from 32 yo sister
menopause 3 yrs ago
uterine fundus – 15 cm above symphysis
fetal HR: 160\/min
next step in mgnt?
Answer:
ultrasonography
gest age and uterine fundus are off by 5 wks
US in the 1st trimester: most accurate way of determining gest age
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