Ob-Gyn NBME Form 4 - Questions and Answers

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Ob-Gyn NBME Form 4 - Questions and Answers 52 yo PMHx: mild hypoT (levothyroxine); stage I breast cancer (5 yrs ago; completed tamoxifen therapy 1 yr ago; still in remission) menopause: 4 yrs ago FH... x: mom - femoral fx in bike collision at 55 yo SHx: smokes 2 cigs/week for 25 yrs BMI: 19 PE: no thyromegaly; small, well-healed surgical scar over upper outer quadrant of L.breast greatest risk factor for osteoporotic fx? BMI 22 yo - G2P1 - 38 wks gest intermittent, mild, low back pain BP: 130/90 mmHg PE: gucci EFW: 3629 g fetal HR: 120/min cervix - 4 cm dilated and 100% effaced; vertex -1 station most likely cause? normal labor OME talked about how contractions are normal labor and how no contractions are pROM I guess "intermittent, mild, low back pain" are contractions? 52 yo nulligravid last visit w/ physician - 4 yrs ago menses reg SHx: smokes 1 pack of cigs qd but quit 5 yrs ago; drinks 1-2 glasses of wine/wk will get Pap smear, mammogram, and chol testing along w/ what other test at this time? colonoscopy avg risk pts: 50-75 yo colonoscopy should be done q10 yrs mammogram should be done q2 yrs for women 50-74 yo DEXA scans can begin at 65 yo or 60 yo if smoker 42 yo - 3 months of urinary urgency/freq and occasional incontinence; 2 months of numbness below waist gets up 3/night no fever, pain w/ urination, or cloudy urine PMHx: relapsing-remitting MS w/ double vision (10 yrs ago) and R.leg weakness (3 yrs ago) PE: sens to vibration dec BL feet; DTR 3+ BL knees UA: WNL postvoid residual volume: 45 mL most likely cause? detrusor hyperreflexia prob has urge incontinence unable to control when she's going to the bathroom this type of incontinence is related to neurologic abnormalities (clearly seen in this woman), inhibited contractions, and local irritation (cystitis, stone, tumor) tx: antichol meds or TCAs; behavioral training 27 yo - 1 month of postcoital spotting lasting 1-2 days menses reg menarche: 14 yo PSHx: BL tubal ligation (9 yrs ago) SHx: long-distance runner; sex active w/ new partner most likely dx? cervicitis she has a new partner that she's sex active w/ + long-distance runner will inc irritation down there perf environment for bacteria to grow and cause infection can have mild vulvar irritation 27 yo primigravid - 7 wks gest no PMHx; prenatal vitamin labs: dec Hgb (10.1), Hct (30%), MCV (72); ferritin and Fe - WNL next step in dx? hemoglobin electrophoresis this is indicated when: > Hgb < 11 g/dL > MCV < 80 Fl 28 yo nulligravid - inc severe dysmenorrhea over past 2 yrs and pain w/ defecation for 6 months can't conceive for 2 yrs pelvic exam: fixed, tender, retroverted uterus, modularity of uterosacral ligaments, and tender adnexa BL; 5 cm, tender, cystic, R.adnexal mass preg test: neg most likely dx? endometriosis cyclical pelvic and/or rectal pain and dyspareunia estrogen responsive dx: laparoscopy/laparotomy tx: combo OCPs (1st line); ablation; TAH +/- BSO MC cause of infertility in menstruating women > 30 yo 27 yo - G3P3 - sudden onset of severe, sharp pain in RLQ, pain in R.shoulder, LH, nausea, and rectal pressure 6 hrs ago diaphragm LMP: 24 days ago PE: mod tenderness of RLQ w/o guarding/rebound; active bowel sounds culdocentesis: 15 mL of nonclotting, serosanguineous fluid w/ Hct of 5% preg test: neg most likely dx? ruptured corpus luteum cyst culdocentesis = extraction of fluid from the pouch of Douglas serosanguineous = mixture of serum and blood common functional cysts - occur during luteal phase (days 15-28) most form when corpus luteum fails to regress cause delay in menses and dull lower quadrant pain if rupture > acute pain and signs of hemoperitoneum 25 yo - 4 wks of R.sided pelvic pain sex active w/ 1 partner for 3 yrs; condoms LMP: 3 wks ago pelvic exam: 12 cm, cystic, mobile, R.adnexal mass serum Ca 125 conc: 35 (N<35) serum b-hCG: neg abd X-ray: Ca deposits in mass most likely dx? cystic teratoma Ca deposits suggest that this mass contains more than just one material Ca 125 conc borderline - dec chance of ovarian cancer >10 cm, loculated, lobulated, multi-echoic, heterogeneous - suggests complex cyst 22 yo - 2 wks of inc severe vag burning/discharge sex active w/ 1 partner for 1 yr; condoms PE: normal ext genitalia and gray frothy vag discharge vag pH: 5 micro exam: squamous epi cells coated w/ bacteria most app pharmacotherapy? vaginal metronidazole gel prob has bacterial vaginitis - confirmed w/ micro exam ("clue cells") discharge: grayish-white w/ fishy odor +whiff test (on KOH prep) tx: PO or vag metro; vag clindamycin 5 yo - 2 days of foul-smelling, yellow discharge and vag spotting on underpants no pain w/ urination PE: gucci pelvic exam: mild vulvar erythema and purulent discharge at vaginal opening most likely cause? vaginal foreign body #1 cause of vag bleeding in premenstrual girls next suspect sex abuse [Show More]

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