Ob-Gyn NBME Form 4 Comprehensive
Questions (Frequently Tested) with
Verified Answers Graded A+
42 yo - 1 yr of vag bleeding
2-5 days q2 wks
flow: light to heavy w/ clots
menses previously: reg 25-29 days; lasting 7 days w/ heavy flow
no PMHx; no meds
sex active w/ 1 partner; condoms inconsistently
FHx: mom died of colon ca; mat grandma died of breast ca
BMI: 29
uterus normal sized
ovaries can't be palp
occult blood in stool: neg
endometrial biopsy: grade I adenoCA w/ atypical endometrial hyperplasia
next step in mgnt? - Answer: hysterectomy
for endometrial ca:
simple hyperplasia: progesterone
atypical hyperplasia or adenoCA: hysterectomy + BSO
mets: add chemo to TAH + BSO
27 yo primigravid - 30 wks gest - 3 wks of pain in arms/numbness in hands
PE: mild weakness of thumb ABduction BL; sens dec to pinprick in index finger on R
most likely dx? - Answer: carpal tunnel syndrome
very common for pregnant women to get this
,due to compression of median nerve
42 yo - G5P5 - contraception
menses: reg 28 days
LMP: 3 days ago
PMHx: HTN (BB) - but often forgets to take it; at 21 yo - tx for Chlamydia; 2nd preg - Pap: low-
grade squamous intraepithelial lesion; F/U Pap: no abnormalities
has had no abnormal Paps since
sex active and monogamous w/ hubby
PE w/ pelvic exam: gucci
most effective contraception that she'll easily remember to use
most app recommendation? - Answer: placement of an IUD
condoms and diaphragm - least effective; have to remember to put these on/in
OCP - needs to be taken daily
depo-provera - injection q3 months
but this isn't as effective as IUD
lasts 5 yrs; don't need to worry about it
32 yo primigravid - 10 wks gest
PMHx: 2-3 seizures/yr (phenytoin)
has had 2 seizures over past 2 wks
PE: uterus consistent in size w/ 10 wks gest
serum phenytoin conc: 5 (N: 10-20)
next step in mgnt? - Answer: inc her current anticonvulsant meds
ideally you would want her on lamotrigine or levetiracetam
honestly terrible question bc you don't want to give valproic acid, carbamazepine, and
phenytoin
, 32 yo - 3 yrs of inc irregular menses
were irregular at 45-60 days > now 90 days
menarche: 14 yo
periods last 2-7 days
asymptomatic
no PMHx
BMI: 39
BP: 140/80 mmHg
PE: velvety pigmented skin over axillae and groin
serum hormone conc most likely inc? - Answer: testosterone
"velvety pigmented skin" = acanthosis nigricans; seen in obese and DM pts
hyperandrogenism/insulin resistance: menstrual cycle disturbances, hirsutism, obesity, acne,
androgenic alopecia, and acanthosis nigricans
labs: inc testosterone; inc LH/FSH ratio (3:1)
17 yo - primigravid - dec fetal movement over past 2 days
doesn't remember LMP; only 1 previous prenatal visit
PE: uterus 32 wks gest size
US: biparietal diameter consistent w/ 31 wks gest; duodenal bubble and flaccid tone of fetus
most likely cause? - Answer: Down syndrome
duodenal bubble suggests duodenal atresia
flaccid tone suggests hypotonia
57 yo - G6P6 - 6 months of immediate loss of urine when she coughs/exercises
kids born vaginally
Questions (Frequently Tested) with
Verified Answers Graded A+
42 yo - 1 yr of vag bleeding
2-5 days q2 wks
flow: light to heavy w/ clots
menses previously: reg 25-29 days; lasting 7 days w/ heavy flow
no PMHx; no meds
sex active w/ 1 partner; condoms inconsistently
FHx: mom died of colon ca; mat grandma died of breast ca
BMI: 29
uterus normal sized
ovaries can't be palp
occult blood in stool: neg
endometrial biopsy: grade I adenoCA w/ atypical endometrial hyperplasia
next step in mgnt? - Answer: hysterectomy
for endometrial ca:
simple hyperplasia: progesterone
atypical hyperplasia or adenoCA: hysterectomy + BSO
mets: add chemo to TAH + BSO
27 yo primigravid - 30 wks gest - 3 wks of pain in arms/numbness in hands
PE: mild weakness of thumb ABduction BL; sens dec to pinprick in index finger on R
most likely dx? - Answer: carpal tunnel syndrome
very common for pregnant women to get this
,due to compression of median nerve
42 yo - G5P5 - contraception
menses: reg 28 days
LMP: 3 days ago
PMHx: HTN (BB) - but often forgets to take it; at 21 yo - tx for Chlamydia; 2nd preg - Pap: low-
grade squamous intraepithelial lesion; F/U Pap: no abnormalities
has had no abnormal Paps since
sex active and monogamous w/ hubby
PE w/ pelvic exam: gucci
most effective contraception that she'll easily remember to use
most app recommendation? - Answer: placement of an IUD
condoms and diaphragm - least effective; have to remember to put these on/in
OCP - needs to be taken daily
depo-provera - injection q3 months
but this isn't as effective as IUD
lasts 5 yrs; don't need to worry about it
32 yo primigravid - 10 wks gest
PMHx: 2-3 seizures/yr (phenytoin)
has had 2 seizures over past 2 wks
PE: uterus consistent in size w/ 10 wks gest
serum phenytoin conc: 5 (N: 10-20)
next step in mgnt? - Answer: inc her current anticonvulsant meds
ideally you would want her on lamotrigine or levetiracetam
honestly terrible question bc you don't want to give valproic acid, carbamazepine, and
phenytoin
, 32 yo - 3 yrs of inc irregular menses
were irregular at 45-60 days > now 90 days
menarche: 14 yo
periods last 2-7 days
asymptomatic
no PMHx
BMI: 39
BP: 140/80 mmHg
PE: velvety pigmented skin over axillae and groin
serum hormone conc most likely inc? - Answer: testosterone
"velvety pigmented skin" = acanthosis nigricans; seen in obese and DM pts
hyperandrogenism/insulin resistance: menstrual cycle disturbances, hirsutism, obesity, acne,
androgenic alopecia, and acanthosis nigricans
labs: inc testosterone; inc LH/FSH ratio (3:1)
17 yo - primigravid - dec fetal movement over past 2 days
doesn't remember LMP; only 1 previous prenatal visit
PE: uterus 32 wks gest size
US: biparietal diameter consistent w/ 31 wks gest; duodenal bubble and flaccid tone of fetus
most likely cause? - Answer: Down syndrome
duodenal bubble suggests duodenal atresia
flaccid tone suggests hypotonia
57 yo - G6P6 - 6 months of immediate loss of urine when she coughs/exercises
kids born vaginally
